Thrombocytopenia (defined as a platelet count <150×10(9)) is a well-known complication in patients with liver cirrhosis and has been observed in 76% to 85% of patients. Significant thrombocytopenia (platelet count <50×10(9) to 75×10(9)) occurs in approximately 13% of patients with cirrhosis. Thrombocytopenia can negatively impact the care of patients with severe liver disease by potentially interfering with diagnostic and therapeutic procedures. Multiple factors can contribute to the development of thrombocytopenia including splenic platelet sequestration, immunological processes, bone marrow suppression by chronic viral infection, and reduced levels or activity of the hematopoietic growth factor thrombopoietin. The present review focuses on the etiologies and management options for severe thrombocytopenia in the setting of advanced liver disease.

Neurotoxicity is a rare side-effect of cefepime. There are previous reports of cefepime neurotoxicity in patients whose dosages were not adjusted for their kidney disease. We report a toxic case of non-convulsive status epilepticus in a patient receiving renally-dosed cefepime. A 70-y-old woman was admitted with febrile neutropenia for which renally-dosed cefepime was started. On day 4 she developed altered mental status with orofacial myokymia. Blood and urine cultures were negative. Cerebrospinal fluid analysis was normal. Head computed tomography and magnetic resonance imaging showed no acute intracranial process. An electroencephalogram showed non-convulsive status epilepticus. Anticonvulsants were started, but she continued to have seizures. At this time, careful review of her medication list with temporal association of symptoms suggested cefepime as a probable cause and the drug was stopped. Within 24 h of discontinuation, her mental status began to improve and returned to baseline in 3 days. Our case illustrates that cefepime toxicity may still occur in patients who are dose-adjusted for renal insufficiency. It also underscores the importance of assessing for additional risk factors like history of stroke and seizures. Because cefepime-induced status epilepticus is completely reversible, prompt recognition and medication discontinuance can prevent further morbidity and mortality.

Polypectomy was as effective as surgical therapy for small tumors. For larger tumors, surgical therapy is better than polypectomy for right-sided tumors, but both are equally effective for left-sided tumors.

Background. Approximately one-fifth of all esophageal cancer cases are defined as early esophageal cancer (EEC). Although endoscopic therapy (ET) has been shown to be equally effective as esophagectomy (EST) in patients with EEC, there is little information comparing the survival outcomes of the two therapies based on anatomical location. Methods. A population-based study was conducted and the data was obtained from Surveillance, Epidemiology, and End Results program. Patients with EEC (i.e., stages Tis and T1a) and treated with either ET or EST were analyzed to compare EEC-related survival for three different locations of tumor. Results. The overall EEC-specific 1-year and 5-year mean (±SE) survival rates were 11.66 ± 0.05 and 52.80 ± 0.58 months, respectively. Tumors located in lower third had better 5-year survival compared to those located in middle third (83.50% versus 73.10%, p < 0.01). However, when adjusted for age, race, gender, marital status, grade, stage of tumor, histological type, and treatment modality, there was no significant difference. Conclusion. The EEC-specific 1-year or 5-year adjusted survival did not differ by anatomic location of the tumor. Therefore, ET might serve as a minimally invasive yet effective alternative to EST to treat EEC.