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Mangiaterra T, Alonso-Alonso R, Rabinovich A, De Dios Soler M, Galluzzo L, Soria M, Colli S, De Matteo E, Rodriguez Pinilla SM, Chabay P. Presence of Epstein-Barr virus (EBV) antigens detected by sensitive methods has no influence on local immune environment in diffuse large B cell lymphoma. Cancer Immunol Immunother 2024; 73:29. [PMID: 38280007 PMCID: PMC10821829 DOI: 10.1007/s00262-023-03617-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/16/2023] [Indexed: 01/29/2024]
Abstract
EBV+ diffuse large B cell lymphoma (DLBCL) not otherwise specified (NOS) is a new entity confirmed by the World Health Organization (WHO) in 2017. In this new entity, the virus may contribute to a tolerogenic microenvironment. Traces of the virus have been described in DLBCL with more sensitive methods, in cases that were originally diagnosed as negative. The aim of this study was to analyze the expression of immune response genes in the tumor microenvironment to disclose the role of the virus and its traces in DLBCL. In 48 DLBCL cases, the expression of immune response genes and the presence of molecules that induce tolerance, such as TIM3, LAG3 and PDL1 by immunohistochemistry (IHC), were studied. To broaden the study of the microenvironment, tumor-associated macrophages (TMAs) were also explored. No significant differences were observed in the expression of immune response genes in the EBV+ DLBCL and those cases that were EBV- DLBCL but that exhibited viral traces, assessed by ViewRNA assay. Only the EBV+ DLBCL cases displayed a significantly higher increase in the expression of CD8 and cytotoxic T cells detected by gene expression analysis, and of PDL1 in tumor cells and in the expression of CD68 in the tumor microenvironment detected by IHC, not observed in those cases with viral traces. The increase in CD8 and cytotoxic T cells, PDL1 and CD68 markers only in EBV+ DLBCL may indicate that traces of viral infection might not have influence in immune response markers.
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Affiliation(s)
- T Mangiaterra
- Molecular Biology Laboratory, Pathology Division, Multidisciplinary Institute for Investigation in Pediatric Pathologies (IMIPP), CONICET-GCBA, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - R Alonso-Alonso
- Pathology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A Rabinovich
- Molecular Biology Laboratory, Pathology Division, Multidisciplinary Institute for Investigation in Pediatric Pathologies (IMIPP), CONICET-GCBA, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - M De Dios Soler
- Pathology Division, Marie Curie Hospital, Buenos Aires, Argentina
| | - L Galluzzo
- Pathology Division, Prof. Dr. Juan P. Garrahan Hospital, Buenos Aires, Argentina
| | - M Soria
- Hematology Division, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - S Colli
- Pathology Division, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - E De Matteo
- Molecular Biology Laboratory, Pathology Division, Multidisciplinary Institute for Investigation in Pediatric Pathologies (IMIPP), CONICET-GCBA, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
- Pathology Division, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | | | - P Chabay
- Molecular Biology Laboratory, Pathology Division, Multidisciplinary Institute for Investigation in Pediatric Pathologies (IMIPP), CONICET-GCBA, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina.
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Davidesko S, Pikovsky O, Al-Athamen K, Hackmon R, Erez O, Miodownik S, Rabinovich A. Von-Willebrand factor antigen: a biomarker for severe pregnancy complications in women with hereditary TTP? J Thromb Haemost 2023; 21:1623-1629. [PMID: 36889591 DOI: 10.1016/j.jtha.2023.02.022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVES To determine a possible association between severe obstetric morbidity (SOM) and elevated non-pregnant vWF antigen levels (NPvWF) in women with hereditary thrombotic thrombocytopenic purpura (hTTP) and whether the latter can predict the response to fresh frozen plasma (FFP) transfusion. STUDY DESIGN A cohort-based study of women with hTTP due to homozygous c.3772delA mutation of ADAMTS13 who had pregnancies both with and without FFP treatment. Occurrences of SOM were determined from medical records. GEE logistic regressions and ROC curve analysis determined the NPvWF antigen levels associated with development of SOM. RESULTS 14 women with hTTP had 71 pregnancies; 17 (24%) culminated in pregnancy loss, 32 (45%) were complicated by SOM. FFP transfusions were administered in 32 (45%) of pregnancies. Treated women had decreased SOM (28% vs. 72%, p<0.001) and preterm TTP exacerbations (18% vs. 82%, p<0.001), and higher median NPvWF antigen levels than those with uncomplicated pregnancies (p=0.018). Amongst treated women, median NPvWF antigen levels were higher in those with SOM compared to those without (225% vs. 165%, p=0.047). Logistic regression models demonstrated a significant two-way association between elevated NPvWF antigen levels (OR 1.08 for SOM, 95% CI 1.001-1.165, p=0.046) and SOM (OR 1.6 for elevated NPvWF antigen, 95% CI 1.329-1.925, p<0.001). ROC curve analysis demonstrated that NPvWF antigen level of 195% had 75% sensitivity and 72% specificity for SOM. CONCLUSION Elevated NPvWF antigen levels are associated with SOM in women with hTTP. Women with levels >195% may benefit from increased surveillance and more intensive FFP treatment during pregnancy.
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Affiliation(s)
- Sharon Davidesko
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev Beer Sheva Israel.
| | - Oleg Pikovsky
- Transfusion Medicine Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Hematology Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Kayed Al-Athamen
- Hematology Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rinat Hackmon
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Offer Erez
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev Beer Sheva Israel; Department of Obstetrics and Gynecology, Hutzel Women's Hospital, School of Medicine, Wayne State University, Detroit, MI
| | - Shayna Miodownik
- Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anat Rabinovich
- Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Zektser M, Rabinovich A, Grinbaum U, Porges T, Gozlan A, Gourevitch A, Al-Athamen K, Barrett O, Peles I, Kaisman-Elbaz T, Levi E. Primary Central Nervous System Lymphoma: Clinical Characteristics, Treatment Options and Therapeutic Outcome in 36 Patients. A Single Center Experience. Isr Med Assoc J 2022; 24:654-660. [PMID: 36309861] [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: 06/16/2023]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare aggressive non-Hodgkin's lymphoma. There are limited data on the management of PCNSL outside of clinical trials. OBJECTIVES To report experience with three main high-dose methotrexate (HDMTX)-based protocols for PCNSL treatment at one medical center. METHODS We conducted a retrospective review of the medical records of patients diagnosed with PCNSL who were treated at Soroka Medical Center between 2007 and 2019. RESULTS The study included 36 patients, median age 64.9 years; 33 patients received a HDMTX backbone induction therapy, 21 (58.3%) received consolidation treatment in addition. In the entire cohort, 25 patients (75.7%) achieved complete remission (CR, CRu-unconfirmed), with mean progression-free survival (PFS) 32 ± 6.9 months and median overall survival (OS) 59.6 ± 12.4 months. More aggressive regiment such as combination of rituximab, HDMTX, cytarabine and thiotepa had better responses 5 (100%) CR, but also a higher incidence of side effects such as neutropenic fever 5 (100%). In subgroup analysis by age (younger vs. older than 60 years), the PFS was 24.2 vs. 9.3 months, and OS was 64.1 vs. 19.4 months, respectively. CONCLUSIONS A difference in CR and PFS favored a more aggressive protocol, but the toxicity of the multiagent combinations was significantly higher. The prognosis in younger was better than in older patients, with higher rates of CR, PFS, and OS, although not statistically significant. Overall treatment outcomes are encouraging; however, there is a real need for an adaptive approach for older patients and balancing among the effectiveness and side effects.
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Affiliation(s)
- Miri Zektser
- Hematology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Anat Rabinovich
- Hematology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Uri Grinbaum
- Hematology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Tzvi Porges
- Hematology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Aya Gozlan
- Hematology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Anna Gourevitch
- Hematology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Kayed Al-Athamen
- Hematology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Orit Barrett
- Neurosurgery, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ido Peles
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Tehila Kaisman-Elbaz
- Neurosurgery, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Etai Levi
- Hematology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Pikovsky O, Erez O, Rabinovich A. Treatment response in congenital thrombotic thrombocytopenic purpura to aid in pregnancy counseling and management: a reply. Am J Obstet Gynecol 2022; 226:595. [PMID: 34838801 DOI: 10.1016/j.ajog.2021.11.1362] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Oleg Pikovsky
- Department of Obstetrics and Gynecology, Emek Medical Center, Ben Gurion University of the Negev, Afula, Israel
| | - Offer Erez
- Department of Obstetrics and Gynecology, Emek Medical Center, Ben Gurion University of the Negev, Afula, Israel.
