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Devastating Event (devastating + event)
Selected AbstractsCentral nervous system dissemination in immunocompetent patients with aggressive lymphomas: incidence, risk factors and therapeutic optionsHEMATOLOGICAL ONCOLOGY, Issue 2 2009Andrés J. M. Ferreri Abstract Central nervous system (CNS) dissemination is a rare (4,5%) but usually fatal complication of aggressive lymphomas. Prophylaxis modalities to prevent CNS dissemination in aggressive lymphomas cannot be widely applied to every lymphoma patient since it is associated with increased risk of neurotoxicity. Therefore, identification of high-risk patients as the best candidates to receive CNS prophylaxis constitutes a major endpoint in the management of these malignancies. Various risk factors and models for CNS recurrence have been described. Parameters reflecting the extent and proliferation of the disease, like elevated serum lactate dehydrogenase levels, involvement of multiple extranodal sites, advanced stage and high age-adjusted International Prognostic Index (IPI) score, as well as the involvement of specific anatomic sites, like testes, orbit, paranasal sinuses, have been identified and confirmed as important to predict CNS dissemination. Management of this complication in aggressive lymphomas with conventional-dose chemotherapy is associated with disappointing results, while some preliminary but encouraging experiences suggest a potential role of high-dose chemotherapy and stem cell transplantation. The analysis of recent clinical studies could lead to advancement in the prognosis of aggressive lymphomas, but several questions regarding the optimum chemotherapy combination, the best conditioning regimen and the role of radiation therapy and intrathecal chemotherapy remain still unanswered. The purposes of the present review are to critically analyse current data on the risk of CNS dissemination in aggressive lymphomas, the clinical presentation of secondary CNS lymphomas and the efficacy of CNS prophylaxis as well as to discuss the available therapeutic options for this devastating event. Copyright © 2009 John Wiley & Sons, Ltd. [source] Hydrological importance of an unusual hazard in a mountainous basin: flood and landslideHYDROLOGICAL PROCESSES, Issue 14 2006Umesh K. Haritashya Abstract The Bhagirathi River, a proglacial melt water stream of the Gangotri Glacier, is the principal source of the Ganges river system. The upper part of the basin lies in the high altitude region of the Garhwal Himalayas and is extensively covered by glaciers. We provide hydro-meteorological insight into a severe storm that produced unusual high rains in June 2000 in the uppermost part of the Bhagirathi River. This storm was concentrated upstream of Gangotri town and triggered landslides/rockslides at several locations between the glacier snout and Gangotri town. One of the major rockslides blocked the Bhagirathi River at Bhujbas, about 3 km downstream of the Gangotri Glacier snout, creating an artificial lake at this location. High stream flow in the river, generated by rapid runoff response from mountain slopes along with melt runoff from the glacier, quickly increased the level of water stored in the artificial lake. Daily rainfall in this region rarely exceeds 10 mm, while total rainfall during this 6-day storm was 131·5 mm. This unusual rain event occurred during the tourist season in June, consequently trapping a large number of tourists and vendors in this area. Sudden release of stored water generated floods that created havoc downstream of the artificially created lake. This paper presents the hydrological and meteorological information related to such an unusual and devastating event observed in the high altitude region of the Himalayas. Copyright © 2006 John Wiley & Sons, Ltd. [source] Late free-flap salvage with catheter-directed thrombolysisMICROSURGERY, Issue 4 2008Andrew P. Trussler M.D. Introduction: Despite high success rates with free-tissue transfer, flap loss continues to be a devastating event. Flap salvage is often successful if vascular complications are recognized and treated early. However, delayed presentation of flap compromise is an ominous predictor of flap loss. Late free-flap salvage has been described with poor long-term results. Catheter-directed thrombolysis (CDT) has only been described in context with free-tissue transfer in a case of distal bypass salvage. Objectives: The authors examined the efficacy of highly selective CDT in late salvage of free-flaps with vascular compromise. Methods: Two patients underwent highly selective CDT after delayed presentation (>5 days) of flap compromise. Patient 1 is a 59-year-old woman who underwent delayed breast reconstruction with a free TRAM flap and presented with arterial thrombosis 12 days postoperatively. Patient 2 is a 53-year-old man who underwent fibular osteocutaneous free-flap reconstruction of a floor of mouth defect who developed venous thrombosis 6 days postoperatively. Patient 2 underwent two attempted operative anastamotic revisions with thrombectomies and local thrombolysis prior to CDT. Results: The average time of presentation was 9 days, with the average time to CDT being 9.5 days. Patient 1 had an arterial thrombosis, whereas Patient 2 had a venous thrombosis. Both patients underwent successful thrombolysis after super-selective angiograms. Continuous infusions of thrombolytic agents were used in both patients for ,24 h. Average length of stay postCDT was 7 days with no perioperative complications. Long-term follow-up demonstrated complete flap salvage with no soft tissue loss. Conclusion: Despite extremely delayed presentation, aggressive CDT was successful in both breast, and head and neck reconstructions with excellent long-term flap results. CDT appears to be a useful modality in managing difficult cases of free-flap salvage. © 2008 Wiley-Liss, Inc. Microsurgery, 2008. [source] Rings of Steel, Rings of Concrete and Rings of Confidence: Designing out Terrorism in Central London pre and post September 11thINTERNATIONAL JOURNAL OF URBAN AND REGIONAL RESEARCH, Issue 1 2004Jon CoaffeeArticle first published online: 24 FEB 200 This article is a reaction to the rapid changes many urban areas are undertaking in attempts to counter the contemporary terrorist threat since the devastating events of September 11th. The response of central London authorities both pre- and post- September 11th is used as the lens through which to view attempts to reduce the real and perceived threat of terrorist attack through the adoption of territorial approaches to security, both physical and technological, which are increasingly being utilized at ever-expanding spatial scales. It argues that this situation all too often produces a scenario of ,splintered urbanism' as security rings are thrown up around carefully selected sections of cities deemed most at risk. It further argues for a balance to be struck between competing concerns for freedom of access, mobility and other democratic freedoms, and the need for cities to adopt increasingly militarized security perspectives in their counter-terrorism efforts. Cet article présente une réaction aux rapides changements que de nombreuses zones urbaines entreprennent afin de contrer la menace terroriste actuelle depuis les ravages du 11 septembre. La réponse des autorités du centre de Londres, à la fois avant et après cette date, sert ainsi de loupe permettant d'observer les efforts de minimisation de cette menace d'agression, tant subjective que réelle. Il s'agit de démarches territoriales à l'égard de la sécurité (matérielle et technologique) appliquées de plus en plus souvent à des échelles spatiales sans cesse élargies. De cette situation, naît trop souvent un scénario ,d'urbanisme fragmenté', les anneaux de sécuritéétant jetés autour de portions soigneusement sélectionnées de villes jugées le plus en danger. L'article défend la nécessité de trouver un équilibre entre les préoccupations opposées que sont les liberté d'accès, mobilité ou autres libertés démocratiques et le besoin des villes d'adopter des perspectives sécuritaires de plus en plus militarisées dans leurs tentatives contre le terrorisme. [source] | ||||||||||