St Francis Hospital and Medical Center

Hartford, CT, United States

St Francis Hospital and Medical Center

Hartford, CT, United States
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Laslett L.J.,University of California at Davis | Alagona Jr. P.,Penn State Heart and Vascular Institute | Clark III B.A.,St Francis Hospital And Medical Center | Drozda Jr. J.P.,Mercy Health | And 4 more authors.
Journal of the American College of Cardiology | Year: 2012

The environment in which the field of cardiology finds itself has been rapidly changing. This supplement, an expansion of a report created for the Board of Trustees, is intended to provide a timely snapshot of the socio-economic, political, and scientific aspects of this environment as it applies to practice both in the United States and internationally. This publication should assist healthcare professionals looking for the most recent statistics on cardiovascular disease and the risk factors that contribute to it, drug and device trends affecting the industry, and how the practice of cardiology is changing in the United States. © 2012 American College of Cardiology Foundation.

Bockorny B.,University of Connecticut | Codreanu I.,University of Arizona | Dasanu C.A.,St Francis Hospital and Medical Center
British Journal of Haematology | Year: 2012

Richter transformation in chronic lymphocytic leukaemia (CLL) represents an entity of considerable genetic, molecular, immunological and clinical heterogeneity. A rare occurrence, Hodgkin variant of Richter syndrome, has not been comprehensively characterized or systematized to date. We conducted a retrospective analysis of the existing cases of Hodgkin lymphoma as Richter syndrome reported in the medical literature in the previous three and a half decades. Our search identified 86 such patients; this entity affects predominantly older men and the most common histological subtype is mixed cellularity. Interval between the diagnosis of CLL and subsequent development of Hodgkin lymphoma is circa 4·3years. The overall survival of patients was approximately 1·7years in our analysed cohort. However, our pooled data showed that patients in whom CLL had been treated with fludarabine had a shorter survival after transformation compared to the ones not treated with this agent. The role of immunosuppression and Epstein-Barr virus infection in the aetiopathogenesis of this entity remains to be clarified. © 2011 Blackwell Publishing Ltd.

Bockorny B.,University of Connecticut | Dasanu C.A.,St Francis Hospital and Medical Center
Expert Opinion on Biological Therapy | Year: 2013

Introduction: Individuals affected by kidney cancer present a variety of immune abnormalities including cellular immune dysfunction, cytokine alterations and antigen presentation defects. On the other hand, spontaneous remissions are seen in up to 4% of renal cell carcinoma (RCC) patients and they are thought to occur via immune mechanisms. Areas covered: The authors comprehensively review the immune abnormalities in RCC patient and describe the kidney cancer immunotherapy candidates that are most advanced in their clinical development. Most relevant publications were identified through searching the PubMed database; the obtained information was thoroughly analyzed and synthesized. Expert opinion: As cure in advanced RCC cannot be accomplished with the current therapy standards such as tyrosine kinase inhibitors and mammalian target of rapamycin inhibitors, new treatment strategies are being sought. Enhancing the immune system represents an appealing avenue for kidney cancer therapy. Disappointingly, high-dose interleukin-2 and interferon-α cause severe toxicity and produce a questionable clinical benefit. The authors postulate that the 'durable responses' seen with these agents in only a handful of RCC patients represent spontaneous remissions. Promising immune strategies in RCC such as anti-cytotoxic T-lymphocyte-associated protein antibodies, anti-programmed cell death 1 (PD1)/PD1 ligand and tumor vaccines may expand the existing options for kidney cancer in future years. © 2013 Informa UK, Ltd.

Inneh I.A.,NYU Langone Medical Center | Lewis C.G.,Orthopedic Associates of Hartford | Schutzer S.F.,St Francis Hospital And Medical Center
Journal of Arthroplasty | Year: 2014

We aimed to identify significant demographic, preoperative comorbidity and surgical predictors for major complications for use in the development of a risk prediction tool for a well-defined population as Total Joint Arthroplasty (TJA) patients. Data on 5314 consecutive patients who underwent primary total hip or knee arthroplasty from October 1, 2008 through September 30, 2011 at a single institution were used in a multivariate regression analysis. The overall incidence of a primary endpoint (reoperation during same admission, extended length of stay, and 30-day readmission) was 3.8%. Significant predictors include certain preexisting genitourinary, circulatory and respiratory conditions; ASA. >2; advanced age and prolonged operating time. Mental health conditions demonstrate a strong predictive effect for subsequent serious complication(s) in TJA patients and should be included in a risk-adjustment tool. © 2014 Elsevier Inc.

Dasanu C.A.,St Francis Hospital and Medical Center
Expert Opinion on Pharmacotherapy | Year: 2011

Introduction: Adult T-cell leukemia/lymphoma (ATL) is a rare disease with a unique geographic distribution. Conducting controlled randomized trials to assess the effective therapeutic strategies has therefore been a significant challenge to date. Areas covered: This review explores the natural history and diagnostic evaluation of ATL, followed by a focused review of existing studies on the most potent individual pharmaceutical agents and combinations used in the therapy of this malignancy. Readers will acquire considerable insights about the clinical subsets, diagnosis and the most effective therapies used in various ATL types. Expert opinion: International, multicenter, randomized clinical trials are essential to design optimal therapeutic strategies for various ATL subsets. It appears that patients with acute ATL type benefit considerably from the first-line combined antiviral therapy with zidovudine and interferon alpha, whereas patients with ATL of the lymphoma type may experience a better outcome with intensive chemotherapy. The role of therapy in smoldering and chronic disease types remains to be clarified. In addition, the results of allogeneic stem-cell transplantation in ATL appear promising, as up to 40% of patients who achieve remission and have suitable donors can now become long-term survivors. Prospective evaluation of novel effective agents and their incorporation into various therapeutic algorithms is stringently needed. © 2011 Informa UK, Ltd.