| | - Anat Rabinovich
- Department of Obstetrics and Gynecology, Emek Medical Center, Ben Gurion University of the Negev, Afula, Israel
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Erez O, Othman M, Rabinovich A, Leron E, Gotsch F, Thachil J. DIC in Pregnancy - Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments. J Blood Med 2022; 13:21-44. [PMID: 35023983 PMCID: PMC8747805 DOI: 10.2147/jbm.s273047] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 09/15/2021] [Indexed: 01/04/2023] Open
Abstract
Obstetrical hemorrhage and especially DIC (disseminated intravascular coagulation) is a leading cause for maternal mortality across the globe, often secondary to underlying maternal and/or fetal complications including placental abruption, amniotic fluid embolism, HELLP syndrome (hemolysis, elevated liver enzymes and low platelets), retained stillbirth and acute fatty liver of pregnancy. Various obstetrical disorders can present with DIC as a complication; thus, increased awareness is key to diagnosing the condition. DIC patients can present to clinicians who may not be experienced in a variety of aspects of thrombosis and hemostasis. Hence, DIC diagnosis is often only entertained when the patient already developed uncontrollable bleeding or multi-organ failure, all of which represent unsalvageable scenarios. Beyond the clinical presentations, the main issue with DIC diagnosis is in relation to coagulation test abnormalities. It is widely believed that in DIC, patients will have prolonged prothrombin time (PT) and partial thromboplastin time (PTT), thrombocytopenia, low fibrinogen, and raised D-dimers. Diagnosis of DIC can be elusive during pregnancy and requires vigilance and knowledge of the physiologic changes during pregnancy. It can be facilitated by using a pregnancy specific DIC score including three components: 1) fibrinogen concentrations; 2) the PT difference - relating to the difference in PT result between the patient's plasma and the laboratory control; and 3) platelet count. At a cutoff of ≥26 points, the pregnancy specific DIC score has 88% sensitivity, 96% specificity, a positive likelihood ratio (LR) of 22, and a negative LR of 0.125. Management of DIC during pregnancy requires a prompt attention to the underlying condition leading to this complication, including the delivery of the patient, and correction of the hemostatic problem that can be guided by point of care testing adjusted for pregnancy.
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Affiliation(s)
- Offer Erez
- Maternity Department “D”, Division of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences Ben Gurion University of the Negev, Beer Sheva, Israel
- Department of Obstetrics and Gynecology, Hutzel Women’s Hospital, Wayne State University, Detroit, MI, USA
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Anat Rabinovich
- Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Elad Leron
- Division of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Francesca Gotsch
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata, AOUI Verona, University of Verona, Verona, Italy
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
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Davidesko S, Pikovsky O, Al-Athamen K, Hackmon R, Erez O, Miodownik S, Rabinovich A. Von-Willebrand factor antigen: a biomarker for severe pregnancy complications in women with hereditary TTP? Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Miodownik S, Pikovsky O, Erez O, Kezerle Y, Lavon O, Rabinovich A. Unfolding the pathophysiology of congenital thrombotic thrombocytopenic purpura in pregnancy: lessons from a cluster of familial cases. Am J Obstet Gynecol 2021; 225:177.e1-177.e15. [PMID: 33621545 DOI: 10.1016/j.ajog.2021.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Thrombotic thrombocytopenic purpura (TTP), a rare, potentially life-threatening thrombotic microangiopathy, manifests either as congenital TTP or acquired forms. It is caused by the absence or severe depletion of a disintegrin and metalloproteinase with thrombospondin motifs 13 (ADAMTS13) protease, leading to the accumulation of ultra large von Willebrand factor multimers as well as extensive platelet adhesion and clumping, which can ultimately cause severe secondary end-organ damage. Pregnancy can provoke or exacerbate TTP, leading to maternal and fetal complications. OBJECTIVE In this report, we focused on pregnancy outcomes in a recently recognized cohort of congenital TTP patients of Bedouin Arab descent in southern Israel who were all homozygous for a novel c.3772delA variant of the ADAMTS13 gene, leading to the clinical manifestations of TTP largely during pregnancy. STUDY DESIGN All patients presented in this study belong to 2 closely related families of Arab Bedouin descent and were found to be homozygous for a novel ADAMTS13-c.3772delA variant. The cohort consisted of 19 females; 16 of them had congenital TTP and had been pregnant and were thus included. Patient data were collected from electronic medical records. RESULTS Of note, 13 women from our cohort, who delivered 14 fetuses (owing to 1 twin pregnancy), were diagnosed with congenital TTP following complicated pregnancies, which included recurrent pregnancy loss, stillbirth, early onset preeclampsia (both mild and severe), hemolysis, elevated liver enzymes and low platelet count syndrome, intrauterine growth restriction with abnormal Doppler flow, preterm premature rupture of membranes, and a total perinatal mortality rate of 30.7% (4/13). An additional 3 women, who were diagnosed owing to complications outside of pregnancy and at older ages, experienced TTP during their pregnancies, which occurred before diagnosis. Subsequent pregnancies were treated with fresh frozen plasma leading to a 100% fetal survival rate in the pregnancies that reached fetal viability. All placentas had lesions consistent with maternal vascular underperfusion. However, the severity and frequency of these lesions were lower in the 8 placentas from pregnancies treated with fresh frozen plasma. CONCLUSION This case series details a distinctive cohort of congenital TTP patients, all homozygous for the same, novel ADAMTS13 variant, who presented with clinical complications during pregnancy and maternal vascular lesions of underperfusion in the placenta. Our findings imply that the variant identified in the ADAMTS13 gene in our cohort may have a specific functional impact on the placenta, and that treatment with fresh frozen plasma during pregnancy ameliorates the course of the disease, leading to a milder phenotype or a normal pregnancy in the majority of cases.
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Gomez-Tolub R, Rabinovich A, Kachko E, Benshalom-Tirosh N, Tirosh D, Thachil J, Besser L, Than NG, Erez O. Placental abruption as a trigger of DIC in women with HELLP syndrome: a population-based study. J Matern Fetal Neonatal Med 2020; 35:3259-3269. [PMID: 32933344 DOI: 10.1080/14767058.2020.1818200] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Disseminated Intravascular Coagulation (DIC) is a life-threatening condition. Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome is one of the obstetrical syndromes mostly associated with DIC and thus, high rates of fatal complications. There is a lack of information regarding epidemiologic and clinical characteristics of women who developed HELLP syndrome with and without DIC. Additionally, until now, there is no adapted and widely accepted way to diagnose DIC among pregnant women presenting with HELLP syndrome, despite the evident maternal mortality linked to the disease. Objectives: (1) Address the gaps in knowledge regarding the prevalence, epidemiologic and clinical characteristics of women with HELLP syndrome who develop DIC; and (2) determine the risk factors for the development of DIC among women with HELLP syndrome. STUDY DESIGN This was a population-based retrospective cohort study, including all women who delivered at the Soroka University Medical Center between the years 2001-2017. The study population was divided into three groups: (1) comparison group (n = 207,266 deliveries); (2) HELLP syndrome without DIC (n = 320); (3) HELLP syndrome with DIC (n = 21). The diagnosis of DIC was based on the ICD-9 code as recorded in the obstetrical database of the Soroka University Medical Center. The coding is based on the diagnosis made by the attending physician during hospitalization. RESULTS (1) The rate of HELLP syndrome in the study population was 0.16% (341/207,607), of them 6.16% (21/341) had DIC; (2) among patients with HELLP syndrome, those with DIC had a higher median gravidity and parity; (3) a higher rate of severe maternal morbidity including blood product transfusion, placental abruption, eclampsia, acute renal failure and maternal death was observed in those who had HELLP syndrome and DIC compared to those with HELLP syndrome without DIC and the comparison group (p-value <.001 for comparison among the three groups); (4) among women with HELLP syndrome, those with DIC had a longer median PT difference, higher serum creatinine and lower AST as well as ALT median concentrations than those without DIC; (5) patients with HELLP syndrome and DIC had a higher rate of stillbirth and postpartum death than patients in the other groups (p-value <.001 for comparison among the three groups); and (6) placental abruption was an independent risk factor for the development of DIC in women with HELLP syndrome (p-value <.001). CONCLUSIONS (1) Among women with HELLP syndrome, those who developed DIC had a higher rate of maternal and neonatal morbidity and mortality than those without DIC; and (2) placental abruption, but not abnormal liver function, was an independent risk factor for the development of DIC in women with HELLP syndrome.
