This study suggests that surgical therapy improves survival among patients with localized, as well as metastatic, NF-pNEC. Enucleation may be oncologically equivalent to resection.

Background-Although ventricular assist devices (VADs) provide effective treatment for endstage heart failure, VAD support remains associated with significant risk for adverse events (AEs). To date there has been no detailed assessment of the incidence of a full range of AEs using standardized event definitions. We sought to characterize the frequency and timing of AE onset during the first 60 days of VAD support, a period during which clinical observation suggests the risk of incident AEs is high.

Our study shows severe heterogeneous brain MR abnormalities in cbl-C/D defect. We observed unusual basal ganglia lesions in 30 % of our cases and also found a high incidence of hydrocephalus and supratentorial white matter abnormalities.

Background Acute limb ischemia (ALI) is a highly morbid and fatal vascular emergency with little known about contemporary, long-term patient outcomes. The goal was to determine predictors of long-term mortality and amputation following open and endovascular treatment of ALI. Methods A retrospective review of ALI patients at a single institution from 2005-2011 was performed to determine the impact of revascularization technique on 5-year mortality and amputation. For each main outcome two multivariable models were developed; the first adjusted for preoperative clinical presentation and procedure type, the second also adjusted for postoperative adverse events. Results Four hundred and forty-five limbs in 411 patients were treated for ALI. Interventions included surgical thrombectomy (48%), emergent bypass (18%), and endovascular revascularization (34%). Mean age was 68 ± 15 years, 54% were male, and 23% had cancer. The majority of patients presented with Rutherford Classification IIa (54%) or IIb (39%). The etiology of ALI included embolism (27%), in-situ thrombosis (28%), thrombosed bypass grafts (32%), and thrombosed stents (13%). Patients treated with open procedures had significantly more advanced ischemia and higher rates of post-operative respiratory failure, while patients undergoing endovascular interventions had higher rates of technical failure. Rates of post-procedural bleeding and cardiac events were similar between both treatments. Excluding Rutherford Class III patients (n=12), overall 5-year mortality was 54% (stratified by treatment, 65% for thrombectomy, 63% for bypass, and 36% for endovascular, p<.001); 5-year amputation was 28% (stratified by treatment, 18% for thrombectomy, 27% for bypass, and 17% for endovascular, p=0.042). Adjusting for comorbidities, patient presentation, adverse events and treatment method, the risk of mortality increased with age (HR=1.04, p<.001), female gender (HR=1.50, p=.031), cancer (HR=2.19, p<.001), fasciotomy (HR=1.69, p=.204) in-situ thrombosis or embolic etiology (HR=1.73, p=.007), cardiac adverse events (HR=2.25, p<.001), respiratory failure (HR=2.72, p<.001), renal failure (HR=4.70, p<.001) and hemorrhagic events (HR=2.25, p=.003). Risk of amputation increased with advanced ischemia (Rutherford IIb compared to IIa, HR=2.57, p<.001), thrombosed bypass etiology (HR=3.53,p=.002), open revascularization (HR=1.95,p=.022), and technical failure of primary intervention (HR=6.01, p<.001). Conclusions Following the treatment of ALI, long-term mortality and amputation rates were greater in patients treated with open techniques; OR patients presented with a higher number of comorbidities and advanced ischemia, while also experiencing a higher rate of major postoperative complications. Overall, mortality rates remained high and were most strongly associated with baseline comorbidities, acuity of presentation, and perioperative adverse events, particularly respiratory failure. Comparatively, amputation risk was most highly associated with advanced ischemia, thrombose...

Introduction Gender-related differences in type B aortic dissection (TBAD) presentation and outcomes are not well understood. The objective of this study is to assess the impact of gender on short-term outcomes in patients with TBAD. Methods Patients with TBAD were identified from National Inpatient Sample datasets from 2009–2012 according to previously published methods. The primary outcomes of interest were in-hospital mortality and major complications (renal, cardiac, pulmonary, paraplegia, and stroke-related) between men and women. An inverse propensity-weighted regression was used to balance comorbid and clinical presentation differences. Subgroup analyses were performed on those undergoing endovascular (TEVAR) and open repair, and for elderly patients over the age of 70. Results We identified 9855 patients with TBAD; females were fewer (43.6%, n=4293), and presented at a later age (69.8±15.5 vs. 62.8±15.6, p<0.001). Females had more comorbidities (median Elixhauser 4 [IQR 2–5] vs. 3 [IQR 2–5], p<0.001), and were more often managed non-operatively (87.4% vs. 81.8%, p<0.001) compared to males. For those undergoing intervention, 58% (n=903) had open repair and TEVAR rates were higher in females compared to males (45.6% vs. 40.0%, p<0.001). Unadjusted mortality rates did not differ significantly by gender (male: 11.6% vs. female: 10.7%). In an adjusted propensity-weighted regression, gender did not significantly affect in-hospital mortality or stroke rates, but females were less likely to have acute renal failure during their hospitalization and more likely to experience cardiac events when undergoing open repair. Elderly females were also less likely to experience acute renal failure but had higher odds of cardiac events regardless of intervention compared to elderly men. Conclusions In comparison to men, females with TBAD presented at a later age, were more likely to undergo TEVAR, sustain a perioperative cardiac event with open surgery, and less likely to experience acute renal complications overall. Elderly females were additionally more likely to sustain a cardiac event regardless of operative status. Future studies should attempt to identify anatomic and epidemiologic reasons for these differences.