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Gu JY, Lu C, Shi H, Yang CD. [Case series and clinical analysis of 14 cases of catastrophic antiphospholipid syndrome]. Beijing Da Xue Xue Bao Yi Xue Ban 2018; 50:1033-1038. [PMID: 30562777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Catastrophic antiphospholipid syndrome (CAPS), also known as Asherson's syndrome, is a special subtype of antiphospholipid syndrome (APS) characterized by multiple intravascular thrombosis involving multiple organs systems or tissues simultaneously or continuously, high titer antiphospholipid antibodies and high mortality rate. This article's aims was to analyze the clinical manifestation, laboratory examination and treatment therapy of CAPS for the purpose of improving the understanding, diagnosis and treatment of the disease in clinical practice. METHODS Retrospective analysis and descriptive statistics were applied to the clinical manifestations and laboratory findings of 14 CAPS cases from APS Shanghai Database (APS-SH) with catastrophic antiphospholipid. RESULTS Of the 14 CAPS patients, 12 cases satisfied the 2003 CAPS Classification Criteria accepted in the 10th International Congress on Antiphospholipid Antibody, and were diagnosed as definite APS and 2 cases were diagnosed as probable CAPS. Three cases were categorized as primary APS and 11 as APS secondary to systemic lupus erythematosus (SLE). Infection was mostly commonly seen before the onset of CAPS, followed by SLE activity and surgery. Among the involved organs, systems and tissues, brain and lung were most commonly affected sites of arterial thrombosis while peripheral vein was most commonly affected in venous thrombosis events among the clinical events. Triple positivity of anticardiolipin antibody (aCL), anti-β2 glyeoprotein I antibody (aβ2GPI), lupus anticoagulant (LA) were detected in 54.55% of the patients. Thrombocytopenia and decreased hemoglobin were frequently seen in the CAPS patients, and the majority proved to be hemolytic anemia. Of all the cases, 6 ended with death. The triple therapy strategy (anticoagulants, glucocorticoid, intravenous immunoglobulin and/or plasma exchange) could help to improve prognosis, cyclophosphamide and rituximab might benefit the patients with other comorbidities such as SLE and micro-angiopathic hemolytic anemia (MHA). CONCLUSION CAPS patients suffer from life-threatening acute multiple small vessel thrombosis with high titer of antiphospholipid antibody, potentially leading to multiple organ failure and a poor prognosis, thus early diagnosis and sufficient treatment are critical to prevent the progression of disease and improve the prognosis.
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Affiliation(s)
- J Y Gu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - C Lu
- Department of Rheumatism, Central Hospital of Songjiang District, Shanghai 201600, China
| | - H Shi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - C D Yang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
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Abstract
The use of extracorporeal circulation for cardiac surgery and extracorporeal life support poses tremendous challenges to the hemostatic equilibrium given its diametric tendency to trigger hyper- and hypocoagulopathy. The necessity of anticoagulant therapy to counteract the hemostatic activation by the extracorporeal circuitry compounded by unfavorable patient and surgical factors significantly increase the risk of catastrophic bleeding in patients who require extracorporeal circulation. Preoperative measures, such as stratification of high-risk bleeding patients, and optimization of the modifiable variables, including anemia and thrombocytopenia, provide a crude estimation of the likelihood and may modify the risk of catastrophic bleeding. The anticipation for catastrophic bleeding subsequently prompts the appropriate preparation for potential resuscitation and massive transfusion. Equally important is intraoperative prevention with the prophylactic application of tranexamic acid, an antifibrinolytic agent that has promising benefits in reduction of blood loss and transfusion. In the event of uncontrolled catastrophic bleeding despite preemptive strategies, all effort must be centered on regaining hemostasis through surgical control and damage control resuscitation to protect against worsening coagulopathy and end organ failure. When control of bleeding is reinstated, management should shift focus from systemic therapy to targeted hemostatic therapy aimed at the potential culprits of coagulopathy as identified by point of care hemostatic testing. This review article outlines the strategies to appropriately intervene using prediction, prevention, preparation, protection, and promotion of hemostasis in managing catastrophic bleeding in extracorporeal circulation.
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Affiliation(s)
- Keyvan Karkouti
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Loretta T S Ho
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
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Abstract
Catastrophic antiphospholipid antibody syndrome (CAPS) and macrophage activation syndrome (MAS) are both life-threatening hematologic disorders that infrequently afflict patients with rheumatologic disease. CAPS is characterized by fulminant multiorgan damage related to small vessel thrombosis in the setting of persistent antiphospholipid antibodies. It can occur in patients with rheumatologic diseases such as systemic lupus erythematosus but can also affect patients who do not have rheumatologic disease. By contrast, the term MAS is applied when patients with rheumatologic disease develop hemophagocytic lymphohistiocytosis (HLH); therefore, patients with MAS have an underlying rheumatologic disease by definition. Similar to CAPS, HLH/MAS can have a fulminant presentation, but the pathogenesis and manifestations are different. In both CAPS and MAS, management generally includes but is not limited to immunosuppression with steroids. Fatalities are relatively common and morbidity is often significant. Early recognition of these disorders and initiation of timely treatment are important. More effective therapies for both syndromes are urgently needed.
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Affiliation(s)
- John M Gansner
- Department of Medicine, Division of Hematology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Nancy Berliner
- Department of Medicine, Division of Hematology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Ghiasvand H, Olyaeemanesh A, Majdzadeh R, Abdi Z, Mobinizadeh M. Has the Financial Protection Been Materialized in Iranian Health System? Analyzing Household Income and Expenditure Survey 2003-2014. J Res Health Sci 2018; 18:e00404. [PMID: 29445050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/24/2017] [Accepted: 12/26/2017] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The financial protection against catastrophic and impoverishing health expenditures is one of the main aspects of the universal health coverage. This study aimed to present a clear picture of the financial protection situation in Iran from 2003-2014. STUDY DESIGN This is an analytical study on secondary data of Statistical Center of Iran (SCI). The study has some policy implications for policy makers; therefore, it is an applied one. METHODS Data related to the Iranian rural and urban household payments on health expenditures was obtained from annual surveys of the SCI. WHO researchers' approach was used to calculate the Fairness of Financial Contribution Indicator (FFCI), the headcount and overshoot ratios of catastrophic and impoverishing health expenditures. A logistic regression was conducted to identify the determinants of probability of occurrence of catastrophic health expenditure among Iranian households in 2014. RESULTS The mean of FFCI for rural and urban households was 0.854 (0.41) and 0.867 (0.32), respectively. The average headcount ratios of catastrophic and impoverishing health expenditures were 1.32% (0.24) and 0.33% (P=0.006) for rural households and 1.4% (0.6) and 0.28% (P=0.001) for urban households. Concerning rural households, the overshoot of catastrophic and impoverishing health expenditures was 14.94% (P=0.001) and 7.22% (0.53); it was 15.59% (1.54) and 7.76% (0.52) for urban households. CONCLUSIONS No significant and considerable change was found in the headcount ratios of catastrophic and impoverishing health expenditure and in their overshoot or gap amounts. This suggested a lack of well-designed and effective schemes for materializing the financial protection in Iran.