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Affiliation(s)
- Rachel Gomez-Tolub
- Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anat Rabinovich
- Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eric Kachko
- Center of Clinical Research, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Neta Benshalom-Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dan Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Limor Besser
- Department of Obstetrics and Gynecology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nandor Gabor Than
- Systems Biology of Reproduction Lendulet Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary.,Maternity Clinic, Budapest, Hungary
| | - Offer Erez
- Division of Obstetrics and Gynecology, Maternity Department "D" and Obstetrical Day Care Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Rabinovich A, Abdul-Kadir R, Thachil J, Iba T, Othman M, Erez O. Reply to "Errors in the diagnosis for DIC due to a statistical misunderstanding". J Thromb Haemost 2020; 18:1792-1793. [PMID: 32619348 DOI: 10.1111/jth.14831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Anat Rabinovich
- Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Rezan Abdul-Kadir
- Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK
| | - Jecko Thachil
- Department of Hematology, Manchester Royal Infirmary, Manchester, UK
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University, Tokyo, Japan
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
| | - Offer Erez
- Maternity Department "D", Division of obstetrics and Gynecology, Soroka University Medical Center, School of Medicine Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Rabinovich A, Gu CS, Vedantham S, Kearon C, Goldhaber SZ, Gornik HL, Kahn SR. External validation of the SOX-PTS score in a prospective multicenter trial of patients with proximal deep vein thrombosis. J Thromb Haemost 2020; 18:1381-1389. [PMID: 32145144 PMCID: PMC7545582 DOI: 10.1111/jth.14791] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/23/2020] [Accepted: 02/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Using data from the SOX Trial, we recently developed a clinical prediction model for occurrence of the postthrombotic syndrome (PTS) after proximal deep vein thrombosis (DVT), termed the SOX-PTS score. The score includes anatomical extent of DVT; body mass index; and baseline Villalta score. OBJECTIVE To externally validate the SOX-PTS score. METHODS Logistic regression analysis of data from the ATTRACT Trial that evaluated pharmacomechanical catheter directed thrombolysis in patients with proximal DVT. The primary outcome was the occurrence of PTS (defined as Villalta score ≥ 5) from 6 to 24 months after DVT. Secondary outcomes included moderate-severe PTS (Villalta scale ≥ 10) and severe PTS (Villalta scale ≥ 14). Predictive performance was assessed by discrimination and calibration. An updated score was evaluated in an exploratory analysis. RESULTS Six hundred and ninety-one ATTRACT patients were included, of whom 328 (47%) developed PTS. The c-statistic was 0.63; 95% confidence interval (CI) 0.59-0.67 for PTS. The model's performance appeared to be better for the outcomes moderate to severe PTS and severe PTS (c-statistic 0.67; 95% CI 0.62-0.72 for moderate-severe PTS and 0.70; 0.64-0.77 for severe PTS). An updated model with age as an additional variable performed similarly to the original model. CONCLUSION We externally validated the SOX-PTS score for estimating the risk of developing PTS, moderate to severe PTS, and severe PTS, in patients with proximal DVT. The score may be useful to predict PTS at the time of DVT diagnosis. Further external validation in different patient cohorts is required.
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Affiliation(s)
- Anat Rabinovich
- Thrombosis and Hemostasis unit, Hematology institute, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Chu-Shu Gu
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Clive Kearon
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada
| | - Samuel Z. Goldhaber
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Heather L. Gornik
- University Hospitals, Case Western Reserve University, Cleveland Ohio, USA
| | - Susan R. Kahn
- Jewish General Hospital, Lady Davis Institute, Center for Clinical Epidemiology, Montreal, QC, Canada
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Pikovsky O, Arafat M, Ovadia H, Sharoni Y, Al-Athamen K, Kanengisser-Pines B, Keren-Politansky A, Levi I, Erez O, Parvari R, Rabinovich A. Congenital thrombotic thrombocytopenic purpura in a large cohort of patients carrying a novel mutation in ADAMTS13 gene. Thromb Res 2020; 185:167-170. [DOI: 10.1016/j.thromres.2019.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/10/2019] [Accepted: 12/04/2019] [Indexed: 11/25/2022]
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Rabinovich A, Abdul-Kadir R, Thachil J, Iba T, Othman M, Erez O. DIC in obstetrics: Diagnostic score, highlights in management, and international registry-communication from the DIC and Women's Health SSCs of the International Society of Thrombosis and Haemostasis. J Thromb Haemost 2019; 17:1562-1566. [PMID: 31218838 DOI: 10.1111/jth.14523] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Anat Rabinovich
- Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Rezan Abdul-Kadir
- Katharine Dormandy Haemophilia and Thrombosis Centre and Department of Obstetrics and Gynaecology, The Royal Free NHS Foundation Hospital, London, UK
- University College, London, UK
| | - Jecko Thachil
- Department of Hematology, Manchester Royal Infirmary, Manchester, UK
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University, Tokyo, Japan
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
- School of Baccalaureate Nursing, St. Lawrence College, Kingston, Ontario, Canada
| | - Offer Erez
- Maternity Department, University Soroka, Gynecology and Obstetrics Division, Soroka University Medical Center, School of Medicine Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Awesat J, Sagy I, Haviv YS, Rabinovich A, Jotkowitz A, Shleyfer E, Barski L. Dabigatran-induced nephropathy and its successful treatment with Idarucizumab - case report and literature review. Thromb Res 2018; 169:120-122. [PMID: 30032039 DOI: 10.1016/j.thromres.2018.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 07/08/2018] [Accepted: 07/12/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Anticoagulant induced renal injury has been previously described with Warfarin treatment. In the last decade direct oral anticoagulants (DOAC) were introduced. They include direct inhibitors of factor Xa (Rivaroxaban, Apixaban, Edoxaban) and a thrombin inhibitor (Dabigatran). There are isolated reports describing acute kidney injury (AKI) due to the use of DOACs. CASE REPORT We report a clinical case of an 80-year-old patient recently started on Dabigatran for new onset atrial fibrillation. She presented with AKI and hematuria, urine specimen showed RBC casts, and a working diagnosis of anticoagulant nephropathy due to Dabigatran was made. During hospitalization she was treated with Idarucizumab with a full recovery of renal function. To the best of our knowledge, there are 4 published case reports describing kidney injury produced by Dabigatran. CONCLUSION The use of DOACs is increasing rapidly, with increasing concern about its safety profile and, in particular, its potential harmful effect on renal function. As described in our case, treatment with Praxbind for Dabigatran induced kidney injury may be an acceptable management strategy that may obviate the need for urgent dialysis in selected cases by complete reversal of the AKI.
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Affiliation(s)
- Jenan Awesat
- Department of Internal Medicine F, Soroka University Medical Center, Beer-Sheva, Israel.
| | - Iftach Sagy
- Department of Internal Medicine F, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yosef S Haviv
- Department of Nephrology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Anat Rabinovich
- Thrombosis and Hemostasis unit, Hematology institute, Soroka University Medical Center, Beer-Sheva, Israel
| | - Alan Jotkowitz
- Department of Internal Medicine F, Soroka University Medical Center, Beer-Sheva, Israel
| | - Elena Shleyfer
- Department of Internal Medicine F, Soroka University Medical Center, Beer-Sheva, Israel
| | - Leonid Barski
- Department of Internal Medicine F, Soroka University Medical Center, Beer-Sheva, Israel
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Hizkiyahu R, Rabinovich A, Thachil J, Sheiner E, Shaked G, Sebbag G, Maymon E, Erez O. Modified ISTH pregnancy-specific DIC score in parturients with liver rupture: population-based case series. J Matern Fetal Neonatal Med 2018; 32:2517-2523. [DOI: 10.1080/14767058.2018.1439469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ranit Hizkiyahu
- Department of Obstetrics and Gynecology “B”, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Anat Rabinovich
- Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center, Be’er Sheva, Israel
| | - Jecko Thachil
- Department of Hematology, Manchester Royal Infirmary, Manchester, UK
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology “B”, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Gad Shaked
- Department of General Surgery and Trauma Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Gilbert Sebbag
- Department of General Surgery and Trauma Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Eli Maymon
- Department of Obstetrics and Gynecology “B”, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Offer Erez
- Maternity Department “D” and Obstetrical Day Care Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
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Rabinovich A, Ducruet T, Kahn SR. Development of a clinical prediction model for the postthrombotic syndrome in a prospective cohort of patients with proximal deep vein thrombosis. J Thromb Haemost 2018; 16:262-270. [PMID: 29193770 DOI: 10.1111/jth.13909] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 06/22/2017] [Indexed: 11/28/2022]
Abstract
Essentials We developed a prediction model for postthrombotic syndrome (PTS) after deep vein thrombosis (DVT). High risk predictors were iliac vein DVT, BMI>35 and moderate-severe Villalta category. Patients with a score ≥4 had an odds ratio of 5.9 (95% CI 2.1-16.6) for PTS. SOX-PTS score may select DVT patients for close monitoring or aggressive strategies to treat DVT. SUMMARY Background Postthrombotic syndrome (PTS) is a chronic complication that develops in 20-50% of patients after deep vein thrombosis (DVT). Although individual risk factors for PTS have been characterized, the ability to predict which DVT patients are likely to develop PTS remains limited. Objective To develop a clinical prediction score for PTS in patients with DVT. Methods The derivation cohort consisted of participants in the SOX Trial, a randomized double-blind placebo-controlled trial of elastic compression stockings versus placebo stockings worn for 2 years after DVT to prevent PTS in patients with a first proximal DVT, enrolled in 24 community and tertiary-care hospitals from 2004 to 2010. Multivariable logistic regression analysis of baseline characteristics was performed. The outcome was the occurrence of PTS, diagnosed starting from 6 months or later according to Ginsberg's criteria. Results Seven hundred and sixty-two patients were included in the analysis. The median follow-up was 728 days. The model includes three independent predictors, and has a range of possible scores from 0 to 5. High-risk predictors were: index DVT in the iliac vein; body mass index of ≥ 35 kg m-2 ; and moderate-severe Villalta severity category at DVT diagnosis. As compared with patients with a score of 0, those with a score of ≥ 4 had an odds ratio of 5.9 (95% confidence interval 2.1-16.6) for developing PTS. Conclusions To our knowledge, this is the first clinical prediction score for PTS. We identified three independent predictors that, when combined, predicted PTS risk after a first proximal DVT. The SOX-PTS score requires external validation before it can be considered for clinical use.