Dasanu C.A.,St Francis Hospital And Medical Center
Journal of Oncology Pharmacy Practice | Year: 2012

A recent large randomized clinical trial showed a survival advantage with 36 vs 12 months of adjuvant imatinib in patients with resected gastrointestinal stromal tumors (GISTs). However, there was a higher therapy discontinuation rate with the longer duration of treatment. Preferences of individual GIST patients and the imatinib risk/benefit ratio should always be sought before employing this agent in adjuvant setting for longer than 12 months. A shorter duration of therapy may be preferred in patients with a limited life expectancy, serious cardiovascular co-morbidities, diminished compliance or poor adherence to oral therapy. Further study of underlying economic, psychosocial, and physical barriers of longer vs shorter duration of adjuvant therapy in this patient population is probably warranted. © 2012 The Author(s) Reprints and permissions.

Dasanu C.A.,St Francis Hospital And Medical Center
Journal of Oncology Pharmacy Practice | Year: 2011

Although rare, cardiac rhythm abnormalities have been documented with bortezomib use in clinical trials. These side effects must be recognized promptly by physicians of various specialties as well as pharmacists. Special attention is required in patients with liver function abnormalities, elderly and patients with pre-existing cardiac conditions. Prompt bortezomib withdrawal is essential in these cases as it may prevent dismal outcomes. This is the first report of a complete heart block caused by bortezomib in the setting of myeloma therapy outside a clinical trial. The author discusses further various heart rhythm and other autonomic nervous system abnormalities attributed to bortezomib in the existing literature. © The Author(s) 2010.

Bockorny B.,University of Connecticut Health Center | Dasanu C.A.,St Francis Hospital and Medical Center
Clinical Lymphoma, Myeloma and Leukemia | Year: 2012

Large granular lymphocyte (LGL) leukemia features a group of indolent lymphoproliferative diseases that display a strong association with various autoimmune conditions. Notwithstanding, these autoimmune conditions have not been comprehensively characterized or systematized to date. As a result, their clinical implications remain largely unknown. The authors offer a comprehensive review of the existing literature on various autoimmune conditions documented in the course of T-cell LGL (T-LGL) leukemia. Though some of them are thought be secondary to the LGL leukemia, others could be primary and might even play a role in its pathogenesis. A considerable clinico-laboratory overlap between T-LGL leukemia associated with rheumatoid arthritis and Felty's syndrome suggests that they are just different eponyms for the same clinical entity. © 2012 Elsevier Inc.

Zanoria S.J.T.,University of Connecticut Health Center | Zuwallack R.,St Francis Hospital and Medical Center
Chronic Respiratory Disease | Year: 2013

Patients with clinically stable chronic obstructive pulmonary disease (COPD) are physically inactive, and this inactivity appears to be an independent predictor of hospitalizations. To explore this relationship further, we compared physical activity of COPD patients assessed in 2008 to subsequent hospitalizations and mortality. Sixty adults with a history of cigarette smoking, a diagnosis of COPD, a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of <0.70, and no recent exacerbation were studied. Physical activity was measured using a triaxial accelerometerworn on the waist for seven consecutive days and the vector magnitude units (VMUs) that are the sum of movements in three planes over each minute were recorded. Those patients with mean VMU < 170 (the median) were considered to be less physically active, and those with a 6-minute walk distance (6MWD) test of <350 m were considered to have lower functional exercise capacity. These two variables, along with age, gender, and a history of exacerbations in the preceding 12 months, FEV1, body mass index, and supplemental oxygen requirement, were related to subsequent all-cause and respiratory-related hospitalizations that occurred over the ensuing 53 ± 2 months. The mean age was 68 ± 11 years, 50% were male, and the FEV1 was 53 ± 19%. All-cause and respiratory-related hospitalizations occurred in 58 and 35%, respectively. A 6MWD < 350 m and VMU < 170 each significantly predicted subsequent all-cause and respiratory-related hospitalizations in univariate Cox proportional hazards analyses after controlling for previous exacerbations. Both 6MWD < 350 m and VMU < 170 counts remained in a multivariate model predicting respiratory-related hospitalization. These results indicate that both directly measured physical activity and functional exercise capacity are important predictors of hospitalization in COPD. © The Author(s) 2013.

Dasanu C.A.,St Francis Hospital And Medical Center
Journal of Oncology Pharmacy Practice | Year: 2012

The incidence of second malignancies was shown to be increased in patients with multiple myeloma. Although a shared genetic predisposition or common environmental carcinogens may account for the occurrence of both myeloma and additional cancers, multiple immune defects encountered in myeloma might play an important role in this regard. This review explores the impairments in both cellular and humoral mediated immunity in multiple myeloma, linking them with increased susceptibility to infections and additional cancers. In addition, the recent therapeutic advances transformed myeloma into a chronic entity, with multiple relapses and salvage therapies, which may result in cumulative immunosuppression. Although recent reports have suggested an increased rate of second cancers in myeloma patients treated with lenalidomide, the true impact of this agent and other novel anti-myeloma therapies on the incidence of additional malignancies remains to be clarified. © The Author(s) 2011.

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