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Subtotal splenectomy appears to control hemolysis while maintaining splenic function. The laparoscopic approach is safe and effective and should be considered the procedure of choice in hereditary microspherocytosis. Laparoscopic subtotal splenectomy presents an advantage over open subtotal splenectomy, resulting in decreased blood loss, shorter hospital stay, no conversions, fewer operative and postoperative complications, and excellent remission rates. On the basis of our experience, the preservation of the lower pole of the spleen seems to be a first-line option for the optimal evaluation of the residual splenic mass.

Background and Objectives: The treatment of chronic lymphocytic leukemia (CLL) has acquired new targeted therapies. In clinical trials, ibrutinib improved outcomes safely. Real-world data called for a reappraisal of ibrutinib strategies. We report on a single center’s experience with ibrutinib monotherapy, aiming to explore the outcomes, tolerability, and prognosis of CLL patients in routine clinical practice. Materials and Methods: Data were collected from all CLL patients treated with ibrutinib at Fundeni Clinical Institute, Bucharest, Romania, between January 2016 and June 2021. Results: A total of one hundred twenty-three CLL adult patients were treated with ibrutinib. Of the patients, 87% had relapsed/refractory CLL. The median age at ibrutinib initiation was 65 years; 44.7% of patients were staged Rai III/IV. At 32-month median follow-up, the median progression-free survival (PFS) was 50 months, the overall survival (OS) was not reached, and the overall response rate (ORR) was 86.2%. The age or number of previous therapies did not impact outcomes or tolerability. An Eastern Cooperative Oncology Group performance status (ECOG PS) score ≥ 2 and shorter time from initiation of last therapy (TILT) before ibrutinib predicted inferior PFS. Baseline characteristics had no impact on the OS except for TILT in R/R CLL patients. Drug-related adverse events (AEs) of any grade and grade ≥ 3 AEs were reported in 82.1% and 30.9% of the patients, respectively. Infections were the most common AEs (29.3%). Drug discontinuation was permanent in 43.9% of patients, mainly due to disease progression (17.1%) and toxicity (8.9%). Patients with a Cumulative Illness Rating Scale (CIRS) score ≥ 6 had a higher risk for toxicity-related discontinuation. An ECOG PS ≥ 2 predicted an increased rate of permanent discontinuation and grade ≥ 3 AEs. Conclusions: The outcomes of this study align with the results from ibrutinib clinical trials. Our study demonstrated that poor patient fitness, early relapse before ibrutinib, and permanent ibrutinib discontinuation are essential outcome determinants. Patient comorbidity burden and fitness were significant predictors for ibrutinib intolerance.

Introducere: Cancerul gastric este rareori cauza unei hemoragii digestive superioare acute. Comorbidităţile pacientului pot avea un efect negativ atât asupra rezultatelor imediate cât şi asupra celor tardive, după rezecţia chirurgicală a unui cancer gastric. Asocierea cancerului gastric cu hemofilia A şi angiodisplazie nu a mai fost raportată până în prezent în literatura de specialitate, iar impactul acestei asocieri asupra rezultatelor postoperatorii este necunoscut. Prezentarea cazului: Un bărbat de 49 de ani, cunoscut cu hemofilie A, se prezintă cu hemoragie digestivă superioară şi anemie secundară severă, fiind diagnosticat cu adenocarcinom gastric. Se practică gastrectomie totală cu splenectomie şi limfodisecţie D2. Evoluţia postoperatorie a fost complicată de apariţia unui nou episod de hemoragie digestivă datorat prezenţei leziunior angiodisplazice la nivelul cecului şi jejunului; episodul de hemoragie digestivă a fost tratat fde această dată, cu success, prin embolizare radiologică. În perioada pre şi postoperatorie pacientul a primit factor VIII, dar a dezvoltat auto-anticorpi împotriva factorului VIII. Astfel, administrarea de factor VIII a fost întreruptă şi înlocuită cu FEIBA ("factor

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