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Affiliation(s)
- A Rabinovich
- Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - T Ducruet
- URCA-CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - S R Kahn
- Department of Epidemiology, Biostatistics, and Occupational Health, and Division of Internal Medicine and Department of Medicine, Jewish General Hospital, McGill University, Montréal, Quebec, Canada
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Rabinovich A, Cohen JM, Kahn SR. The predictive value of markers of fibrinolysis and endothelial dysfunction in the post thrombotic syndrome. Thromb Haemost 2017; 111:1031-40. [DOI: 10.1160/th13-11-0931] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/05/2014] [Indexed: 11/05/2022]
Abstract
SummaryThe post thrombotic syndrome (PTS) develops in 20–40% of deep venous thrombosis (DVT) patients. Risk factors for PTS have not been well elucidated. Identification of risk factors would facilitate individualised risk assessment for PTS. We conducted a systematic review to determine whether biomarkers of fibrinolysis or endothelial dysfunction can predict the risk for PTS among DVT patients. Studies were identified by searching the electronic databases PubMed, EMBASE, Scopus and Web of science. We included studies published between 1990 and 2013, measured biomarker levels in adult DVT patients, and reported rates of PTS development. Fourteen studies were included: 11 investigated the association between D-dimer and PTS; three examined fibrinogen; two measured von Willebrand factor; one measured plasminogen activator inhibitor-1; one assessed ADAMTS-13 (A Disintegrin and Metalloprotease with Thrombospondin type 1 repeats) and one measured factor XIII activity. Studies varied with regards to inclusion criteria, definition of PTS, time point and method of biomarker measurement. We were unable to meta-analyse results due to marked clinical heterogeneity. Descriptively, a significant association with PTS was found for D-dimer in four studies and factor XIII in one study. Further prospective research is needed to elucidate whether these markers might be useful to predict PTS development.
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Rabinovich A, Vislapu N, Rasooly I, Lerman Y. THE EFFICACY OF A FALLS CLINIC FOR ELDERLY AND THE ADDED ROLE OF THE TILT TABLE
TEST. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A. Rabinovich
- Geriatrics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,
- Tel Aviv University, Tel Aviv, Israel,
| | - N. Vislapu
- Geriatrics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,
| | - I. Rasooly
- Geriatrics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,
- Israel Ministry of Health, Geriatric Division., Jerusalem, Israel
| | - Y. Lerman
- Geriatrics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,
- Tel Aviv University, Tel Aviv, Israel,
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Abstract
Postthrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT) that develops in 20-50% of patients. PTS manifests as a spectrum of symptoms and signs of chronic venous insufficiency that can impose significant morbidity and have a negative impact on quality of life. Chronic venous hypertension caused by a combination of residual venous obstruction and valvular reflux is believed to play a major role in the pathophysiology of PTS. The Villalta scale is the most widely applied clinical scale used to diagnose and define PTS. Proximal DVT and recurrent ipsilateral DVT are the two principal established risk factors for PTS, and efforts in recent years have been focused on identifying a combination of clinical and biomarker predictors that will define high-risk patients and possibly new therapeutic targets. The best way to prevent PTS is to prevent the occurrence of DVT, and to provide optimal anticoagulation for the acute phase of DVT once it occurs. Recent years have brought progress in our understanding of the role of endovascular techniques in the prevention and treatment of PTS and the subgroups of patients that may benefit from these modalities. Pharmacomechanical catheter-directed thrombolysis is the most promising interventional modality for prevention of PTS. This review summarizes the current state of evidence on PTS of the lower limbs, and highlights areas where uncertainty still exists that require further research.
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Affiliation(s)
- A Rabinovich
- Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - S R Kahn
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Division of Internal Medicine and Department of Medicine, McGill University, Montreal, Canada
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Chandrananth J, Rabinovich A, Karahalios A, Guy S, Tran P. Impact of adherence to local antibiotic prophylaxis guidelines on infection outcome after total hip or knee arthroplasty. J Hosp Infect 2016; 93:423-7. [DOI: 10.1016/j.jhin.2016.02.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/19/2016] [Indexed: 01/03/2023]
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Mastrolia SA, Novack L, Thachil J, Rabinovich A, Pikovsky O, Klaitman V, Loverro G, Erez O. LMWH in the prevention of preeclampsia and fetal growth restriction in women without thrombophilia. A systematic review and meta-analysis. Thromb Haemost 2016; 116:868-878. [PMID: 27440387 DOI: 10.1160/th16-02-0169] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/17/2016] [Indexed: 12/18/2022]
Abstract
Placental mediated pregnancy complications such as preeclampsia and fetal growth restriction (FGR) are common, serious, and associated with increased morbidity and mortality. We conducted a systematic review and meta-analysis to determine the effect of treatment with low-molecular-weight heparins (LMWHs) for secondary prevention of these complications in non thrombophilic women. We searched the electronic databases PubMed, Scopus, and Cochrane Library for randomised controlled trials addressing this question. Five studies including 403 patients met the inclusion criteria, 68 developed preeclampsia and 118 FGR. The studies were very heterogeneous in terms of inclusion criteria, LMWH preparation, and dosage. Meta-analyses were performed using random-effect models. The overall use of LMWHs was associated with a risk reduction for preeclampsia (Relative risk (RR) 0.366; 95 % confidence interval (CI), 0.219-0.614) and FGR (RR 0.409; 95 % CI, 0.195-0.932) vs. no treatment. From the data available for analysis it appears that the use of Dalteparin is associated with a risk reduction for preeclampsia (p=0.002) and FGR (p<0.001); while Enoxaparin is associated with risk reduction for preeclampsia (p=0.013) but not for FGR (p=0.3). In spite of the small number of studies addressing the research question, and the high variability among them, our meta-analysis found a modest beneficial effect of LMWH for secondary prevention of preeclampsia and FGR. Further studies are needed to address these questions before a definite conclusion can be reached.
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Affiliation(s)
| | | | | | | | | | | | | | - Offer Erez
- Prof. Offer Erez, MD, Acting Director Maternity Department D and Obstetrical Day care Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, P. O.Box 151, 84101, Beer Sheva, Israel, Tel.: +972 8 6400061, E-mail
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Rabinovich A, Bernard L, Ramanakumar AV, Stroian G, Gotlieb WH, Lau S, Bahoric B. Para-aortic and pelvic extended-field radiotherapy for advanced-stage uterine cancer: dosimetric and toxicity comparison between the four-field box and intensity-modulated techniques. Curr Oncol 2015; 22:405-11. [PMID: 26715873 DOI: 10.3747/co.22.2727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In patients with advanced-stage endometrial carcinoma (eca), extended-field radiotherapy (efrt) is traditionally delivered by the 3-dimensional conformal (3d-crt) 4-field box technique. In recent years, the use of intensity-modulated radiotherapy (imrt) in gynecologic cancers has increased. We compared the delivery of efrt by the 3d-crt and contemporary imrt techniques. METHODS After surgical staging and adjuvant chemotherapy in 38 eca patients, efrt was delivered by either imrt or 3d-crt. Doses to the organs at risk, side effects, and outcomes were compared between the techniques. RESULTS Of the 38 eca patients, 33 were stage iiic, and 5 were stage ivb. In the imrt group, maximal doses to rectum, small intestine, and bladder were significantly higher, and mean dose to bladder was lower (p < 0.0001). Most acute gastrointestinal, genitourinary, and hematologic side effects were grade i or ii and were comparable between the groups. In long-term follow-up, only grade 1 cystitis at 3 months was statistically higher in the imrt patients. No grade iii or iv gastrointestinal or genitourinary toxicities were observed. No statistically significant differences in overall and disease-free survival or recurrence rates were observed between the techniques. CONCLUSIONS In advanced eca patients, imrt is a safe and effective technique for delivering efrt to the pelvis and para-aortic region, and it is comparable to the 3d-crt 4-field box technique in both side effects and efficacy. For centres in which imrt is not readily available, 3d-crt is a valid alternative.