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Affiliation(s)
- Hesam Ghiasvand
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- National Institute of Health Research and Health Equity Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Majdzadeh
- Community Based Participatory Research Centre and Knowledge Utilization Research Centre, Tehran University of Medical Sciences and Iran's National Institute of Health Research, Tehran, Iran
| | - Zhaleh Abdi
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Catastrophic antiphospholipid syndrome is a rapidly progressive life-threatening disease that causes multiple organ thromboses and dysfunction in the presence of antiphospholipid antibodies. A high index of clinical suspicion and careful investigation are required to make an early diagnosis so that treatment with anticoagulation and corticosteroids can be initiated; plasma exchange and/or intravenous immunoglobulins can be added if the life-threatening condition persists. Despite aggressive treatment and intensive care unit management, patients with catastrophic antiphospholipid syndrome have a 48% mortality rate, primarily attributable to cardiopulmonary failure. This article reviews the current information on the etiopathogenesis, clinical manifestations, diagnosis, management, and prognosis of catastrophic antiphospholipid syndrome.
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Affiliation(s)
- Setu K Vora
- Pulmonary Physicians of Norwich, Norwich, Connecticut, USA
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56
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Schuklenk U. And there we go again: the ethics of placebo-controlled RCT in case of catastrophic illness. J Med Ethics 2015; 41:952-953. [PMID: 24143005 DOI: 10.1136/medethics-2013-101653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 09/29/2013] [Indexed: 06/02/2023]
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57
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Lee WL, Chang WH, Wang KC, Guo CY, Chou YJ, Huang N, Huang HY, Yen MS, Wang PH. The Risk of Epithelial Ovarian Cancer of Women With Endometriosis May be Varied Greatly if Diagnostic Criteria Are Different: A Nationwide Population-Based Cohort Study. Medicine (Baltimore) 2015; 94:e1633. [PMID: 26426652 PMCID: PMC4616839 DOI: 10.1097/md.0000000000001633] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This article aims to test the hypothesis that the risk of epithelial ovarian cancer (EOC) in women with endometriosis might be changed by enrolling different population. A nationwide 14-year historic cohort study using the National Health Insurance Research Database (NHIRD) of Taiwan and the Registry for Catastrophic Illness Patients was conducted. A total of 239,385 women aged between 20 and 51 years, with at least 1 gynecologic visit after 2000, were analyzed. Cases included women with a diagnosed endometriosis, which was established along a spectrum from at least 1 medical record of endometriosis (recalled endometriosis) to tissue-proved ovarian endometriosis (n = X). Controls included women without any diagnosis of endometriosis (n = 239,385 - X). We used Cox regression, and computed hazard ratios (HRs) with 95% confidence intervals (95% CI) to determine the risk of EOC in patients. The EOC incidence rates (IRs, per 10,000 person-years) of women with endometriosis ranged from 1.90 in women with recalled endometriosis to 18.70 in women with tissue-proved ovarian endometrioma, compared with those women without any diagnosis of endometriosis (0.77-0.89), contributing to crude HRs ranging from 2.59 (95% CI, 2.09-3.21; P < 0.001) to 24.04 (95% CI, 17.48-33.05; P < 0.001). After adjustment for pelvic inflammatory disease, infertility, Charlson co-morbidity index, and age, adjusted HRs were ranged from the lowest of 1.90 (95% CI, 1.51-2.37; P < 0.001) in recalled endometriosis to the highest of 18.57 (95% CI, 13.37-25.79; P < 0.001) in tissue-proved ovarian endometrioma, which was inversely related to the prevalence rate of endometriosis (from the highest of 30.80% in recalled endometriosis to the lowest of 1.54% in tissue-proved ovarian endometrioma). The risk of EOC in women with endometriosis varied greatly by different criteria used. Women with endometriosis might have a more apparently higher risk than those reported by systematic review and meta-analysis.
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Affiliation(s)
- Wen-Ling Lee
- From the Department of Nursing, Oriental Institute of Technology, New Taipei City (W-LL, K-CW); Department of Medicine, Cheng-Hsin General Hospital (W-LL); Department of Obstetrics and Gynecology (W-LL, M-SY, P-HW); Department of Nursing (W-LL, W-HC, P-HW); Institute of Hospital and Health Care Administration and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan (C-YG, Y-JC, NH); Department of Nursing (W-HC); Department of Obstetrics and Gynecology (W-HC, M-SY, P-HW); Biostatics Task Force, Taipei Veterans General Hospital, Taipei, Taiwan (H-YH); Department of Medical Research (P-HW); and China Medical University Hospital, Taichung, Taiwan
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58
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Horikoshi M, Inokuma S, Matsubara E, Honda Y, Okada R, Kobuna M, Miura Y, Kobayashi S, Kawai S, Kumasaka T. Atypical Subacute Recurrence of Catastrophic Antiphospholipid Syndrome in a Japanese Female Patient. Intern Med 2015; 54:2923-7. [PMID: 26568011 DOI: 10.2169/internalmedicine.54.5150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Catastrophic antiphospholipid syndrome (CAPS) survivors rarely relapse. We herein report a case of a second CAPS episode with an unusual subacute course and no microangiopathic hemolytic anemia (MAHA), a common CAPS symptom. During the first episode, the 69-year-old woman responded well to high-dose glucocorticoids and plasma exchange. On relapse, these treatments plus rituximab were ineffective and she died of multi-organ failure and bacterial cholangitis. The absence of MAHA and a subacute course do not exclude a CAPS recurrence.
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Affiliation(s)
- Masanobu Horikoshi
- Department of Allergy and Rheumatic Diseases, Japanese Red Cross Medical Center, Japan
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Muller C. CALIFORNIA STATE UNIVERSITY CATASTROPHIC (CAT) LEAVE DONATION PROGRAM: DEMOGRAPHICS, ECONOMIC SECURITY, AND SOCIAL EQUITY. J Health Hum Serv Adm 2015; 38:108-159. [PMID: 26369237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The California State University (CSU) Chancellor's Office reached an agreement with all CSU collective bargaining units and Employee Relations on a uniform Catastrophic (CAT) Leave Donation Program in 1992. The CAT Leave Donation Program allows employees to donate sick and/or vacation leave credits to employees who are incapacitated due to a catastrophic illness or injury and have exhausted all of their own leave credits. This also extends to employees with whom family illnesses are deemed catastrophic, thus requiring the employee to care for an immediate family member. Stakeholders include union represented employees who accrue leave credits as well as any employee who receives or donates hours of leave credits in the program. Other stakeholders include the family members and program administrators.
