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The wandering spleen: an unusual case of thrombocytopenia
Mirkes C, Nguyen G, Cable C
Journal of Blood Medicine , 2011, DOI: http://dx.doi.org/10.2147/JBM.S24168
Abstract: ndering spleen: an unusual case of thrombocytopenia Case report (2030) Total Article Views Authors: Mirkes C, Nguyen G, Cable C Published Date December 2011 Volume 2011:2 Pages 161 - 163 DOI: http://dx.doi.org/10.2147/JBM.S24168 Curtis Mirkes, George Nguyen, Christian Cable Department of Internal Medicine, Division of Hematology and Oncology, Texas A&M Health Science Center, College of Medicine, Scott & White Healthcare, Temple, TX, USA Abstract: Thrombocytopenia is a common laboratory finding in current medical practices. The workup of thrombocytopenia can be challenging with numerous causes that can be included in the differential diagnosis. Thrombocytopenia can be due to bone marrow hypoproliferation, peripheral destruction, or sequestration. This paper presents a case of isolated thrombocytopenia in a young female and discusses the causes of thrombocytopenia.
The wandering spleen: an unusual case of thrombocytopenia
Mirkes C,Nguyen G,Cable C
Journal of Blood Medicine , 2011,
Abstract: Curtis Mirkes, George Nguyen, Christian CableDepartment of Internal Medicine, Division of Hematology and Oncology, Texas A&M Health Science Center, College of Medicine, Scott & White Healthcare, Temple, TX, USAAbstract: Thrombocytopenia is a common laboratory finding in current medical practices. The workup of thrombocytopenia can be challenging with numerous causes that can be included in the differential diagnosis. Thrombocytopenia can be due to bone marrow hypoproliferation, peripheral destruction, or sequestration. This paper presents a case of isolated thrombocytopenia in a young female and discusses the causes of thrombocytopenia.Keywords: peripheral sequestration, enlarged spleen, congenital, hypertension, hypersplenism, diaphragmatic hernia
Reduced dose maintenance eculizumab in atypical hemolytic uremic syndrome (aHUS): an update on a previous case report
Ohanian M, Cable C, Halka K
Clinical Pharmacology: Advances and Applications , 2011, DOI: http://dx.doi.org/10.2147/CPAA.S23687
Abstract: uced dose maintenance eculizumab in atypical hemolytic uremic syndrome (aHUS): an update on a previous case report Case report (3129) Total Article Views Authors: Ohanian M, Cable C, Halka K Published Date November 2011 Volume 2011:3 Pages 45 - 50 DOI: http://dx.doi.org/10.2147/CPAA.S23687 Maro Ohanian, Christian Cable, Kathleen Halka Department of Hematology/Oncology, Scott & White Healthcare and The Texas A&M Health Science Center, College of Medicine, Temple, TX, USA Objective: To describe how maintenance eculizumab sustains improved renal function in severe atypical hemolytic uremic syndrome (aHUS). Case report: A previously described 50-year-old woman with aHUS had a remarkable recovery with eculizumab, which safely reversed profound neurologic damage and eliminated the need for dialysis. Her recovery has been sustained on long-term eculizumab treatment. She initially received eculizumab 900 mg weekly for four doses. On week 5 she commenced maintenance therapy starting at 1200 mg every 2 weeks. Due to nausea and vomiting at that dose, the maintenance dosing was reduced to 600 mg weekly, beginning on dose seven. After receiving 600 mg weekly for nine doses, eculizumab was then reduced to 600 mg every 2 weeks, with continued improvement in renal function. This dosing is lower than the usual 1200 mg every 2 weeks described in the adult literature and used in current clinical trials of aHUS. Conclusion: Six months after the initial diagnosis, our patient continues to have improved renal function on maintenance doses of eculizumab as low as 600 mg every 2 weeks.