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Affiliation(s)
- A Rabinovich
- Division of Gynecologic Oncology, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - L Bernard
- Division of Radiation Oncology, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - A V Ramanakumar
- Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, QC
| | - G Stroian
- Division of Radiation Oncology, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - W H Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - S Lau
- Division of Gynecologic Oncology, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - B Bahoric
- Division of Radiation Oncology, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
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Rabinovich A, Cohen JM, Cushman M, Kahn SR. Association between inflammation biomarkers, anatomic extent of deep venous thrombosis, and venous symptoms after deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 2015; 3:347-353.e1. [PMID: 26992609 DOI: 10.1016/j.jvsv.2015.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Inflammation may play a role in pathogenesis of venous thromboembolism, but the nature of this relationship is not yet understood. The objective of this study was to assess whether inflammation marker levels measured at diagnosis of deep venous thrombosis (DVT) and change in levels during the first month after DVT are associated with anatomic extent of DVT and severity of venous signs and symptoms at baseline and 1 month. METHODS The BioSOX study is a biomarker substudy of the Compression Stockings to Prevent the Post-Thrombotic Syndrome (SOX) trial, a multicenter, randomized controlled trial that included patients with a first, acute, symptomatic, proximal DVT. Blood samples were collected from participants at baseline and 1 month, and C-reactive protein (CRP), intercellular adhesion molecule 1, interleukin (IL)-6, and IL-10 were measured by established assays. Linear regression was used to assess the association between continuous log-transformed baseline biomarker levels and anatomic extent of DVT, classified as iliac or common femoral DVT vs femoral or popliteal DVT (reference). Proportional odds ordinal logistic regression models were used to analyze the association between biomarker level and Villalta score (as a measure of severity of venous signs and symptoms) at baseline and 1 month. RESULTS Among 717 patients, 60.2% were male, and the mean age was 55.2 years. There was a significant association between more extensive DVT (common femoral or iliac) and levels of CRP and IL-6 at DVT diagnosis. Median (interquartile range) CRP level was 11.6 mg/L (3.84-39.5) in patients with common femoral or iliac DVT vs 6.86 mg/L (3.11-22) in patients with popliteal or femoral DVT, and median IL-6 level was 6.36 pg/mL (1.09-14.37) vs 4.40 pg/mL (2.35-8.27), respectively. These differences were statistically significant in linear regression analyses. In addition, compared with those in the lowest quartile, each higher quartile of baseline CRP concentration was associated with an odds ratio of 2.89 (1.93-4.33) for having a more severe Villalta category at baseline and 1.98 (1.28-3.08) for having a more severe Villalta category 1 month after DVT. Higher baseline levels of IL-6 were associated with Villalta severity category at baseline (odds ratio, 2.40 [1.61-3.59]). Change in biomarker levels during the first month after DVT was not strongly associated with the 1-month Villalta score. CONCLUSIONS Levels of CRP and IL-6 at DVT diagnosis were associated with thrombotic disease burden, as measured by DVT extent, and severity of DVT symptoms and signs. Further studies are required to more fully elucidate the role of inflammation in DVT and its clinical course.
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Affiliation(s)
- Anat Rabinovich
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jacqueline M Cohen
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Mary Cushman
- Departments of Medicine and Pathology, Cardiovascular Research Institute, University of Vermont College of Medicine, Burlington, Vt
| | - Susan R Kahn
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Internal Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada.
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Rabinovich A, Cohen JM, Kahn SR. Predictive value of markers of inflammation in the postthrombotic syndrome: a systematic review: inflammatory biomarkers and PTS. Thromb Res 2015; 136:289-97. [PMID: 26139086 DOI: 10.1016/j.thromres.2015.06.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 05/29/2015] [Accepted: 06/17/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The postthrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT). Inflammation may contribute to its pathophysiology. OBJECTIVES We conducted a systematic review of studies that analyzed the association between biomarkers of inflammation and PTS in DVT patients. METHODS The electronic databases PubMed, EMBASE, Medline, Scopus and Web of Science were searched for studies published until March 2015 that measured blood inflammation biomarker levels in adult DVT patients and reported their association with PTS development. Two reviewers independently performed full text assessment and data extraction. RESULTS Ten studies were included. Nine reported on the association between C-reactive protein and PTS; Interleukin (IL)-6 was measured in six studies; IL-8 in four studies; Intracellular adhesion molecule (ICAM)-1 in three studies; IL-10 and vascular cell adhesion molecule-1 in two studies; and monocyte chemotactic protein-1, matrix metalloprotease-9, P-Selectin, tumor necrosis factor α and erythrocyte sedimentation rate were measured in one study. Studies differed in terms of populations included, exclusion criteria, methods used for biomarker measurement and statistical measures of association between biomarkers and PTS. We were able to metaanalyze results only for IL-6 and found no significant association. Descriptively, ICAM-1 was significantly associated with PTS in two out of three studies that measured it. Other biomarkers did not demonstrate a significant association with PTS. CONCLUSIONS Our systematic review found conflicting results regarding the role of inflammatory biomarkers as predictors of PTS. ICAM -1 appears to be a promising marker for further investigation.
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Affiliation(s)
- A Rabinovich
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada
| | - J M Cohen
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - S R Kahn
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Division of Internal Medicine, Department of Medicine, McGill University, Montreal, Canada.
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Rabinovich A, Cohen JM, Cushman M, Wells PS, Rodger MA, Kovacs MJ, Anderson DR, Tagalakis V, Lazo-Langner A, Solymoss S, Miron MJ, Yeo E, Smith R, Schulman S, Kassis J, Kearon C, Chagnon I, Wong T, Demers C, Hanmiah R, Kaatz S, Selby R, Rathbun S, Desmarais S, Opatrny L, Ortel TL, Ginsberg JS, Kahn SR. Inflammation markers and their trajectories after deep vein thrombosis in relation to risk of post-thrombotic syndrome. J Thromb Haemost 2015; 13:398-408. [PMID: 25495610 DOI: 10.1111/jth.12814] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/09/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) is a frequent chronic complication of deep vein thrombosis (DVT). OBJECTIVE In the BioSOX study, we investigated whether inflammation markers predict the risk of PTS after DVT. METHODS We measured C-reactive protein (CRP), ICAM-1, interleukin (IL)-6, and IL-10, at baseline, and 1 month and 6 months after a first proximal DVT, among 803 participants in the SOX trial. Participants were prospectively followed for 24 months for development of PTS. RESULTS Median CRP levels at 1 month, ICAM-1 levels at baseline, 1 month and 6 months, IL-6 levels at 1 month and 6 months and IL-10 levels at 6 months were higher in patients who developed PTS than in those who did not. Multivariable regression with the median as a cutoff showed risk ratios (RRs) for PTS of 1.23 (95% confidence interval [CI] 1.05-1.45) and 1.25 (95% CI 1.05-1.48) for ICAM-1 at 1 month and 6 months, respectively, and 1.27 (95% CI 1.07-1.51) for IL-10 at 6 months. Quartile-based analysis demonstrated a dose-response association between ICAM-1 and PTS. ICAM-1 and IL-10 were also associated with PTS severity. Analysis of biomarker trajectories after DVT demonstrated an association between the highest-trajectory group of ICAM-1 and PTS. CONCLUSIONS In this prospective study, ICAM-1 over time was most consistently associated with the risk of PTS. Further study is required to confirm these findings and assess their potential clinical relevance.
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Affiliation(s)
- A Rabinovich
- Centre for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Cho YI, Wright KC, Kim HS, Cho DJ, Rabinovich A, Fridman A. Stretched arc discharge in produced water. Rev Sci Instrum 2015; 86:013501. [PMID: 25638080 DOI: 10.1063/1.4905169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 12/16/2014] [Indexed: 06/04/2023]
Abstract
The objective of the present study was to investigate the feasibility of stretching an arc discharge in produced water to increase the volume of produced water treated by plasma. Produced water is the wastewater generated by hydraulic fracturing of shale during the production phase in shale-oil or shale-gas exploration. The electric conductivity of produced water is in the range of 50-200 mS/cm, which provides both a challenge and opportunity for the application of plasmas. Stretching of an arc discharge in produced water was accomplished using a ground electrode and two high-voltage electrodes: one positioned close to the ground electrode and the other positioned farther away from the ground. The benefit of stretching the arc is that the contact between the arc and water is significantly increased, resulting in more efficient plasma treatment in both performance and energy cost.
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Affiliation(s)
- Y I Cho
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - K C Wright
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - H S Kim
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - D J Cho
- Drexel Plasma Institute, Drexel University, Camden, New Jersey 08103, USA
| | - A Rabinovich
- Drexel Plasma Institute, Drexel University, Camden, New Jersey 08103, USA
| | - A Fridman
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania 19104, USA
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Abstract
Postthrombotic syndrome (PTS) is the most frequent complication of deep vein thrombosis (DVT). From 20% to 50% of the patients will develop PTS after DVT, and from 5% to 10%, severe PTS. PTS is diagnosed on clinical grounds, based on the presence of signs and symptoms of venous insufficiency in the leg ipsilateral to DVT. The Villalta scale, a clinical scale that incorporates venous symptoms and signs, is a recommended standard for the diagnosis of PTS. Identifying which patients are at high risk of developing PTS would help improve the management of patients with DVT and allow physicians to provide patients with individualized information on their expected prognosis. Clinical predictors of PTS have been progressively characterized, but the ability to predict which patient with DVT is likely to develop PTS remains limited. A number of risk factors for PTS have been identified; of these, proximal location of DVT and a previous ipsilateral DVT are the most important. This review discusses the knowledge gained over the last decade on the diagnosis and predictors of PTS.