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60
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Kronbichler A, Frank R, Kirschfink M, Szilágyi Á, Csuka D, Prohászka Z, Schratzberger P, Lhotta K, Mayer G. Efficacy of eculizumab in a patient with immunoadsorption-dependent catastrophic antiphospholipid syndrome: a case report. Medicine (Baltimore) 2014; 93:e143. [PMID: 25474424 PMCID: PMC4616391 DOI: 10.1097/md.0000000000000143] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Catastrophic antiphospholipid syndrome (CAPS) is a rare but devastating complication in patients with antiphospholipid syndrome (APS) with a high morbidity and mortality.We describe a case of a 30-year old female patient with immunoglobulin A (IgA) deficiency who underwent splenectomy because of idiopathic thrombocytopenic thrombocytopenia. Subsequently, an APS and finally systemic lupus erythematosus was diagnosed. After an uncomplicated pregnancy that was terminated by cesarean section, the patient developed severe CAPS with cerebral, myocardial, renal, and pulmonary involvement.Because of IgA deficiency, standard therapy consisting of plasmapheresis and intravenous immunoglobulins in addition to steroids was not tolerated. After 8 sessions of immunoadsorption (IAS), massive pulmonary hemorrhage was controlled but relapsed twice whenever IAS was terminated. As other immunosuppressive agents were considered dangerous because of the risk of infections in the face of severe hypogammaglobulinemia, we administered eculizumab, an inhibitor of the terminal complement pathway, which led to a persistent control of her disease. Interestingly, eculizumab therapy was associated with a further decline of complement C3 and C4 serum levels. The patient developed a subsequent flare of her systemic lupus erythematosus, potentially indicating that complement inhibition by eculizumab is not effective in preventing lupus flares.Taken together, we describe a unique case of life-threatening and difficult-to-treat CAPS with a good clinical response after terminal complement complex inhibition with eculizumab. Further controlled trials are necessary to investigate the value of eculizumab in patients with CAPS.
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Affiliation(s)
- Andreas Kronbichler
- From the Department of Internal Medicine IV (Nephrology and Hypertension) (AK, PS, GM); Department of Radiology (RF), Medical University Innsbruck, Innsbruck, Austria; Institute of Immunology (MK), University of Heidelberg, Heidelberg, Germany; 3rd Department of Medicine (AS, DC, ZP), Research Laboratory, Faculty of Medicine, Semmelweis University, Budapest, Hungary; and Department of Nephrology and Dialysis (KL), Academic Teaching Hospital Feldkirch, Feldkirch, Austria
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61
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Chang CC, Hsiao PJ, Chiu CC, Chen YC, Lin SH, Wu CC, Chen JS. Catastrophic hemophagocytic lymphohistiocytosis in a young man with nephrotic syndrome. Clin Chim Acta 2014; 439:168-71. [PMID: 25451951 DOI: 10.1016/j.cca.2014.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 10/15/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND In its early stage, necrotizing fasciitis mimics a milder cutaneous infection, such as cellulitis, and is an uncommon but potentially fatal complication of nephrotic syndrome. It may trigger an uncontrolled and catastrophic immune response, such as hemophagocytic lymphohistiocytosis (HLH). CASE REPORT A 19-y-old man presented with steroid-resistant nephrotic syndrome and rapidly progressing Escherichia coli monomicrobial necrotizing fasciitis with bacteremia. The conditions developed one day after steroid therapy, leading to multiple organ dysfunction syndrome. A provisional diagnosis of HLH was promptly made, based upon the patient's fever, unremitting shock, marked pancytopenia, hyperferritinemia, hypofibrinogenemia, and the typical histiocytic hemophagocytosis in pleural effusion. Despite aggressive medical treatment and organ support, the patient died 8 days after transfer to our intensive care unit. Final bone marrow examination confirmed the diagnosis of HLH. CONCLUSIONS Although nephrotic syndrome associated with E. coli infection is common, this is the first reported case of E. coli monomicrobial necrotizing fasciitis with bacteremia resulting in HLH in a patient with nephrotic syndrome.
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Affiliation(s)
- Chin-Chun Chang
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Po-Jen Hsiao
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Chih-Chien Chiu
- Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Ying-Chieh Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Shih-Hua Lin
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Chia-Chao Wu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Jin-Shuen Chen
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan.
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Lee WY, Shaw I. The impact of out-of-pocket payments on health care inequity: the case of national health insurance in South Korea. Int J Environ Res Public Health 2014; 11:7304-18. [PMID: 25046630 PMCID: PMC4113877 DOI: 10.3390/ijerph110707304] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/25/2014] [Accepted: 07/02/2014] [Indexed: 11/16/2022]
Abstract
The global financial crisis of 2008 has led to the reinforcement of patient cost sharing in health care policy. This study aimed to explore the impact of direct out-of pocket payments (OOPs) on health care utilization and the resulting financial burden across income groups under the South Korean National Health Insurance (NHI) program with universal population coverage. We used the fourth Korean National Health and Nutrition Examination Survey (KNHNES-IV) and the Korean Household Income and Expenditure Survey (KHIES) of 2007, 2008 and 2009. The Horizontal Inequity Index (HIwv) and the average unit OOPs were used to measure income-related inequity in the quantitative and qualitative aspects of health care utilization, respectively. For financial burden, the incidence rates of catastrophic health expenditure (CHE) were compared across income groups. For outpatient and hospital visits, there was neither pro-poor or pro-rich inequality. The average unit OOPs of the poorest quintile was approximately 75% and 60% of each counterpart in the richest quintile in the outpatient and inpatient services. For the CHE threshold of 40%, the incidence rates were 5.7%, 1.67%, 0.72%, 0.33% and 0.27% in quintiles I (the poorest quintile), II, III, IV and V, respectively. Substantial OOPs under the NHI are disadvantageous, particularly for the lowest income group in terms of health care quality and financial burden.
