British Hospital

About: British Hospital is a healthcare organization based out in Montevideo, Uruguay. It is known for research contribution in the topics: Population & Hazard ratio. The organization has 445 authors who have published 358 publications receiving 7878 citations. The organization is also known as: British Hospital.

BRAF V600E Mutation in First-Line Metastatic Colorectal Cancer: An Analysis of Individual Patient Data From the ARCAD Database.

Abstract: Background First-line therapeutic strategies for patients with BRAFV600E-mutated (BRAFmt) metastatic colorectal cancer (mCRC) mainly rely on subgroup analyses from randomized controlled trials (RCTs). We aimed at assessing the prognostic and predictive impact of BRAFmt for the efficacy of targeted therapies with first-line chemotherapy. Methods Individual patient data from first-line RCTs with BRAF and KRAS status data in the ARCAD database were pooled. Progression-free survival and overall survival (OS) were assessed using Kaplan-Meier and Cox models. Outcomes were compared between treatment groups that were concurrently randomized whenever possible. Results 6391 patients from 10 RCTs were included: 573 BRAFmt (9.0%), 2059 KRASmt (32.2%) and 3759 double wild-type (58.8%). BRAFmt mCRC patients experienced statistically significantly poorer OS than those with KRASmt (adjusted hazard ratio [HRadj] =1.46, 95% confidence interval [95%CI] = 1.30-1.64) and patients with double wild-type tumors (HRadj =2.14, 95%CI = 1.94-2.36). Anti-EGFR agents did not improve progression-free survival or OS of BRAFmt mCRC patients, based on 4 RCTs testing chemotherapy ± anti-EGFR (HRadj =0.96, 95%CI = 0.71-1.30 and HRadj =0.85, 95%CI = 0.66-1.14, respectively). Conclusion Our data suggest that the addition of anti-EGFR agents to chemotherapy is ineffective as first-line treatment for BRAFmt mCRC patients.

Bailout percutaneous external shunt to restore carotid flow in a patient with acute type A aortic dissection and carotid occlusion.

Abstract: PURPOSE To report the use of an external common femoral to carotid artery shunt in the setting of acute type A aortic dissection associated with carotid occlusion and stroke. TECHNIQUE The procedure is illustrated in a 52-year-old man who presented with a type A dissection extending into the innominate trunk, with associated occlusion of the right common carotid artery (CCA). Angiography showed no collateral circulation to the right cerebral hemisphere. To re-establish brain perfusion in this setting, a percutaneous external shunt was installed from the common femoral artery to the right CCA. The 5-F femoral sheath used during diagnostic angiography was replaced by an 8-F femoral introducer securely fixed to the skin with silk sutures. Ultrasound-guided percutaneous CCA access was obtained using an 18-G needle and a 6-F introducer, also sutured to the skin. The ICA and intracranial branches showed no evidence of thrombosis at this level. A plastic tube was used to connect the femoral and carotid sheath side arms to restore ICA flow. Transcranial Doppler showed normal flow at the right middle cerebral artery after shunt placement. The patient was immediately transferred to the operating room for aortic surgery, during which an intrapericardially ruptured aorta was found. The ascending aorta and proximal arch were replaced under cardiopulmonary bypass and circulatory arrest, but the patient died during the procedure due to uncontrolled bleeding. CONCLUSION A temporary percutaneous external femoral-carotid shunt can restore blood flow to the brain whenever the carotid artery is occluded by the dissection flap and adequate collateral flow is absent.

Jak-2 Positive Myeloproliferative Neoplasms

Abstract: Originally described by Dameshek in 1951, myeloproliferative disorders are today classified as myeloproliferative Neoplasms (MPNs) in WHO’s Classification of Tumors of Hematopoietic and Lymphoid Tissues. The term includes a range of conditions, [ie, BCR-ABL-positive chronic myelogenous leukemia (CML), chronic neutrophilic leukemia (CNL), polycythemia vera (PV), primary myelofibrosis (PMF), essential thromobocythemia (ET), chronic eosinophilic leukemia not otherwise specified (CEL-NOS), mastocytosis, and unclassifiable myeloproliferative neoplasm]. In the specific case of CML, a better understanding of the pathogenesis and pathophysiology of the disease has led to a targeted therapy. The presence of chromosome Philadelphia, t(9;22)(q34;11) results in the oncogene BCR-ABL, which characterizes the disease; this molecular rearrangement gives rise to a tyrosine-kinase, which in turn triggers the proliferation of the myeloid line through the activation of the signaling pathways downstream. Tyrosine-kinase inhibitors (TKIs) have altered the therapy and monitoring of CML patients and improved both their prognosis and quality of life. In 2005, various groups of investigators described a new point mutation of the gene JAK2 associated to MPNs. Although the presence of this mutation has led to a modification in the diagnostic criteria of these conditions, the impact of the use of JAK2 inhibitors on the prognosis and course of the disease continues to be controversial.