Hematology/oncology clinics of North America
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Hematol. Oncol. Clin. North Am. · Oct 1992
Review Multicenter Study Clinical TrialCurrent concepts in coronary thrombolysis.
It has become increasingly apparent that the success of coronary thrombolysis depends on a dynamic balance between fibrinolytic and procoagulant activity. The differential properties of specific plasminogen activators determine the rate at which clot lysis is induced, the extent to which procoagulant activity and platelet activation are increased, and the extent to which recurrent thrombosis is inhibited. ⋯ The recent development of a variety of new anticoagulants with different mechanisms of action may result in even more effective treatment strategies. Whether these newer agents will result in improved survival in patients treated with coronary thrombolysis without compromising safety will need to be established by clinical trials.
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Hematol. Oncol. Clin. North Am. · Feb 1990
ReviewThrombotic thrombocytopenic purpura and related disorders.
This article provides us with background information on the disease. Clinical features, variants and classification, laboratory findings, and pathology are discussed. Knowledge of the disease's pathogenesis has increased recently and specific causes discussed are predisposing factors, triggering agents, endothelial damage, defective PGI2 bioavailability, FVIII/vWF multimeric structure abnormalities, platelet activation, and hemolytic anemia. Proposed specific therapies discussed are steroids, heparin, antiplatelet agents, prostacyclin, splenectomy, immunosuppressive agents, plasma infusion, and plasma exchange.
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Elevated platelet counts may be encountered as a reactive phenomenon secondary to a variety of systemic conditions (thrombocytosis) or may represent a primary disorder of the bone marrow (thrombocythemia). The diagnosis of essential thrombocythemia is difficult and relies on exclusion of other myeloproliferative states and nonhematologic illnesses associated with increased platelet number. The paradoxic clinical complications of hemorrhage and thrombosis, the presence of splenomegaly, and the finding of various qualitative platelet abnormalities point to existence of the neoplastic disorder. Although treatment of the symptomatic patient with platelet lowering agents or antiplatelet drugs may be indicated and effective, the role of therapy in the asymptomatic individual remains highly controversial.
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Hematol. Oncol. Clin. North Am. · Dec 1989
Randomized Controlled Trial Clinical TrialSystemic therapy in resectable breast cancer.
There is now convincing evidence that adjuvant systemic therapy for high-risk breast cancer can significantly reduce tumor mortality at 5 years. The overall treatment benefit for women with node-positive tumors may be considered moderate but clinically important. ⋯ Primary (neoadjuvant) chemotherapy can allow conservative surgery in most tumors suitable for mastectomy, but this form of treatment remains, at present, experimental. Potential long-term toxicity from systemic adjuvant therapy should be continuously monitored.
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Hematol. Oncol. Clin. North Am. · Jun 1989
ReviewSecond neoplasms in Hodgkin's disease: current controversies.
Aggressive, multimodal treatment of Hodgkin's disease has led to dramatic increases in survival but not without significant early toxicity and late complications. The most serious late complication is the development of a secondary neoplasm. These secondary cancers include acute nonlymphocytic leukemia, non-Hodgkin's lymphoma, and various solid tumors.