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Affiliation(s)
- Weon-Young Lee
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, 84 Heukseok-Ro, Dongjak-Gu, Seoul 156-756, Korea.
| | - Ian Shaw
- School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
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63
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Podolak B, Blickstein D, Inbal A, Eizner S, Rahamimov R, Yussim A, Mor E. Renal transplantation in a patient with catastrophic antiphospholipid syndrome and heparin-induced thrombocytopenia. Isr Med Assoc J 2014; 16:61-62. [PMID: 24575510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Bezalel Podolak
- Department of Transplantation, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Dorit Blickstein
- Thrombosis Hemostasis Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Aida Inbal
- Thrombosis Hemostasis Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Sigal Eizner
- Department of Transplantation, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Ruth Rahamimov
- lnstitute of Nephrology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Alexander Yussim
- Department of Transplantation, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Eytan Mor
- Department of Transplantation, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
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64
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Dem'ianova KA, Kozlovskaia NL, Shilov EM, Bobrova LA, Kozlov LV, Sorokin ID, Roshchupkina SV, Nikiforova NV, Dobrosmyslov IA, Romanova MD. [Alterations of the complement system in patients with catastrophic antiphospholipid syndrome]. TERAPEVT ARKH 2014; 86:30-37. [PMID: 25095653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To investigate alterations of the complement system in patients with catastrophic antiphospholipid syndrome (CAPS). SUBJECTS AND METHODS Four patients (2 men aged 23 and 40 years and 2 women aged 39 and 58 years) diagnosed as having CAPS, including 3 patients with systemic lupus erythematosus and secondary antiphospholipid syndrome (APS) and 1 patient with primary APS, were examined. The activity of the complement components C1-C5 and total hemolytic activity were determined in all the patients at the moment of an acute episode and in 1 patient after treatment. RESULTS The activity of the studied complement components and total hemolytic complement activity proved to be significantly decreased in all the patients. That of complement components recovered after treatment using fresh frozen plasma. The possibility and mechanisms of complement system activation in the patients with CAPS are discussed. CONCLUSION The preliminary results obtained by the examination of few cases may lead to the conclusion that the complement system may be involved in the development of CAPS.
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65
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Levy Y, Berla M. The complexities of anticoagulation in the antiphospholipid syndrome. Isr Med Assoc J 2014; 16:54-56. [PMID: 24575508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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67
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Stillman M. Debriefing after catastrophe. Acad Med 2013; 88:787. [PMID: 23708602 DOI: 10.1097/acm.0b013e31828f8817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Michael Stillman
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
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68
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Sciascia S, Lopez-Pedrera C, Roccatello D, Cuadrado MJ. Catastrophic antiphospholipid syndrome (CAPS). Best Pract Res Clin Rheumatol 2013; 26:535-41. [PMID: 23040365 DOI: 10.1016/j.berh.2012.07.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 07/16/2012] [Indexed: 01/09/2023]
Abstract
Catastrophic antiphospholipid syndrome (CAPS) is a very severe variant of the classic APS, characterised by clinical evidence of multiple organ involvement developing over a very short period of time, histopathological evidence of multiple small vessel occlusions and laboratory confirmation of the presence of antiphospholipid antibodies (aPL), usually in high titre. Although patients with catastrophic APS represent less than 1% of all patients with APS, this is usually a life-threatening condition. In this article, we aimed to review the state-of-the art about current knowledge in pathogenesis, clinical manifestations, diagnosis and treatment strategies in CAPS.
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Affiliation(s)
- Savino Sciascia
- Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, UK.
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69
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Shreders A, Bar M. A case of seronegative catastrophic antiphospholipid antibody syndrome. Conn Med 2013; 77:81-83. [PMID: 23513635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Catastrophic antiphospholipid antibody syndrome (CAPS) is a rare syndrome associated with multiorgan failure that carries a high mortality rate. It has been defined previously by the presence of autoantibodies in a patient with acute multiorgan failure as a result of small vessel occlusion by multiple thrombi. We report a patient who meets all criteria of CAPS except for persistent seronegativity.
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Affiliation(s)
- Amanda Shreders
- Stamford Hospital/Columbia University, College of Physicians and Surgeons, 30 Shelburne Road, Stamford, CT 06904, USA
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Arbabi EM, Carrim ZI, Doherty MD, Vize CJ. Catastrophic antiphospholipid syndrome. Clin Exp Ophthalmol 2013; 41:609-11. [PMID: 23278947 DOI: 10.1111/ceo.12062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 11/19/2012] [Indexed: 11/29/2022]
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71
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Le Jeune C, Danin PE, Lega JC, Bohe J, Piriou V. [Anticoagulation and antiphospholipid syndrome: be careful to the catastrophe]. Ann Fr Anesth Reanim 2012; 31:806-809. [PMID: 22925943 DOI: 10.1016/j.annfar.2012.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 07/06/2012] [Indexed: 06/01/2023]
Abstract
Antiphospholipid syndrome associate thromboembolic events (arterial or venous), and presence of antiphospholipid antibodies, and require anticoagulation. A catastrophic variant may develop, resulting in multiorgan failure, with high mortality rate. This article presented a patient with antiphospholipid syndrome presenting a catastrophic antiphospholipide syndrome after anticoagulation suspending for gastrointestinal bleeding. Multidisciplinary management in intensive care unit and aggressive therapies (corticosteroids, anticoagulation, plasma exchange) were essential to rescue the patient.
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Affiliation(s)
- C Le Jeune
- Service de médecine interne - médecine vasculaire, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
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72
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Park HC, Yoon HB, Lee TW, Jung JY, Chin HJ, Kim YS, Kim S. Recurrent thrombotic events after catastrophic antiphopholipid syndrome. Korean J Intern Med 2012; 27:232-4. [PMID: 22707899 PMCID: PMC3372811 DOI: 10.3904/kjim.2012.27.2.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 01/09/2009] [Accepted: 03/12/2009] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hayne Cho Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Bae Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae Woo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji Yong Jung
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ho Jun Chin
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Suhnggwon Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Abstract
OBJECTIVES/HYPOTHESIS To gather qualitative and semiquantitative information about catastrophic complications during and following tracheotomy. STUDY DESIGN National survey distributed to American Academy of Otolaryngology-Head and Neck Surgery members via the Academy weekly email newsletter during April and May 2011. METHODS A total of 478 respondents provided estimates of the number of four specific tracheotomy-related complications (innominate artery fistula, esophageal fistula, acute tracheotomy occlusion, and obstructing granuloma), all catastrophic events, and events resulting in death or permanent disability encountered during their careers. There were 253 respondents who provided 405 free-text descriptions of specific events. RESULTS The respondents experienced approximately one catastrophic event every 10 years and one event resulting in death or permanent disability every 20 years. More than 90% occurred more than 1 week after surgery. Categories of physicians who experienced more events per year included academic physicians and laryngologists. Pediatric otolaryngologists had twice as many innominate artery fistulas per year of practice as others. Qualitative (free-text) descriptions of the most serious events demonstrated that more of these events involved loss of airway and volume bleeds, usually from innominate or carotid artery erosion. Many of the events due to airway loss involved potentially correctable deficits in family education, nursing care, home care, and other structural factors. CONCLUSIONS Even when we allow for selection bias, these data suggest that a substantial number of tracheotomy complications leading to death or permanent disability occur at a national level. The vast majority of events occur more than 1 week after the procedure. Many of the described events were caused by factors that should be amenable to prospective system improvement strategies.