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Bilavsky E, Temkin E, Lerman Y, Rabinovich A, Salomon J, Lawrence C, Rossini A, Salvia A, Samso JV, Fierro J, Paul M, Hart J, Gniadkowski M, Hochman M, Kazma M, Klein A, Adler A, Schwaber MJ, Carmeli Y. Risk factors for colonization with extended-spectrum beta-lactamase-producing enterobacteriaceae on admission to rehabilitation centres. Clin Microbiol Infect 2014; 20:O804-10. [PMID: 24674024 DOI: 10.1111/1469-0691.12633] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/17/2014] [Accepted: 03/22/2014] [Indexed: 12/31/2022]
Abstract
Patients newly admitted to rehabilitation centres are at high risk of colonization with multidrug-resistant bacteria because many of them have experienced prolonged stays in other healthcare settings and have had high exposure to antibiotics. We conducted a prospective study to determine the prevalence of and risk factors for colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in this population. Subjects were screened by rectal swab for ESBL-PE within 2 days of admission. Swabs were plated on chromagar ESBL plates and the presence of ESBL was verified by a central laboratory. A multilevel mixed effects model was used to identify risk factors for ESBL-PE colonization. Of 2873 patients screened, 748 (26.0%) were positive for ESBL-PE. The variables identified as independently associated with ESBL-PE colonization were: recent stay in an acute-care hospital for over 2 weeks (OR=1.34; 95% CI, 1.12, 1.6), history of colonization with ESBL-PE (OR=2.97; 95% CI, 1.99, 4.43), unconsciousness on admission (OR=2.59; 95% CI, 1.55, 4.34), surgery or invasive procedure in the past year (OR=1.49; 95% CI, 1.2, 1.86) and antibiotic treatment in the past month (OR=1.80; 95% CI, 1.45, 2.22). The predictive accuracy of the model was low (area under the ROC curve 0.656). These results indicate that ESBL-PE colonization is common upon admission to rehabilitation centres. Some risk factors for ESBL-PE colonization are similar to those described previously; however, newly identified factors may be specific to rehabilitation populations. The high prevalence and low ability to stratify by risk factors may guide infection control and empirical treatment strategies in rehabilitation settings.
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Affiliation(s)
- E Bilavsky
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Levi I, Feuchtwanger M, Rabinovich A, Grotto I. Clinical and epidemiologic characteristics of non Hodgkin's lymphoma in Bedouins in the south of Israel. Springerplus 2014; 2:672. [PMID: 24386618 PMCID: PMC3874137 DOI: 10.1186/2193-1801-2-672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 12/10/2013] [Indexed: 11/10/2022]
Abstract
The presentation of Non Hodgkin’s Lymphoma (NHL) may vary in relation to ethnicity or environmental effects. The objective of our study was to characterize NHL among the Negev Bedouin population, compared to the Jewish population. Retrospective data were collected for 45 Bedouin and 45 Jewish patients who were treated at Soroka University Medical Center between 1990 and 2007. Upon diagnosis, rates of aggressive NHL types, involvement of extra-lymphatic organs, as well as mean LDH were higher among Bedouin. Treatment response was poorer among the Bedouin: overall survival and disease-free survival were higher among Jews (mean of 145 and 168 months, respectively, compared with 70 and 45 months, respectively, among Bedouin; p < 0.01 for both). In summary, disease aggressiveness and poor response to treatment among the Negev Bedouin may shed some light on the pathogenicity of NHL and may indicate a need for more aggressive treatment in different ethnic groups.
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Affiliation(s)
- Itai Levi
- Hematology Institute, Soroka University Medical Center, Beer-Sheva, Israel ; Department of Hematology, Soroka University Medical Center, PO Box 151, Beer-Sheva, Israel
| | - Michal Feuchtwanger
- Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anat Rabinovich
- Hematology Institute, Soroka University Medical Center, Beer-Sheva, Israel
| | - Itamar Grotto
- Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Rabinovich A, Cohen JM, Prandoni P, Kahn SR. Association between thrombophilia and the post-thrombotic syndrome: a systematic review and meta-analysis. J Thromb Haemost 2014; 12:14-23. [PMID: 24406063 DOI: 10.1111/jth.12447] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 10/03/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The postthrombotic syndrome (PTS) is a frequent chronic complication of deep vein thrombosis (DVT), occurring in 20-40% of patients. Identifying risk factors for PTS may be useful to provide patients with prognostic information and target prevention strategies. OBJECTIVE To conduct a systematic review to assess whether, among patients with DVT, inherited and acquired thrombophilias are associated with a risk of PTS. METHODS We searched the electronic databases PubMed, EMBASE, Scopus, and Web of Science for studies published from 1990 to 2013 that assessed any thrombophilia in adult DVT patients and its association with the development of PTS. We calculated odds ratios and 95% confidence intervals for PTS according to the presence of thrombophilia. Meta-analysis was performed using the random-effects model. RESULTS Sixteen studies were included: 13 assessed factor V Leiden (FVL), 10 assessed prothrombin mutation, five assessed protein S and C deficiencies, three assessed antithrombin deficiency, four assessed elevated FVIII levels, and six assessed antiphospholipid antibodies. None of the meta-analyses identified any thrombophilia to be predictive of PTS. Both FVL and prothrombin mutation appeared protective among studies including patients with both first and recurrent DVT and studies in which more than 50% of patients had an unprovoked DVT. CONCLUSIONS Our meta-analysis did not demonstrate a significant association between any of the thrombophilias assessed and the risk of PTS in DVT patients. Other biomarkers in the pathophysiological pathway may be more predictive of PTS.
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Affiliation(s)
- A Rabinovich
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Gemer O, Eitan R, Gdalevich M, Mamanov A, Piura B, Rabinovich A, Levavi H, Saar-Ryss B, Halperin R, Finci S, Beller U, Bruchim I, Levy T, Ben Shachar I, Ben Arie A, Lavie O. Can parametrectomy be avoided in early cervical cancer? An algorithm for the identification of patients at low risk for parametrial involvement. Eur J Surg Oncol 2013; 39:76-80. [DOI: 10.1016/j.ejso.2012.10.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 10/07/2012] [Accepted: 10/12/2012] [Indexed: 11/16/2022] Open
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Shalev H, Perez-Avraham G, Kapelushnik J, Levi I, Rabinovich A, Swinkels DW, Brasse-Lagnel C, Tamary H. High levels of soluble serum hemojuvelin in patients with congenital dyserythropoietic anemia type I. Eur J Haematol 2012; 90:31-6. [PMID: 23095116 DOI: 10.1111/ejh.12027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Congenital dyserythropoietic anemia (CDA) is a rare group of red blood cell disorders with ineffective erythropoiesis and secondary hemochromatosis. Inappropriate suppression of hepcidin and high levels of growth differentiation factor 15 (GDF15) have been described in CDA I and II patients, probably contributing to secondary hemochromatosis. Hemojuvelin (HJV) is an important regulator of serum hepcidin, while soluble form of HJV (s-HJV) competitively down-regulates hepcidin. METHODS We determined the soluble hemojuvelin (s-HJV) levels in 17 patients with CDA I and in 17 healthy volunteers (HV) and looked for correlations with other parameters of iron overload and erythropoiesis. RESULTS Significantly higher levels of s-HJV were found in patients (2.32 ± 1.40 mg/L) compared with healthy volunteers (0. 69 ± 0.44 mg/L) (P = 0.001). Western blot analysis confirmed the presence of high levels of s-HJV in CDA I patients. s-HJV positively correlated with serum ferritin, erythropoietin, soluble transferrin receptor, and GDF15 and negatively correlated with hepcidin to ferritin ratios. CONCLUSIONS We for the first time documented high levels of serum s-HJV in CDA I patients, suggesting that it may contribute to iron loading pathology in CDA I and eventually in other anemias with ineffective erythropoiesis.
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Affiliation(s)
- Hanna Shalev
- Hematology Department, Soroka Medical Center, Faculty of Medicine, Ben-Gurion University, Beer Sheva, Israel
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Rabinovich A, Dagan G, Miloh T. Boundary effects on effective conductivity of random heterogeneous media with spherical inclusions. Phys Rev E Stat Nonlin Soft Matter Phys 2012; 86:046601. [PMID: 23214702 DOI: 10.1103/physreve.86.046601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 09/11/2012] [Indexed: 06/01/2023]
Abstract
It is common to determine the effective conductivity of heterogeneous media by assuming stationarity of the random local properties. This assumption is not obeyed in a boundary layer of a body of finite size. The effect of different types of boundaries is examined for a two-phase medium with spherical inclusions of given conductivity distributed randomly in a matrix of a different conductivity. Exact solutions are derived for the apparent conductivity and the boundary layer thickness. The interaction between the spheres and the boundaries is fully incorporated in the solutions using a spherical harmonics expansion and the method of images. As applications, the corrections for the effective conductivity are given for two cases of finite bodies: the Maxwell sphere and a cylinder of flow parallel to the axis.
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Affiliation(s)
- A Rabinovich
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
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Rabinovich A, Weiss D, Weissman M, Novack V, Levi I. Dexrazoxane does not affect treatment outcome in non-Hodgkin's lymphoma patients. Am J Hematol 2012; 87:830-2. [PMID: 22648436 DOI: 10.1002/ajh.23250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 04/02/2012] [Accepted: 04/23/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Anat Rabinovich
- Hematology Institute, Soroka University Medical Center, Beer-Sheva, Israel
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Abu-Ghanem S, Rabinovich A, Delgado B, Benharroch D, Ariad S, Levi I, Geffen DB. Chronic myelogenous leukemia diagnosed in two patients with breast cancer. Leuk Lymphoma 2011; 52:2399-401. [DOI: 10.3109/10428194.2011.600483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Piura B, Rabinovich A, Apel-Sarid L, Shaco-Levy R. Carcinosarcoma of the fallopian tube with metastasis of its epithelial component to the ovary, appendix and omentum. J OBSTET GYNAECOL 2009; 29:566-7. [PMID: 19697224 DOI: 10.1080/01443610902780815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- B Piura
- Department of Obstetrics and Gynaecology, Unit of Gynaecologic Oncology, Soroka Medical Centre and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.