Reduced dose maintenance eculizumab in atypical hemolytic uremic syndrome (aHUS): an update on a previous case report
Ohanian M,Cable C,Halka K
Clinical Pharmacology: Advances and Applications , 2011,
Abstract: Maro Ohanian, Christian Cable, Kathleen Halka Department of Hematology/Oncology, Scott & White Healthcare and The Texas A&M Health Science Center, College of Medicine, Temple, TX, USA Objective: To describe how maintenance eculizumab sustains improved renal function in severe atypical hemolytic uremic syndrome (aHUS). Case report: A previously described 50-year-old woman with aHUS had a remarkable recovery with eculizumab, which safely reversed profound neurologic damage and eliminated the need for dialysis. Her recovery has been sustained on long-term eculizumab treatment. She initially received eculizumab 900 mg weekly for four doses. On week 5 she commenced maintenance therapy starting at 1200 mg every 2 weeks. Due to nausea and vomiting at that dose, the maintenance dosing was reduced to 600 mg weekly, beginning on dose seven. After receiving 600 mg weekly for nine doses, eculizumab was then reduced to 600 mg every 2 weeks, with continued improvement in renal function. This dosing is lower than the usual 1200 mg every 2 weeks described in the adult literature and used in current clinical trials of aHUS. Conclusion: Six months after the initial diagnosis, our patient continues to have improved renal function on maintenance doses of eculizumab as low as 600 mg every 2 weeks. Keywords: eculizumab, aHUS, thrombotic microangiopathy, atypical hemolytic uremic syndrome
Quasi-Kernels for Oriented Paths and Cycles  [PDF]
Stephen Bowser, Charles Cable
Open Journal of Discrete Mathematics (OJDM) , 2012, DOI: 10.4236/ojdm.2012.22010
Abstract: If D is a digraph, then K∈V(D) is a quasi-kernel of D if D［K］is discrete and for each y∈V(D)－K there is x∈K such that the directed distance from y to x is less than three. We give formulae for the number of quasi-kernels and for the number of minimal quasi-kernels of oriented paths and cycles.
Mantle cell leukemia as a cause of leukostasis
Smith D,Cable C,Chisholm C,Linz W
Blood and Lymphatic Cancer: Targets and Therapy , 2011,
Abstract: Daniel Smith1, Christian Cable2, Cary Chisholm1, Walter Linz1, William Koss1, Sheila Dobin1, Edward Rappaport11Department of Pathology, 2Internal Medicine, Scott and White Healthcare/Texas A & M Health Science Center College of Medicine, Temple, TX, USAAbstract: A 72-year-old man was admitted with hypoxemic respiratory distress. Given a white blood cell count of 600 × 109/L and symptoms of leukostasis, emergency leukapheresis was initiated. The white blood cell count immediately after the first leukapheresis was paradoxically increased to over 700 × 109/L. Peripheral blood smear findings showed morphologically immature mononuclear cells and numerous circulating mitotic figures. Initial flow cytometry results showed a lambda light chain-restricted B lymphoid population positive for CD20, CD19, CD5, and FMC-7, and negative for TdT, CD10, CD23, CD34, CD117, and myeloid markers, suggesting classification as a blastoid variant of mantle cell lymphoma in a leukemic phase. Subsequent testing using DNA fluorescence in situ hybridization was positive for t(11;14), confirming the diagnosis of mantle cell leukemia. Although mantle cell lymphoma occasionally transforms or can even present as leukemia (leukocytes >40 × 109/L), it is rare for it to present with such profound leukocytosis and an overwhelming number of pleomorphic/blastoid forms. Although morphology suggested acute lymphoblastic leukemia, a more specific diagnosis of blastoid variant mantle cell lymphoma was obtained in 12 hours by applying complementary techniques of flow cytometry and rapid cytogenetics.Keywords: mantle cell lymphoma, chemotherapy, leukapheresis, lymphocytic leukemia
Leptomeningeal myelomatosis in previously treated high-risk kappa light chain multiple myeloma: case report and literature review
Ohanian M, Alaly J, Samuel S, Cable C, Halka K
Blood and Lymphatic Cancer: Targets and Therapy , 2011, DOI: http://dx.doi.org/10.2147/BLCTT.S22703
Abstract: omeningeal myelomatosis in previously treated high-risk kappa light chain multiple myeloma: case report and literature review Case report (2741) Total Article Views Authors: Ohanian M, Alaly J, Samuel S, Cable C, Halka K Published Date September 2011 Volume 2011:1 Pages 9 - 18 DOI: http://dx.doi.org/10.2147/BLCTT.S22703 Maro Ohanian1, James Alaly2, Stephen Samuel3, Christian Cable1, Kathleen Halka1 1Department of Hematology/Oncology, 2Department of Radiology, 3Department of Hematopathology, Scott and White Healthcare, The Texas A&M Health Science Center College of Medicine, Temple, Texas, USA Objective: To describe leptomeningeal myelomatosis (LM) in previously treated high-risk kappa light chain multiple myeloma (MM) and to review the literature. Case report: A 71-year-old female with previously treated kappa light chain myeloma presented with right lumbosacral discomfort. Magnetic resonance imaging (MRI) of spine