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Affiliation(s)
- Preety Das
- School of Clinical Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
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74
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Al-Beladi FI. Catastrophic antiphospholipid syndrome presenting as fever of unknown origin. Saudi J Kidney Dis Transpl 2012; 23:110-113. [PMID: 22237230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Antiphospholipid syndrome is characterized by the presence of antiphospholipid antibodies with characteristic clinical manifestation, which include venous, arterial thrombosis, thrombotic microangiopathy, and recurrent fetal loss. The syndrome can be secondary to many causes including systemic lupus erythematosus (SLE) or "primary" antiphospholipid syndrome (APLS). We report a case of a man with catastrophic antiphospholipid syndrome (CAPS), which occurs when three or more organ systems are affected by thrombosis in less than a week. Catastrophic antiphospholipid syndrome is uncommon but often fatal. The patient received a successful treatment that controlled this disease and included intravenous heparin, antiplatelet, intravenous corticosteroid, and plasmapheresis.
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Affiliation(s)
- Fatma I Al-Beladi
- Department of Medicine, King Abdul Aziz University Hospital, Jeddah, Saudi Arabia.
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75
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Jeon GJ, Song BG, Kim TH, Yang HJ, Ma BO, Park YH, Kang GH, Chun WJ, Oh JH. Catastrophic massive intracardiac thrombus in a 40-year-old patient with dilated cardiomyopathy. Nepal Med Coll J 2011; 13:226-228. [PMID: 22808822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Dilated cardiomyopathy has been associated with left ventricular (LV) thrombosis which leads to substantial morbidity and mortality as a site for systemic emboli. We report an interesting case of a stroke and acute limb ischemia secondary to a large mobile pedunculated LV thrombus in 40-year-old patient with dilated cardiomyopathy.
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Affiliation(s)
- G J Jeon
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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76
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Affiliation(s)
- Matus Rehak
- Department of Ophthalmology, University of Leipzig, Leipzig, Germany
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77
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Derks M, Oudijk MA, van der Made F, van den Born BJH, van der Post JAM. [Catastrophic antiphospholipid syndrome during pregnancy]. Ned Tijdschr Geneeskd 2011; 155:A3263. [PMID: 21771361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Antiphospholipid syndrome (APS) had been previously diagnosed in three pregnant women aged 32, 27 and 36 years, respectively. All three of them were using low-molecular weight heparin for the prevention of thromboembolic complications. The first two women were admitted because of foetal growth retardation. In the first patient, either HELLP syndrome or exacerbation of APS was suspected. A caesarean section was performed due to foetal distress. The patient's condition deteriorated further postoperatively. Multiple infarctions in liver and placenta were identified. Catastrophic antiphospholipid syndrome (CAPS) was diagnosed. Despite intensive medical treatment including anticoagulation the patient died of massive pulmonary embolism. The second patient suffered from thrombocytopaenia, disturbances in hepatic function and epigastric pain. CAPS was diagnosed. The condition improved after treatment with glucocorticoids, but because of a poor foetal prognosis, delivery was induced and a lifeless son was born. The third woman was admitted due to pyelonephritis. Shortly thereafter, symptoms of HELLP syndrome developed and she was administered glucocorticoids. Hepatic infarcts and petechiae developed, indicating CAPS. Delivery was induced and a girl was born. Glucocorticoid treatment was resumed and combined with immunoglobulins and plasmapheresis. The patient recovered and was discharged together with her daughter. CAPS is a life-threatening variation of APS. It is characterised by multiple thromboses and rapidly progressive multi-organ failure. Mortality is high, but seems to diminish with treatment by immunosuppressive therapy. In pregnancy, clinical signs of CAPS are similar to those of HELLP syndrome. Since the treatment for HELLP syndrome is different from CAPS, a correct diagnosis is essential. Because of the rarity of this condition in combination with high rates of perinatal and maternal mortality, care for pregnant patients with APS should be centralised in academic centres and close cooperation between obstetricians and internal medicine is necessary.
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Affiliation(s)
- Marloes Derks
- Academisch Medisch Centrum, Amsterdam, Divisie Obstetrie, the Netherlands.
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78
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Cantu RC, Gean AD. Second-impact syndrome and a small subdural hematoma: an uncommon catastrophic result of repetitive head injury with a characteristic imaging appearance. J Neurotrauma 2010; 27:1557-64. [PMID: 20536318 PMCID: PMC2956379 DOI: 10.1089/neu.2010.1334] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There have been a handful of previously published cases of athletes who were still symptomatic from a prior head injury, and then suffered a second injury in which a thin, acute subdural hematoma (SDH) with unilateral hemisphere vascular engorgement was demonstrated on CT scan. In those cases, the cause of the brain swelling/dysautoregulation was ascribed to the presence of the acute SDH rather than to the acceleration/deceleration forces that caused the SDH. We believe that the brain swelling is due to "second-impact dysautoregulation," rather than due to the effect of the SDH on the underlying hemisphere. To support our hypothesis, we present 10 additional cases of acute hemispheric swelling in association with small SDHs in athletes who received a second head injury while still symptomatic from a previous head injury. The clinical history and the unique neuroimaging features of this entity on CT are described and illustrated in detail. The CT findings included an engorged cerebral hemisphere with initial preservation of grey-white matter differentiation, and abnormal mass effect and midline shift that appeared disproportionately greater than the size of the SDH. In addition, the imaging similarities between our patients and those with non-accidental head trauma (shaken-baby syndrome) will be discussed.
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Affiliation(s)
- Robert C Cantu
- Department of Neurosurgery, Center for the Study of Traumatic Encephalopathy, Boston University Medical Center, Concord, MA 01742, USA.
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79
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Abstract
The catastrophic antiphospholipid syndrome (APS) is a potentially life-threatening condition, the diagnosis of which requires a high degree of clinical awareness on the part of attending physicians. Patients with APS present with 1) clinical evidence of multiple organ involvement developed over a very short time; 2) histopathologic evidence of multiple small-vessel occlusions; and 3) laboratory confirmation of the presence of antiphospholipid antibodies, usually in high titer. A combination of anticoagulants, corticosteroids, intravenous immunoglobulins, and plasma exchanges is the basic treatment for all patients with this severe condition. Unfortunately, despite current therapies, the mortality rate is still high (around 30%). However, once patients with catastrophic APS have recovered, they usually follow a stable course with continued anticoagulation and few patients present with a relapse of the catastrophic episode.
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Affiliation(s)
- Ricard Cervera
- Department of Autoimmune Diseases, Servei de Malalties Autoimmunes, Hospital Clínic, Villarroel 170, Barcelona, Catalonia, 08036, Spain.
