Hematology/oncology clinics of North America
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Hematol. Oncol. Clin. North Am. · Aug 2011
ReviewThe role of surgery in advanced renal cell carcinoma: cytoreductive nephrectomy and metastasectomy.
Renal cell carcinoma (RCC) is considered a relatively rare malignancy worldwide. Around a third of patients with RCC present with metastatic disease, and among those patients treated with nephrectomy with curative intent, more than one-third develop metastases during postoperative follow-up. Due to the absence of curative medical treatments for metastatic RCC, surgery remains the mainstay of therapy. Surgery plays a key role in two aspects: cytoreductive nephrectomy to remove the primary renal tumor in the presence of known metastatic disease, and metastasectomy to remove distant metastatic foci in patients with metastatic RCC.
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Because von Willebrand factor (VWF) levels increase during pregnancy, many women with VWD, though not requiring support with hemostatic agents, are at increased risk for delayed postpartum hemorrhage as coagulation factor levels fall to their prepregnancy levels in the puerperium. Women with moderate or severe disease or complicated pregnancies are best served by delivering at a center with an obstetrician, hematologist, and anesthesiologist experienced in managing coagulation disorders. In addition, on-site laboratory facilities with specialized coagulation testing capability, pharmacy, and blood bank support are critical for success. Ensuring optimal outcomes for pregnant women with VWD requires a multidisciplinary approach.
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Hematol. Oncol. Clin. North Am. · Apr 2011
ReviewAnesthesia in the pregnant patient with hematologic disorders.
The management of patients with hematologic disorders in pregnancy involves a multidisciplinary approach involving specialists from hematology, obstetrics, and anesthesiology. Whereas regional anesthesia has led to a decline in maternal morbidity and mortality, the presence of uncorrected coagulopathy or the use of anticoagulant or antithrombotic medications pose a special risk for the rare complication of an epidural hematoma after neuraxial anesthesia. This article briefly reviews the common principles of anesthesia for obstetric patients, provides an obstetric anesthesiologist's perspective on the implications of regional anesthesia in obstetrics, and enhances communication between the specialties.
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Hematol. Oncol. Clin. North Am. · Dec 2010
ReviewAllogeneic cellular gene therapy for hemoglobinopathies.
Hematopoietic stem cell transplantation (HSCT) offers potentially curative therapy for patients with thalassemia major and sickle cell disease (SCD). Current myeloablative treatment protocols allow the cure of 78% to 90% of patients with thalassemia and 72% to 96% with SCD, depending on disease status at the time of transplantation. ⋯ Unrelated donor HSCT is now extensively used to treat thalassemia, with results similar to those obtained following transplantation using HLA-matched sibling donors. Patients who lack a matched related or unrelated donor can now benefit from successful transplantation using haploidentical donors.
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Hematol. Oncol. Clin. North Am. · Dec 2010
ReviewNoninvasive approaches to prenatal diagnosis of hemoglobinopathies using fetal DNA in maternal plasma.
Fetal DNA is present in the plasma of pregnant women and can be used for noninvasive prenatal diagnosis. Early work had focused on the detection of paternally inherited fetal mutations in maternal plasma. Recent advances in single-molecule counting approaches have allowed the mutation dosage of the fetus to be analyzed in maternal plasma. These developments have been demonstrated as feasible for noninvasive prenatal diagnosis of several hemoglobinopathies, including β-thalassemia and hemoglobin E disease.