revealed multiple intradural masses involving the cauda equina, with mass effect on adjacent nerve roots. Brain MRI was unremarkable. Cerebrospinal fluid flow cytometry confirmed an abnormal population of plasma cells with kappa restriction; CD38, CD138, and CD56 were positive. She was originally diagnosed with kappa light chain myeloma 10 months earlier while hospitalized for anemia, thrombocytopenia, renal failure, and hypercalcemia. Bone marrow revealed plasma cell myeloma approaching 100% cellularity, with 92% plasma cells, atypical plasmacytoid cells with prominent nucleoli, and significant cytogenetic abnormalities: deleted 13, c-myc rearrangements, -X, +1. Treatments consisted of seven cycles of bortezomib with weekly dexamethasone. Her last dose had been 4 months earlier. After treatment, bone marrow demonstrated a complete remission with normal cytogenetics. Her clinical course had otherwise been indolent with a good hematologic response. After diagnosis of LM, therapy included focal external beam radiation to the cauda equina, weekly bortezomib and dexamethasone, intrathecal (IT) cytarabine liposomal every 2 weeks for five doses, and monthly IT cytarabine liposomal thereafter. The cerebrospinal fluid gradually cleared on serial lumbar punctures and follow-up MRI demonstrated near complete resolution of the intradural masses. Five months after diagnosis the patient is essentially asymptomatic. Conclusion: The incidence of central nervous system (CNS) involvement in MM patients is 1%. LM is associated with cytogenetic abnormalities and plasmablastic morphology. It can occur with a seemingly low tumor burden. Novel agents such as bortezomib allow for prolonged survival in high-risk patients; however, with inadequate CNS penetration, complications such as LM may be inevitable.
Leptomeningeal myelomatosis in previously treated high-risk kappa light chain multiple myeloma: case report and literature review
Ohanian M,Alaly J,Samuel S,Cable C
Blood and Lymphatic Cancer: Targets and Therapy , 2011,
Abstract: Maro Ohanian1, James Alaly2, Stephen Samuel3, Christian Cable1, Kathleen Halka11Department of Hematology/Oncology, 2Department of Radiology, 3Department of Hematopathology, Scott and White Healthcare, The Texas A&M Health Science Center College of Medicine, Temple, Texas, USAObjective: To describe leptomeningeal myelomatosis (LM) in previously treated high-risk kappa light chain multiple myeloma (MM) and to review the literature.Case report: A 71-year-old female with previously treated kappa light chain myeloma presented with right lumbosacral discomfort. Magnetic resonance imaging (MRI) of spine revealed multiple intradural masses involving the cauda equina, with mass effect on adjacent nerve roots. Brain MRI was unremarkable. Cerebrospinal fluid flow cytometry confirmed an abnormal population of plasma cells with kappa restriction; CD38, CD138, and CD56 were positive. She was originally diagnosed with kappa light chain myeloma 10 months earlier while hospitalized for anemia, thrombocytopenia, renal failure, and hypercalcemia. Bone marrow revealed plasma cell myeloma approaching 100% cellularity, with 92% plasma cells, atypical plasmacytoid cells with prominent nucleoli, and significant cytogenetic abnormalities: deleted 13, c-myc rearrangements, -X, +1. Treatments consisted of seven cycles of bortezomib with weekly dexamethasone. Her last dose had been 4 months earlier. After treatment, bone marrow demonstrated a complete remission with normal cytogenetics. Her clinical course had otherwise been indolent with a good hematologic response. After diagnosis of LM, therapy included focal external beam radiation to the cauda equina, weekly bortezomib and dexamethasone, intrathecal (IT) cytarabine liposomal every 2 weeks for five doses, and monthly IT cytarabine liposomal thereafter. The cerebrospinal fluid gradually cleared on serial lumbar punctures and follow-up MRI demonstrated near complete resolution of the intradural masses. Five months after diagnosis the patient is essentially asymptomatic.Conclusion: The incidence of central nervous system (CNS) involvement in MM patients is 1%. LM is associated with cytogenetic abnormalities and plasmablastic morphology. It can occur with a seemingly low tumor burden. Novel agents such as bortezomib allow for prolonged survival in high-risk patients; however, with inadequate CNS penetration, complications such as LM may be inevitable.Keywords: leptomeningeal myelomatosis, intrathecal, complete remission
Newly diagnosed congenital factor VII deficiency and utilization of recombinant activated factor VII (NovoSeven®)
Bartosh NS,Tomlin T,Cable C,Halka K
Clinical Pharmacology: Advances and Applications , 2013,