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80
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Al Beladi FI. Catastrophic calciphylaxis in a patient with lupus nephritis and recent onset of end-stage renal disease. Saudi J Kidney Dis Transpl 2010; 21:323-327. [PMID: 20228522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Painful violaceous skin lesions that progress to non-healing ulceration and gangrene characterize calciphylaxis. These lesions are associated with secondary hyperparathyroidism and generally occur in patients on dialysis for more than one year. Hyperphosphatemia and hypoalbuminemia are the major risk factors for calciphylaxis. It is usually resistant to medical treatment although parathyroidectomy can help in controlling the disease. The mortality rate of calciphylaxis is very high due to uncontrollable sepsis. In our case, a young female with systemic lupus erythematosus (SLE) developed calciphylaxis within a short period after the onset of hemodialysis; she had a short period of hyperphosphatemia prior to dialysis. The serum phosphate was 4.24 mmol/L, calcium was 1.66 mmol/L, parathormone was 38 and calcium-phosphate was 7.0 mmol/L. It is likely that SLE provoked the development of calciphylaxis. The patient was treated medically but unfortunately died secondary to sepsis.
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Affiliation(s)
- Fatma I Al Beladi
- Department of Internal Medicine, Nephrology Division, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
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81
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Pengo V, Ruffatti A, Legnani C, Gresele P, Barcellona D, Erba N, Testa S, Marongiu F, Bison E, Denas G, Banzato A, Padayattil Jose S, Iliceto S. Clinical course of high-risk patients diagnosed with antiphospholipid syndrome. J Thromb Haemost 2010; 8:237-42. [PMID: 19874470 DOI: 10.1111/j.1538-7836.2009.03674.x] [Citation(s) in RCA: 402] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The characteristics and the clinical course of antiphospholipid syndrome (APS) in high-risk patients that are positive for all three recommended tests that detect the presence of antiphospholipid (aPL) antibodies have not been described. METHODS This retrospective analysis of prospectively collected data examined patients referred to Italian Thrombosis Centers that were diagnosed with definite APS and tested positive for aPL [lupus anticoagulant (LA), anti-cardiolipin (aCL), and anti-beta2-glycoprotein I (beta2GPI) antibodies]. Laboratory data were confirmed in a central reference laboratory. RESULTS One hundred and sixty patients were enrolled in this cohort study. The qualifying events at diagnosis were venous thromboembolism (76 cases; 47.5%), arterial thromboembolism (69 cases; 43.1%) and pregnancy morbidity (11 cases; 9.7%). The remaining four patients (2.5%) suffered from catastrophic APS. The cumulative incidence of thromboembolic events in the follow-up period was 12.2% (95% CI, 9.6-14.8) after 1 year, 26.1% (95% CI, 22.3-29.9) after 5 years and 44.2% (95% CI, 38.6-49.8) after 10 years. This was significantly higher in those patients not taking oral anticoagulants as compared with those on treatment (HR=2.4 95% CI 1.3-4.1; P<0.003). Major bleeding associated with oral anticoagulant therapy was low (0.8% patient/years). Ten patients died (seven were cardiovascular deaths). CONCLUSIONS Patients with APS and triple positivity for aPL are at high risk of developing future thromboembolic events. Recurrence remains frequent despite the use of oral anticoagulants, which significantly reduces the risk of thromboembolism.
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Affiliation(s)
- V Pengo
- Clinical Cardiology, Thrombosis Center, University Hospital, Padova, Italy.
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82
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Van Natta TL, Parekh KR, Dearmond DT, Iannettoni MD. Damage control: cavoatrial anastomosis during a catastrophic right intrapericardial pneumonectomy. Tex Heart Inst J 2010; 37:587-590. [PMID: 20978577 PMCID: PMC2953238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
While undergoing an intrapericardial pneumonectomy for a massive right pulmonary inflammatory pseudotumor that had invaded the mediastinum, an 18-year-old woman experienced a nearly fatal iatrogenic complication. Dense scarring adjacent to the pseudotumor had drawn in the superior vena cava posterolaterally and fused the right main pulmonary artery to the right superior pulmonary vein within the pericardium. The failure of a linear stapler to secure the pulmonary vessels led to torrential hemorrhage. Attempts to control the bleeding resulted in inadvertent superior vena cava occlusion and central venous pressure elevation. Because cardiopulmonary bypass might not have been reliably established in time to avoid irreversible cerebral ischemia, we borrowed a technique from congenital heart surgery and rapidly fashioned a cavoatrial connection. The patient survived the operation without negative neurologic or cardiac sequelae, recovered fully, and had no recurrence of the pseudotumor. Herein, we describe the intraoperative decisions that were made under intense time pressure to avert catastrophe.
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Affiliation(s)
- Timothy L Van Natta
- Department of Cardiothoracic Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa 52245, USA.
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83
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Dzhumabaeva BT, Biriukova LS, Tsvetaeva NV, Sukhanova GA, Vasil'ev SA, Shavlokhov VS, Karagiulian SR, Kaplanskaia IB, Petrova VI, Avdonin PV. [A case of hemolytic-uremic syndrome with development of catastrophic antiphospholipid syndrome: diagnosis and clinical tactics]. TERAPEVT ARKH 2010; 82:56-60. [PMID: 20564925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The paper describes a case of practically simultaneous development of the hemolytic-uremic syndrome (HUS) and the catastrophic antiphospholipid syndrome (CAPS) complicated by mesenteric vessel thrombosis and small bowel necrosis. Multimodality treatment comprising volume plasmapheresis, fresh frozen plasma transfusion, hemodialysis, anticoagulant and disaggregant therapy could relieve thrombogenic events, such as pulmonary artery thromboembolism and intestinal necrosis.
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84
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Farber NJ, Biederman RWW. Catastrophic right ventricular rupture prevented by coincident coronary artery bypass grafting: the pivotal role of cardiac magnetic resonance imaging. Tex Heart Inst J 2010; 37:123-124. [PMID: 20200646 PMCID: PMC2829798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
WEB SITE FEATURE
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Affiliation(s)
- Nicholas J Farber
- Allegheny Heart Institute, Gerald McGinnis Cardiovascular Institute, Pittsburgh, Pennsylvania 15212, USA
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85
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Cambria RP, Crawford RS, Cho JS, Bavaria J, Farber M, Lee WA, Ramaiah V, Kwolek CJ. A multicenter clinical trial of endovascular stent graft repair of acute catastrophes of the descending thoracic aorta. J Vasc Surg 2009; 50:1255-64.e1-4. [PMID: 19958982 DOI: 10.1016/j.jvs.2009.07.104] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 07/03/2009] [Accepted: 07/25/2009] [Indexed: 11/19/2022]
Affiliation(s)
- Richard P Cambria
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass, USA.