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Affiliation(s)
- B. Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology
| | - A. Rabinovich
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology
| | - R. Shaco-levy
- Institute of Pathology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Piura B, Rabinovich A, Shaco-Levy R. Squamous cell carcinoma arising in ovarian mature cystic teratoma with isolated metastasis to the appendix. J OBSTET GYNAECOL 2009; 29:71-3. [PMID: 19280511 DOI: 10.1080/01443610802484088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- B Piura
- Department of Obstetrics and Gynaecology, Soroka Medical Centre and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Piura B, Rabinovich A, Friger M. Recurrent cervical carcinoma after radical hysterectomy and pelvic lymph node dissection: a study of 32 cases. EUR J GYNAECOL ONCOL 2008; 29:31-36. [PMID: 18386460] [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: 05/26/2023]
Abstract
PURPOSE OF INVESTIGATION To investigate the characteristics of patients with recurrent cervical carcinoma after radical hysterectomy and pelvic lymph node dissection (RHND), and to evaluate the effect of clinical and surgical pathologic factors on the outcome of these patients. METHODS Data from the files of 32 patients with recurrent cervical carcinoma after RHND managed at the Soroka Medical Center from 1962 through 2005 were analyzed. RESULTS These 32 patients represent a recurrence rate of 25.4%. The median recurrence-free interval was 19.3 (range, 1-106) months. The prevailing signs and symptoms were obstructive nephropathy, sacral pain and bowel obstruction. Sixteen (50%) patients had loco-regional recurrence alone, 12 (27.5%) loco-regional plus distant recurrence, and four (12.5%) distant recurrence alone. Treatment modalities included radiotherapy, chemotherapy and various surgical procedures. The 5-year survival rate was 35%, with 22 (68.7%) of the patients dead of disease at the end of follow-up. Univariate analysis demonstrated a significant worsening in survival with each of the following factors: loco-regional plus distant recurrence (p = 0.010), positive pelvic lymph nodes (p = 0.010), tumor size > or = 3 cm (p = 0.013), positive lymph vascular space involvement (p = 0.017) and RHND without bilateral salpingo-oophorectomy (p = 0.042). In a multivariate analysis, extent of recurrent disease (locoregional alone versus loco-regional plus distant recurrence) and pelvic lymph node status (negative vs positive) at RHND were the only significant predictors of survival. Uremia was the most common cause of death. CONCLUSIONS Recurrent cervical carcinoma after RHND is a grave disease with unfavorable prognosis. In both univariate and multivariate analyses, extent of recurrent disease and pelvic lymph node status at RHND were significant predictors of survival.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Abstract
Placental site trophoblastic tumor (PSTT) is a rare variant of gestational trophoblastic disease that originates from the implantation site intermediate trophoblast. We report four patients with PSTT and review pertinent literature. Three patients presented with disease confined to the uterus and one patient with disease extension beyond the uterus. Antecedent pregnancy was full-term pregnancy in three patients and termination of a 21-week pregnancy in one patient. Interval from the antecedent pregnancy was <1 year in three patients and 13 years in one patient. Primary treatment was simple hysterectomy in three patients and radical hysterectomy in one patient. Overall, three patients received chemotherapy; one had EP/EMA as adjuvant chemotherapy, one had EMA/CO for rising levels of serum β-hCG and one had BEP then VIP for recurrent disease. The three patients with disease confined to the uterus have remained after treatment alive and with no evidence of disease, whereas the one patient with disease extension beyond the uterus died of disease despite surgery and aggressive chemotherapy. It is concluded that disease extension beyond the uterus is the most important adverse prognostic factor. Other adverse prognostic factors are interval from antecedent pregnancy >2 years, age >40 years, and mitotic count >5 mitotic figures/10 high-power fields. Because of the relative insensitivity to chemotherapy, hysterectomy is the mainstay of treatment. EP/EMA seems to be the most effective first-line chemotherapy available to date for metastatic and relapsing PSTT
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology and Institute of Pathology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.
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Landau D, Maor E, Maymon E, Rabinovich A, Piura B. Intraplacental choriocarcinoma metastasizing to the maternal lung. EUR J GYNAECOL ONCOL 2006; 27:29-32. [PMID: 16550964] [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: 05/07/2023]
Abstract
BACKGROUND Although normal pregnancy is the precursor of 25% of cases of maternal choriocarcinoma, intraplacental choriocarcinoma in an otherwise normal placenta associated with viable pregnancy has rarely been reported. CASE Examination of the placenta after delivery of a pale and small-for-date infant at term revealed intraplacental choriocarcinoma. There was no evidence of metastatic disease in the mother or child, but the mother exhibited postpartum rising levels of beta-HCG. The mother refused chemotherapy and disappeared from follow-up. Nine months later, she presented with metastatic choriocarcinoma of the lung. Eleven courses of the multi-drug EMA CO regimen effected a decrease of beta-HCG to normal and disappearance of lung metastases. To date, 28 months after the end of chemotherapy, the patient is alive and without evidence of gestational trophoblastic disease. Moreover, since then she has given birth to an additional two children. CONCLUSIONS This case is an example of natural disease progression of intraplacental choriocarcinoma metastasizing to the mother. Furthermore, it supports common knowledge that the multi-drug EMA CO regimen is effective treatment in poor prognosis metastatic choriocarcinoma.
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Affiliation(s)
- D Landau
- Department of Neonatology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Piura B, Rabinovich A, Friger M. Surgical pathologic factors in patients with early-stage cervical carcinoma treated with radical hysterectomy and pelvic lymph node dissection: association with administration of adjuvant radiotherapy and effect on survival. EUR J GYNAECOL ONCOL 2006; 27:573-8. [PMID: 17290585] [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: 05/13/2023]
Abstract
PURPOSE OF INVESTIGATION To identify surgical pathologic factors that best correlate with administration of adjuvant radiotherapy and best predict survival in early-stage cervical carcinoma treated with radical hysterectomy and pelvic lymph node dissection (RHND). METHODS Data from the files of 126 patients with cervical carcinoma treated by RHND at the Soroka Medical Center from 1962 through 2005 were analyzed. RESULTS Fifty-four percent of the patients received postoperative adjuvant radiotherapy. In a univariate analysis, each of the following factors: positive pelvic lymph nodes, lower uterine segment involvement, lymph vascular space involvement, penetration > or = 50% of the cervical wall, grade 2+3, parametrial and/or paracervical involvement, vaginal margin involvement, non-squamous histologic type, tumor size > or = 3 cm and Stage IB2 + IIA was significantly associated with administration of radiotherapy. In a multivariate analysis, positiviy of pelvic lymph nodes was persistently the most significant factor associated with administration of radiotherapy. The 5-year survival rate was 82.6% overall. In a univariate analysis, a significant worsening in survival was demonstrated with positivity of pelvic lymph nodes and positivity of lymph vascular space involvement. In a "better fit" model of multivariate analysis, pelvic lymph node status was the strongest and the only significant predictor of survival. CONCLUSIONS In patients with early-stage cervical carcinoma treated with radical hysterectomy and pelvic lymph node dissection, pelvic lymph node status is the strongest factor affecting administration of adjuvant radiotherapy and the most significant predictor of survival.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Piura B, Rabinovich A, Friger M. Number and distribution of pelvic lymph nodes and effect of surgical pathologic factors on pelvic lymph node status in patients with early-stage cervical carcinoma treated with radical hysterectomy and pelvic lymph node dissection. EUR J GYNAECOL ONCOL 2006; 27:463-6. [PMID: 17139979] [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: 05/12/2023]
Abstract
PURPOSE OF INVESTIGATION To report the number and distribution of pelvic lymph nodes and to identify surgical pathologic factors that best predict positive pelvic lymph nodes in patients with early-stage cervical carcinoma treated with radical hysterectomy and pelvic lymph node dissection (RHND). METHODS Data from the files of 126 patients with cervical carcinoma treated by RHND at the Soroka Medical Center from 1962 through 2005 were analyzed. RESULTS The status of pelvic lymph nodes was known in 114 patients. The exact number of lymph nodes removed from the pelvis of each patient was known in 111 patients. The mean number of lymph nodes removed from the pelvis per patient was 26.6 (median 23; range 1-62). Positive pelvic lymph nodes were found in 35 (30.7%) of the patients with a mean of 3.4 (median 2; range, 1-15) positive pelvic lymph nodes per patient. In a univariate analysis, positive lymph vascular space invasion and positive parametrial and/or paracervical involvement were significant predictors of positive pelvic lymph nodes, whereas penetration > or = 50% of the thickness of the cervical wall and grade 2+3 were of borderline significance. In a multivariate analysis, positive lymph vascular space invasion was the strongest and the only significant predictor of positive pelvic lymph nodes, whereas positive parametrial and/or paracervical involvement was of borderline significance. CONCLUSIONS In patients with early-stage cervical carcinoma treated with RHND, positive lymph vascular space invasion emerged to be the strongest and most significant predictor of positive pelvic lymph nodes.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Abstract
Topotecan has demonstrated antitumor activity in heavily pretreated patients with ovarian carcinoma. This report examines the activity and toxicity of topotecan in 29 heavily pretreated patients with recurrent ovarian, peritoneal, and fallopian tube carcinoma. Topotecan 1.5 mg/m2 was administered intravenously on days 1-5, every 21 days. It was second-line chemotherapy in 6 (20.7%) patients, third-line in 15 (51.7%), fourth-line in 4 (13.8%), fifth-line in 3 (10.3%), and seventh-line in 1 (3.4%). Median dose intensity was 1.667 mg/m(2)/week, and median relative dose intensity was 0.67. Disease complete response was observed in 5 (17.2%) patients, partial response in 1 (3.4%), stable disease in 12 (41.4%), and progressive disease in 11 (37.9%). CA-125 complete response was observed in 3 (10.3%) patients, partial response in 11 (37.9%), stable level in 5 (17.2%), and progressive level in 9 (31%), and no data were available in 1 (3.4%) patient. Toxicity was mainly hematologic: grade 3-4 neutropenia was observed in 20 (69%) patients, grade 3-4 leukopenia in 12 (41.4%), grade 3-4 thrombocytopenia in 9 (31%), and grade 3-4 anemia in 2 (6.9%). It is concluded that topotecan has considerable activity and noncumulative hematologic toxicity in heavily pretreated patients with recurrent ovarian, peritoneal, and fallopian tube carcinoma.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Abstract
Topotecan has demonstrated antitumor activity in heavily pretreated patients with ovarian carcinoma. This report examines the activity and toxicity of topotecan in 29 heavily pretreated patients with recurrent ovarian, peritoneal, and fallopian tube carcinoma. Topotecan 1.5 mg/m2 was administered intravenously on days 1–5, every 21 days. It was second-line chemotherapy in 6 (20.7%) patients, third-line in 15 (51.7%), fourth-line in 4 (13.8%), fifth-line in 3 (10.3%), and seventh-line in 1 (3.4%). Median dose intensity was 1.667 mg/m2/week, and median relative dose intensity was 0.67. Disease complete response was observed in 5 (17.2%) patients, partial response in 1 (3.4%), stable disease in 12 (41.4%), and progressive disease in 11 (37.9%). CA-125 complete response was observed in 3 (10.3%) patients, partial response in 11 (37.9%), stable level in 5 (17.2%), and progressive level in 9 (31%), and no data were available in 1 (3.4%) patient. Toxicity was mainly hematologic: grade 3–4 neutropenia was observed in 20 (69%) patients, grade 3–4 leukopenia in 12 (41.4%), grade 3–4 thrombocytopenia in 9 (31%), and grade 3–4 anemia in 2 (6.9%). It is concluded that topotecan has considerable activity and noncumulative hematologic toxicity in heavily pretreated patients with recurrent ovarian, peritoneal, and fallopian tube carcinoma.