Abstract: Nicole S Bartosh, Tara Tomlin, Christian Cable, Kathleen HalkaDepartment of Internal Medicine, Division of Medical Oncology, Scott and White Healthcare and Texas A and M Health Science Center College of Medicine, Temple, TX, USAAbstract: This case report presents a newly diagnosed congenital factor VII deficiency treated with recombinant activated factor VII (rFVIIa). Congenital factor VII deficiency is a rare autosomal-recessive bleeding disorder that occurs in fewer than 1/500,000 persons. Its presentation can vary from epistaxis to hemarthroses and severe central nervous system bleeding, and correlates poorly with factor VII levels. Our patient had not had a significant hemostatic challenge prior to his presentation and therefore never had any symptomatology suggestive of this disease. He was treated with rFVIIa, and was able to undergo repair of his fractures without bleeding.Case report: A 19-year-old African-American male presented to the emergency room after an altercation that resulted in significant trauma. He sustained bilateral mandibular angle fractures and orbital floor fractures, requiring urgent surgical correction. On initial evaluation, he was noted to have a prolonged prothrombin time of 40.1 seconds, with an International Normalized Ratio of 4.0, a normal activated partial thromboplastin time of 29.9 seconds, and a platelet count of 241. After receiving vitamin K and fresh frozen plasma, he was taken to the operating room for a temporary rigid maxillomandibular fixation. A 1:1 mixing study with normal plasma corrected the prothrombin time (decreasing from 40.7 to 14.7 seconds) and a factor VII assay revealed 5% of the normal factor VII level. The patient was diagnosed with congenital factor VII deficiency. Due to his coagulopathy and the extensive surgical correction needed, rFVIIa was administered and surgery was accomplished without hemorrhagic sequelae.Conclusion: This case report and review describes a rare congenital disease, the history of rFVIIa use, and its mechanism. rFVIIA use in our patient provided a treatment option that allowed the necessary surgical correction, but further prospective studies on dose optimization would ensure adequate dosing with minimal risk of severe side effects.Keywords: factor VII deficiency, recombinant activated factor VII, coagulation cascade
Comparison of bromfenac 0.09% QD to nepafenac 0.1% TID after cataract surgery: pilot evaluation of visual acuity, macular volume, and retinal thickness at a single site
Cable M
Clinical Ophthalmology , 2012, DOI: http://dx.doi.org/10.2147/OPTH.S32179
Abstract: mparison of bromfenac 0.09% QD to nepafenac 0.1% TID after cataract surgery: pilot evaluation of visual acuity, macular volume, and retinal thickness at a single site Original Research (2250) Total Article Views Authors: Cable M Published Date July 2012 Volume 2012:6 Pages 997 - 1004 DOI: http://dx.doi.org/10.2147/OPTH.S32179 Received: 24 March 2012 Accepted: 24 April 2012 Published: 02 July 2012 Melissa Cable Discover Vision Centers, Independence, MO, USA Purpose: The purpose of this study was to investigate the clinical outcomes of bromfenac ophthalmic solution 0.09% once daily (QD) and nepafenac 0.1% ophthalmic suspension three times daily following cataract extraction with posterior chamber intraocular lens implantation, specifically looking at any differences in Early Treatment Diabetic Retinopathy Study visual acuities, macular volume, and/or retinal thickness changes. Methods: Subjects were randomly assigned to receive either bromfenac (n = 10) QD or nepafenac (n = 10) three times daily. Dosing began 3 days before cataract surgery, continuing to day 21 postsurgery. In addition to the investigated nonsteroidal antiinflammatory drug regimen, all subjects received antiinfective intraoperative and postoperative standard of care. Subjects were followed at 1 day and 1, 3, and 6 weeks postoperatively. Study visit assessments included best-corrected visual acuity, biomicroscopy, summed ocular inflammation score (anterior chamber cells and flare grading), intraocular pressure measurement, adverse event recording, and concomitant medication review. Optical coherence tomography was performed at 1, 3, and 6 weeks. Results: Both treatment groups had similar baseline measurements. Outcomes for mean letters read (P = 0.318), mean change in macular volume (P = 0.665), and retinal thickness (P = 0.552) were not statistically different between the groups from baseline through week six, although independently only the bromfenac group demonstrated a statistically significant improvement in letters gained from baseline to week six (P = 0.040). In the same time period, mean macular volume and retinal thickening worsened in the nepafenac group, demonstrating a statistically significant increase (P = 0.006) at week six for macular volume when compared to baseline. One subject in the nepafenac group experienced recurrent inflammation at week six, was unmasked, and then rescued with bromfenac 0.09% QD and difluprednate 0.05% QD. Conclusion: Both bromfenac and nepafenac resulted in positive clinical outcomes of Early Treatment Diabetic Retinopathy Study visual acuities. Postoperative measurements of macular volume and retinal thickness of bromfenac subjects showed a trend toward improved vision, less retinal thickening, and more stable macular volumes overall.
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