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86
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Vyas A, Kadikoy H, Haque W, Abdellatif A. Catastrophic antiphospholipid syndrome presenting as ischemic pancreatitis in systemic lupus erythematosus. JOP 2009; 10:566-569. [PMID: 19734640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT Antiphospholipid syndrome is often associated with systemic lupus erythematosus. Both syndromes have different clinical manifestations based on organ involvement. Antiphospholipid syndrome commonly causes spontaneous abortions, cerebral vascular occlusion, and deep venous thrombosis. Catastrophic antiphospholipid syndrome occurs when three or more organ systems are affected by thromboses in less than a week. CASE REPORT We report a unique case of a young woman with a history of systemic lupus erythematosus and antiphospholipid syndrome who presented with recurrent ischemic pancreatitis. Pancreatitis was refractory to anticoagulation and low dose steroids. Secondary to recurrence of pancreatitis and other organ involvement, she was treated as a presumed case of catastrophic antiphospholipid syndrome. Aggressive treatment with plasmapheresis, corticosteroids, cyclophosphamide, and anticoagulation eventually led to her recovery. CONCLUSION Awareness of this rare, rapidly fatal medical condition prompts vital, early intervention to improve patients' survival. This case report aims to add to the limited therapeutic data available as well as suggest a possible approach to treating this rare syndrome with very high morbidity and mortality.
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Affiliation(s)
- Ajit Vyas
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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87
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Yi H, Zhang L, Singer K, Rozelle S, Atlas S. Health insurance and catastrophic illness: a report on the New Cooperative Medical System in rural China. Health Econ 2009; 18 Suppl 2:S119-S127. [PMID: 19551747 DOI: 10.1002/hec.1510] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The overall goal of the paper is to understand the progress of the design and implementation of China's New Cooperative Medical System (NCMS) program between 2004 (the second year of the program) and 2007. In the paper we seek to assess some of the strengths and weaknesses of the program using a panel of national-representative, household survey data that were collected in 2005 and early 2008. According to our data, we confirm the recent reports by the Ministry of Health that there have been substantial improvements to the NCMS program in terms of coverage and participation. We also show that rural individuals also perceive an improvement in service by 2007. While the progress of the NCMS program is clear, there are still weaknesses. Most importantly, the program clearly does not meet one of its key goals of providing insurance against catastrophic illnesses. On average, individuals that required inpatient treatment in 2007 were reimbursed for 15% of their expenditures. Although this is higher than in 2004, on average, as the severity of the illness (in terms of expenditures on health care) rose, the real reimbursement rate (reimbursement amount/total expenditure on medical care) fell. The real reimbursement rate for illnesses that required expenditures between 4000 and 10,000 yuan (over 10,000 yuan) was only 11% (8%). Our analysis shows that one of the limiting factors is constrained funding.
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Affiliation(s)
- Hongmei Yi
- Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China.
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88
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Furmańczyk A, Komuda-Leszek E, Gadomska W, Windyga J, Durlik M. Catastrophic antiphospholipid syndrome. Pol Arch Med Wewn 2009; 119:427-430. [PMID: 19694227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Antiphospholipid syndrome (APS) is an autoimmune disease with clinical manifestations of arterial and venous thrombosis, concomitant fetal loss and the presence of antiphospholipid antibodies (APLA). This report focuses on the challenges of optimal treatment involving plasma exchange and intravenous human immunoglobulin infusions that is administered in patients with catastrophic APS (CAPS). CAPS is a rare variant of APS defined as acute failure of at least three tissues, organs or systems caused predominantly by small vessel thrombosis confirmed by histopathologic evidence. CAPS develops rapidly and leads to death in 50% of cases. We present the case of a 39-year-old male patient with APS with worsening renal function. Positive lupus anticoagulant, markedly high concentrations of anticardiolipin and anti-beta 2-glikoprotein I antibodies have been observed. According to the criteria introduced by Asherson, a catastrophic form of APS was diagnosed and the patient had been treated with low-molecular-weight heparin, glucocorticosteroids, and plasmapheresis. In order to maintain clinical improvement, the patient was given human immunoglobulins i.v. (1 g/kg body weight). After the procedure, gradual clinical improvement was observed and renal function remained stable (serum creatinine level of 1.5 mg/dl).
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Affiliation(s)
- Agnieszka Furmańczyk
- Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warszawa, Poland.
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89
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Nicholson Perry K, Nicholas MK, Middleton J, Siddall P. Psychological characteristics of people with spinal cord injury-related persisting pain referred to a tertiary pain management center. J Rehabil Res Dev 2009; 46:57-67. [PMID: 19533520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study examines the psychological characteristics of a cohort of individuals with spinal cord injury (SCI) and persisting pain referred to a tertiary pain management center. Forty-five individuals completed measures of pain, mood, disability, and both pain- and SCI-related psychological variables such as self-efficacy and catastrophizing. Compared with a general pain clinic population attending the same tertiary pain management center (n = 5,941), the sample was found to have lower pain intensity, comparable pain catastrophizing levels, and less activity interference due to pain. In contrast, those with SCI pain reported poorer mood. Pain catastrophizing was associated with anxiety, depression, and activity interference due to pain; pain self-efficacy was close to being significantly associated with these variables also. SCI acceptance and self-efficacy were also associated with some of these variables. These findings suggest that the biopsychosocial model of pain is applicable in this sample and that further treatment benefits could be obtained through use of interventions targeting psychological and social variables within this model.
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Affiliation(s)
- Kathryn Nicholson Perry
- The University of Sydney Pain Management and Research Centre, Royal North Shore Hospital, Sydney, Australia. k.nicholsonperry@.uws.edu.au
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90
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Szturmowicz M. [Antiphospholipid syndrome - an update on diagnosis and treatment]. Pneumonol Alergol Pol 2009; 77:460-468. [PMID: 19890826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Antiphospholipid syndrome (APS) was described by Hughes et al in 1986 and then by Harris et al in 1987. The symptoms of disease are related to the presence of autoantibodies directed against plasma and serum proteins that form complexes with phospholipids of cell membranes. The immunologic process involving vascular endothelium, thrombocytes and coagulation factors is responsible for enhancement of procoagulation mechanisms and as a result - venous and arterial thrombosis. Actual criteria of recognition of APS were published in 2006 as a result of 11th International Congress on Antiphospholipid Antibodies which was taking place in 2004 in Sydney. Multiorgan symptoms of disease, criteria of recognition and methods of treatment were discussed in the present paper.
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Affiliation(s)
- Monika Szturmowicz
- Klinika Chorób Wewnetrznych Klati Piersiowej Instytutu Gruźlicy i Chorób Płuc w Warszawie.
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91
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Alba Moratilla C. [Catastrophic left leg V.A.C. Therapy First Prize in 2008. Second convocation]. Rev Enferm 2008; 31:56-60. [PMID: 19043977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This report received the V.A.C. Therapy Prize, second convocation, in the clinical case category of note is the spectacular nature of its results.
