Which differences do elderly patients present in single-stage treatment for cholecysto-choledocholithiasis?

AbstractPatients with symptomatic gallstones present common bile duct stones in approximately 10% of cases. It is possible to resolve both gallbladder and bile duct stones with a single procedure. The aim of this study is to determine the effectiveness of a single stage procedure for gallbladder and bile duct stones in the elderly patients and to expose the differences between the various techniques. From January 2008 to December 2013, we treated 1540 patients with gallbladder stones. In 152 cases, we also found bile duct stones. 150 of these were treated in a single stage procedure. We divided our patients into 2 groups: Group A was younger than 65 (104 patients); Group B was 65 or older (46 patients). We retrospectively compared sex, ASA score, conversion rate, success rate, post-operative complications, hospital stay, and treatment method. We had no intra-operative mortality. 1 patient in Group B, heart condition (ASA 4), died with multiple organ failure (MOF) 10 days after his operation. ASA score: 3.5 ± 0.5 in A vs 2 ± 0.9 in B (P 0.001), post-operative complications 6% in A vs 18.1% in B (P 0.0325) and hospital stay 4.1 ± 2.3 in A vs 9.5 ± 5.5 in B (P 0.0001) were significantly higher in Group B. No differences were found in term of success rate: 94% in A vs 90% in B (P 0.4944). The procedure used to obtain the clearance of the bile duct showed a different success rate across the two groups: for the patients under 65 years old, trans-cystic clearance (TC-CBDE) was successful in 90% of cases, and only 51% for those older than 65, where we had to recall 49% for laparo-endoscopic rendez-vous (RV-IOERC) (P 0.0014). In conclusion, single stage treatment is safe and effective also to elderly patients. The methods used in patients being younger than 65 years old is what appeared to be significantly different

Elotuzumab plus pomalidomide and dexamethasone in relapsed/refractory multiple myeloma: a multicenter, retrospective, real-world experience with 200 cases outside of controlled clinical trials

In the ELOQUENT-3 trial, the combination of elotuzumab, pomalidomide , dexamethasone (EloPd) proved to have a superior clinical benefit over pomalidomide and dexamethasone with a manageable toxicity profile, leading to its approval for the treatment of patients with relapsed/refractory multiple myeloma (RRMM) who have received at least two prior therapies, including lenalidomide and a proteasome inhibitor. We report here a real-world experience of 200 cases of RRMM treated with EloPd in 35 Italian centers outside of clinical trials. In our dataset, the median number of prior lines of therapy was two, with 51% of cases undergoing autologous stem cell transplant and 73% having been exposed to daratumumab. After a median follow-up of 9 months, 126 patients had stopped EloPd, most of them (88.9%) because of disease progression. The overall response rate was 55.4%, a finding in line with the pivotal trial results. Regarding adverse events, the toxicity profile in our cohort was similar to that in the ELOQUENT-3 trial, with no significant differences between younger (<70 years) and older patients. The median progression-free survival was 7 months, which was shorter than that observed in ELOQUENT-3, probably because of the different clinical characteristics of the two cohorts. Interestingly, International Staging System stage III disease was associated with worse progression-free survival (hazard ratio=2.55). Finally, the median overall survival of our series was shorter than that observed in the ELOQUENT-3 trial (17.5 vs. 29.8 months). In conclusion, our real-world study confirms that EloPd is a safe and possible therapeutic choice for patients with RRMM who have received at least two prior therapies, including lenalidomide and a proteasome inhibitor

Reticulated platelets stained with thiazole orange: methodology and clinical application in the diagnosis of idiopathic autoimmune purpura.

Reticulated platelets (RP) are defined as platelets with residual ribosomal RNA which is related to maturation stage. RP stained with thiazole orange (TO) are a useful marker for bone marrow thrombocytopoiesis and could be a simple test to distinguish thrombocytopenia between autoimmune and aplastic disorders. We evaluated RP of 22 patients (3 males and 19 females), median age 53 years (12-78), affected by idiopathic autoimmune purpura (ITP) at the moment of diagnosis and 61 healthy normal controls. RP were studied utilizing a quantitative fluorescent test on platelet rich plasma (PRP) obtained by centrifugation from peripheral blood. The platelets are fixed with paraformaldehyde, stained with TO and analyzed by flow cytometer. The results were examined by a fluorescence histogram where M1, M2, M3 regions were defined on the basis of the incidence of control platelet populations. The analysis of the results suggests that the number of RP was significantly higher in patients affected by ITP, compared with RP number observed in normal subjects (p<0.001). We obtained consistent TO positive platelet rates in patients with ITP when the platelet count was < 20×109/L compared with to patients with platelet counts > 20×109/L (p< 0.05). Furthermore, the number of RP resulted in a relationship with the platelet count: the presence of M2 and M3 fractions is inversely correlated with the platelet count (p=0.05). We concluded that our method of TO positive RP measuring is helpful for the diagnosis of ITP, especially when bone marrow aspiration is not possible and useful for the evaluation of bone marrow thrombopoiesis in different clinical applications

Single-stage procedure for the treatment of cholecysto-choledocolithiasis: a surgical procedures review

Aldo Bove, Raffaella Maria Di Renzo, Gino&nbsp;Palone, Domenica Testa, Valentina Malerba, Giuseppe&nbsp;Bongarzoni Department of Medicine, Dentistry and Biotechnology, University &ldquo;G. d&rsquo;Annunzio&rdquo; of Chieti-Pescara, Chieti, Italy Abstract: While laparoscopic cholecystectomy is generally accepted as the treatment of choice for simple gallbladder stones, in cases in which common bile duct stones are also present, clinical and diagnostic elements, along with intraoperative findings, define the optimal means of treatment. All available options must be accessible to the surgical team which must necessarily be multidisciplinary and include a surgeon, an endoscopist, and a radiologist in order to identify the best option for a truly personalized surgery. This review describes the different techniques and approaches used based on distinctive recommendations and factors, according to the specific cases treated and the results achieved. Keywords: bile duct clearance, cholecysto-choledocolithiasis, one-stage treatmen