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Piura B, Rabinovich A. Doxorubicin and ifosfamide-mesna in advanced and recurrent uterine sarcomas. EUR J GYNAECOL ONCOL 2005; 26:275-8. [PMID: 15991525] [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: 05/03/2023]
Abstract
PURPOSE OF INVESTIGATION To report the experience of a single institution in the south of Israel with doxorubicin and ifosfamide-mesna in patients with advanced/recurrent uterine sarcomas. METHODS The hospital records of five patients with advanced/recurrent uterine sarcomas who had combination chemotherapy with doxorubicin and ifosfamide-mesna were retrospectively reviewed. Doxorubicin 30 mg/m2 was given on days 1 and 2 and ifosfamide 2000 mg/m2 (+ mesna, W/W 60%) was given on days 1, 2 and 3 of every 21 days. Dose intensity, relative dose intensity and average relative dose intensity (ARDI) of chemotherapy were calculated. Response was determined using clinical evaluation and radiological reports. Toxicity was graded using the National Cancer Institute (NCI) criteria. RESULTS The median ARDI of the combination of doxorubicin and ifosfamide received by the patients was 0.68 (range, 0.53-0.74). One (20%) patient had disease complete response lasting three months and four (80%) patients had progressive disease. Toxicity was mainly hematological with grade 3 or 4 leukopenia--four (80%) patients, neutropenia--four (80%), thrombocytopenia--one (20%) and anemia--one (20%). Non-hematological toxicity was negligible. At follow-up, four (80%) patients had died of disease and one (20%) was alive with disease. CONCLUSION Although the combination of doxorubicin and ifosfamide has certain activity in advanced/recurrent uterine sarcomas, the toxicity is of much concern and the results of treatment in terms of response duration and survival are poor.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Cancer Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Piura B, Rabinovich A, Shaco-Levy R, Sukenik S. Vulvar invasive squamous cell carcinoma occurring in a young woman with systemic lupus erythematosus. EUR J GYNAECOL ONCOL 2005; 26:103-5. [PMID: 15755013] [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: 05/02/2023]
Abstract
BACKGROUND Although several studies have demonstrated a possible relationship between systemic lupus erythematosus (SLE) and non-Hodgkin's lymphoma, Hodgkin's lymphoma, leukemia and several solid tumors, it is still debatable whether SLE patients have an increased incidence of cancer overall. CASE We describe a 25-year-old patient with SLE who developed invasive squamous cell carcinoma of the vulva. The patient underwent radical vulvectomy and bilateral groin sentinel lymph node dissection and until to date, one year after surgery, she is alive without evidence of recurrent disease. CONCLUSIONS Only three cases of vaginal/vulvar cancer associated with SLE have previously been mentioned in the literature, but not described in detail. This is the first detailed case report in the literature of vulvar invasive squamous cell carcinoma occurring in a SLE patient. It can only be speculated that the SLE itself and/or the treatment with immunosuppressive drugs provoked malignant transformation and the development of vulvar squamous cell carcinoma in such a young patient.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Agur Z, Arakelyan L, Belilty G, Dahan N, Harpak H, Kogan Y, Merbl Y, Rabinovich A, Shoham M, Ziv I. Application of the Virtual Cancer Patient Engine (VCPE) for improving oncological treatment desig. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Z. Agur
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - L. Arakelyan
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - G. Belilty
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - N. Dahan
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - H. Harpak
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - Y. Kogan
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - Y. Merbl
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - A. Rabinovich
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - M. Shoham
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
| | - I. Ziv
- Institute for Medical BioMathematics (IMBM), Bene Ataroth, Israel; Optimata ltd, Ramat-Gan, Israel
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Piura B, Wolak A, Rabinovich A, Yanai-Inbar I. Giant cell arteritis of the female genital tract. CLIN EXP OBSTET GYN 2004; 31:31-3. [PMID: 14998183] [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: 04/29/2023]
Abstract
Giant cell arteritis (GCA) of the female genital tract is rare with only 30 cases, including this case, documented in the literature. We present a patient who had total abdominal hysterectomy and bilateral salpingo-oophorectomy for an ovarian cyst and on histologic examination GCA involving the arteries of the myometrium, cervical stroma, ovaries and tubes was unexpectedly discovered. Upon questioning of the patient and further investigations it became clear that the patient did have symptoms and signs suggestive of systemic GCA including fatigue, low-grade fever, weight loss and elevated erythrocyte sedimentation rate (ESR). Treatment with oral corticosteroids resulted in rapid and complete recovery. It is concluded that an incidental finding of GCA in the genitalia should alert the clinician to the possibility of systemic GCA. If upon questioning of the patient and further investigations the existence of systemic GCA is confirmed, treatment with corticosteroids should be considered.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Piura B, Rabinovich A. Gemcitabine in heavily pretreated patients with recurrent ovarian, peritoneal and fallopian tube carcinoma. EUR J GYNAECOL ONCOL 2004; 25:449-52. [PMID: 15285301] [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: 04/30/2023]
Abstract
PURPOSE OF INVESTIGATION To report the experience of a single institution in the south of Israel with gemcitabine in heavily pretreated patients with platinum-resistant recurrent ovarian, peritoneal and fallopian tube carcinoma. METHODS The hospital records of 21 patients with ovarian, peritoneal and fallopian tube carcinoma who had salvage chemotherapy with gemcitabine between October 1998 and November 2003 were retrospectively reviewed. Gemcitabine, 1000 mg/m2, was given on days 1, 8, and 15 of every 28 days. Dose intensity and relative dose intensity of gemcitabine were calculated. Response was determined using clinical evaluation, radiological reports and CA-125 level. Toxicity was graded using the National Cancer Institute (NCI) criteria. RESULTS The median relative dose intensity of gemcitabine received by the patients was 0.91, with 17 (81%) patients receiving more than 80% of the planned standard dose intensity. Two (9.5%) patients had complete response of disease lasting for ten and 33 months, respectively, eight (38.1%) had stable disease and 11 (52.4%) had progressive disease. Three (14.3%) patients had CA-125 complete response, five (23.8%) had CA-125 partial response, six (28.5%) had CA-125 stable levels and seven (33.3%) had CA-125 progressive levels. Toxicity was mainly hematological with grade 3-4 toxicity as follows: leukopenia--two (9.5%) patients, neutropenia--four (19%), thrombocytopenia--three (14.3%) and anemia--one (4.7%). CONCLUSION Gemcitabine has some activity and low and well tolerated toxicity in heavily pretreated patients with platinum-resistant recurrent ovarian, peritoneal and fallopian tube carcinoma.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Cancer Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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