Therapy-related myelodysplastic syndrome: Two cytogenetically unrelated abnormal clones in a patient with multiple myeloma

A multiple myeloma patient presented for cytogenetic analysis at diagnosis of secondary MDS, which followed cytotoxic treatment including melphalan. Two abnormal unrelated clones were detected, one of them had 5q−, 7q− with clonal evolution of an additional aberration, t(12;13); in the second clone there was a translocation between the two homologues of chromosome 1 as the only aberration. We suggest that the clone with 5q− and 7q− represented the secondary MDS cells, whereas the abnormal clone with t(1;1) represented the plasmablasts of the multiple myeloma.     

Anatomical alar reconstruction with staged nasolabial flap

The nasolabial flap has for many years been an excellent choice for reconstruction of the nasal ala following excision of skin cancer or trauma. When done as a single-stage procedure the result can be a nonaesthetic appearing mass. We propose an initial excision with flap inset and a second procedure for debulking and contouring the alar groove to complete reconstruction of the aesthetic unit. Representative cases are presented.     

The demographic components of population aging in China

Past trends in fertility and mortality in China have led to an age composition that will age rapidly in the coming decades. In this paper we examine measures of population aging in China from 1953 to 1982, and then project population aging to the year 2050 using a cohort-components methodology. The projected measures of population aging that result from these forecasts are then decomposed into the relative contributions that are made to these changes by past, present, and future trends in fertility and mortality. Results indicate that China's population will age at an unprecedented rate over the next 70 years, both in terms of the absolute size of the elderly population and their proportion of the total population. At least 50 percent of the projected increase in population aging in China between 1980 and 2050 will be a product of the momentum for aging that is already built into the present age structure and vital rates. However, prospective trends in the measures of population aging become increasingly more sensitive to varying assumptions about fertility and mortality with time, and as older age groups are considered. This analysis provides the demographic basis for evaluating the possible effects of population aging on health care, social security, and other social and economic issues.     

Talc sclerodhesis of persistent Morel-Lavallée lesions (posttraumatic pseudocysts): case report of 4 patients

Large posttraumatic pseudocysts are infamous for their tendency to recur despite repeated aspiration. The standard practice has been repeated extensive surgical debridement. To avoid the need for such treatment, talc was used to sclerose the lesion in 4 patients treated between 2000 and 2003. The patients were between the ages of 20 and 73 and had thigh and buttock pseudocysts that persisted for an average of 3 months. Talc was administered under fluoroscopic guidance and suction drainage (wall suction followed by a bulb vacuum drainage system) was applied for an average of 12 days. The patients were followed for an average period of 27 months after talc sclerodhesis. All persistent pseudocysts showed an immediate cessation of fluid accumulation in the treated space without reccurence. One case which was complicated by infection, had to be treated twice with talc to cease the accumulation. In this case, the infection recurred, although fluid accumulation did not recur. Talc sclerodhesis proved to be a simple and rapid method of treatment in posttraumatic cases classically treated by repeated and aggressive surgical methods.     

Acute anticoagulation adjustment in patients with atrial fibrillation at risk for stroke: approaches, strategies, risks and benefits

The acute management of anticoagulation in patients with atrial fibrillation to prevent stroke and other thromboembolic complications includes the use of individualized strategies tailored to the patient and based on the situation (cardioversion, surgeries, dental procedures, cardiac interventions, other invasive procedures and initiation of, or adjustment to, warfarin dosing). The vast range of choices can cause confusion and few randomized controlled clinical trials in this area provide adequate guidance. Chronic anticoagulation management is more straightforward since clinical evidence is ample, randomized clinical trial data provides cogent informaiton and guidelines have been established. Acute management of anticoagulation in patients with atrial fibrillation to prevent thromboembolic complications is often unrecognized but is emerging as a crucial, but challenging, and increasingly complex aspect of the care of patients with atrial fibrillation. This review addresses issues regarding such patients who may be at risk for stroke and require acute adjustments of anticoagulation (in light of, or in lieu of, chronic anticoagulation). Several promising new strategies are considered in light of established medical care. This analysis provides practical recommendations based on available data and presents results from recent investigations that may provide insight into future strategies.