No advantage was found for placement of a vena cava filter in addition to anticoagulation with fondaparinux sodium in terms of safety, recurrent thrombosis, recurrent pulmonary embolism, or survival in this prospective randomized trial evaluating anticoagulation plus a vena cava filter in cancer patients. Favorable complete resolution rates of thrombosis were observed on both study arms.
).Pancreas transplantation allows for a euglycemic state in the absence of exogenous insulin. Exocrine pancreatic drainage can be achieved via the gastrointestinal or urinary tracts. Arterio-enteric fistulas constitute an infrequently encountered but potentially fatal complication associated with failed enteric-drained pancreas transplants.
Case ReportOur patient is a 58-year-old woman who is presented with hematemesis. Work up inclusive of esophagogastroduodenoscopy (EGD), colonoscopy, and capsule endoscopy did not identify any site of hemorrhage. After a 48-hour observation period with no further bleeding, the patient was discharged home. Twenty days later, she was presented to an outside hospital with a severe recurrent gastrointestinal bleed, prompting an emergent transfer to our institution for further diagnosis and treatment.Her past medical and surgical histories were significant for type 1 diabetes mellitus and renal failure, for which she had undergone an isolated living donor-related kidney transplant 5 years before presentation. She underwent a cadaveric pancreas after kidney transplant, 2 years later. The methods of pancreas transplantation utilized were enteric exocrine drainage and systemic venous drainage. The pancreatic allograft functioned well initially, and the patient maintained euglycemia for 2 years. At that point, 1 year before presentation, the pancreatic allograft had failed because of chronic rejection. Her kidney allograft was still functioning normally. Her immunosuppressive regimen consisted of the following: mycophenolate mofetil 250 mg oral, twice a day; tacrolimus 3 mg oral, twice a day; and prednisone 5 mg oral, once a day.The patient was admitted to our intensive care unit and transfused 6 units of packed red blood cells and 2 units of fresh-frozen plasma with an adequate hemodynamic response. A bedside EGD showed large amounts of blood in the stomach and duodenum with no apparent source. On the basis of these findings, it was decided to proceed with an emergency angiogram to identify the source of bleeding and control it, possibly by endovascular approach. While in the radiology department, as the procedure was about to be Keywords ► arterio-enteric fistula ► enteric-drained pancreas transplant ► gastrointestinal bleeding ► endovascular stenting ► allograft pancreatectomy
AbstractEnteric drainage is the preferred method of exocrine diversion in simultaneous kidneypancreas transplantation. Because of improvements in immunosuppression, enteric drainage has become the preferred method of pancreas transplantation in general.Although associated with less potential complications than bladder-drained pancreas, potentially lethal arterio-enteric fistulas in the setting of nonfunctioning allografts represent a constant threat. We herein present a case report, a review of the literature, and a call for caution.
We found that a PSV of greater than 200 cm/s was the best criterion for the diagnosis of IMA stenosis. The sensitivity, specificity, PPV, NPV, and accuracy for the PSV were 90%, 97%, 90%, 97%, and 95%, respectively.
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