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92
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Soltész P, Veres K, Szomják E, Kerekes G, Dér H, Sándor Z, Dezso B, Dévényi K, Szekanecz Z. Catastrophic antiphospholipid syndrome (Asherson's syndrome) associated with cytokeratin 7-positive endometrial cancer. Isr Med Assoc J 2007; 9:891-893. [PMID: 18210936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Pál Soltész
- Cardiovascular Unit, University of Debrecen Medical and Health Science Center, Debrecen, Hungary
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93
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Sinico RA, Di Toma L, Sabadini E, Renoldi P, Li Vecchi M. Catastrophic antiphospholipid syndrome: report of 4 cases. J Nephrol 2007; 20:739-744. [PMID: 18046677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Catastrophic antiphospholipid syndrome (CAPS), described by Asherson in 1992, is a rare form of antiphospholipid syndrome resulting in multiorgan failure with a mortality rate of about 50%. The syndrome occurs in patients with either systemic lupus erythematosus and other rheumatic diseases (systemic sclerosis, rheumatoid arthritis, primary Sjogren syndrome) or alone. Whereas in "classic" antiphospholipid syndrome (APS), medium-large vessels are involved, a diffuse small vessel ischemia and thrombosis (microangiopathic disease) leading to a severe multiorgan dysfunction is predominant in CAPS. "Trigger" factors have been demonstrated in 45% of patients, but in the majority, they remain unknown. Not infrequently, CAPS arises in patients without any previous thrombotic history. The kidney is the organ most commonly affected, followed by the lung, the central nervous system, the heart and the skin. Disseminated intravascular coagulation occurs in approximately 13% of patients. The present study reports the clinical and serological features of 4 patients affected by this rare form of antiphospholipid syndrome. Nephrologists should be aware of the possibility of this syndrome as a cause of multiorgan failure since prompt recognition is essential for effective treatment.
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Affiliation(s)
- R A Sinico
- Department of Nephrology, Immunology and Blood Purification, San Carlo Borromeo Hospital, Milan, Italy
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94
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Patanè S, Marte F, Di Bella G. Catastrophic early drug eluting stents thrombosis and aspirin hypersensitivity. Int J Cardiol 2007; 131:e25-7. [PMID: 17913265 DOI: 10.1016/j.ijcard.2007.07.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2007] [Accepted: 07/01/2007] [Indexed: 11/26/2022]
Abstract
Stent thrombosis is a feared complication of percutaneous coronary intervention. Promises and problems, late complications and early stent thrombosis have been reported after drug eluting stents implantation too. Moreover some patients with imperative cardiologic indications for combination therapy with aspirin and clopidogrel (stent placement and/or acute coronary syndrome) have a history of allergy to aspirin. We present a case of catastrophic early drug eluting stents thrombosis in a 79-year-old Italian woman with aspirin hypersensitivity.
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95
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96
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Carter JJ, Cunningham B. Advocate for patients with catastrophic injury, illness. Hosp Case Manag 2007; 15:101-2, 107-8. [PMID: 17655162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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97
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Abstract
INTRODUCTION Catastrophic antiphospholipid syndrome (CAPS) is a life-threatening disorder urgent for aggressive treatment, and its characterized systemic thromboses and coagulopathy prompt for a rapid diagnosis. CASE REPORT A woman fell into unconsciousness two weeks after a stable course of massive cerebral ischemia was identified due to CAPS with Sjogren syndrome. Her thrombocyte count and coagulation times were was normal at initial. A high blood anti-beta(2)-glycoprotein I antibody level was found. Plasmapheresis rapidly reversed her consciousness and coagulation function. CONCLUSIONS A normal hemostatic parameters should not exclude CAPS. A favorable prognosis depends on the rapidity of appropriate treatment.
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Affiliation(s)
- Wei Hsi Chen
- Neurocritical Care Unit, Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, and School of Medicine, Chang Gung University, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung 833, Taiwan.
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98
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Abstract
External haemorrhage is a significant cause of combat morbidity and mortality. UK DMS have introduced topical haemostatic agents (HemCon, QuikClot) for use as an adjunct to control catastrophic external haemorrhage. Realistic training in new equipment is essential. A model is described that is simple, reproducible, valid, realistic and currently unique in its opportunity to train soldiers to deal with life-threatening external bleeding, without recourse to live animal training. The model has been used successfully to train UK DMS medics, nurses and doctors in Afghanistan.
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99
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Cervera R, Bucciarelli S, Espinosa G, Gómez-Puerta JA, Ramos-Casals M, Shoenfeld Y, Piette JC, Asherson RA. Catastrophic Antiphospholipid Syndrome: Lessons from the "CAPS Registry" A Tribute to the Late Josep Font. Ann N Y Acad Sci 2007; 1108:448-56. [PMID: 17894009 DOI: 10.1196/annals.1422.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Although less than 1% of patients with the antiphospholipid syndrome (APS) develop the catastrophic variant, its potentially lethal outcome emphasizes its importance in clinical medicine today. However, the rarity of this variant makes it extraordinarily difficult to study in any systematic way. In order to put together all the published case reports as well as the new diagnosed cases from all over the world, an international registry of patients with catastrophic APS ("CAPS Registry") was created in 2000 by the European Forum on Antiphospholipid Antibodies. Currently, it documents the entire clinical, laboratory, and therapeutic data of more than 300 patients whose data have been fully registered. This registry can be freely consulted at the Internet (www.med.ub.es/MIMMUN/FORUM/CAPS.HTM) and it is expected that the periodical analysis of these data will allow us to increase our knowledge of this condition.
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Affiliation(s)
- Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain.
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100
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Asherson RA, Cervera R, Shoenfeld Y. Peripheral Vascular Occlusions Leading to Gangrene and Amputations in Antiphospholipid Antibody Positive Patients. Ann N Y Acad Sci 2007; 1108:515-29. [PMID: 17894017 DOI: 10.1196/annals.1422.055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Twenty-one cases from several medical centers (Brazil, Italy, Serbia, South Africa, Israel, and the United Kingdom) with severe peripheral vascular disease progressing to amputations of limbs/digits, all of whom tested positive for antiphospholipid antibodies, are documented. The patients were suffering from either systemic lupus erythematosus, discoid LE, "primary" antiphospholipid syndrome (PAPS), "lupus-like" disease, undifferentiated connective tissue disease. A high frequency of livedo reticularis preceding the arterial occlusions in our series of patients who subsequently progressed to ischemic necrosis and amputation of limbs/digits was noted. Five of the 10 patients, in whom histopathological studies had been performed, demonstrated the typical vasculopathy seen with the antiphospholipid syndrome ("APS vasculopathy"). Complicating vasculitis was present in seven of the patients. Five of the patients developed severe peripheral vascular disease during the course of the catastrophic antiphospholipid (Asherson's) syndrome.
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Affiliation(s)
- Ronald A Asherson
- Division of Immunology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.
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