Christus Health is an international Catholic, faith-based, not-for-profit health system comprising almost 350 services and facilities, including more than 60 hospitals and long-term care facilities, 175 clinics and outpatient centers and dozens of other health ministries and ventures. Its corporate headquarters are in Irving, Texas.Christus Health services can be found in 60 cities in Texas, Arkansas, Louisiana, Georgia, and New Mexico in the U.S.; also, in the Pontificia Universidad Católica de Chile Health Network in Santiago, Chile, and Chihuahua, Coahuila, Nuevo León, Puebla, San Luis Potosí, and Tamaulipas in Mexico. The system employs approximately 30,000 people and has more than 9,500 physicians on facility medical staffs who provide care and support for patients. Christus Health is listed among the top ten Catholic health systems in the U.S., and provided more than $313.5 million in total community benefit in Fiscal Year 2011, which equates to more than $858,900 a day in community benefits.
BACKGROUND:Percutaneous epicardial left atrial appendage (LAA) ligation requires a series of steps and ancillary tools and is thus perceived as complex. OBJECTIVE:In this report, we evaluate the feasibility, safety, and effectiveness of a modified approach for LAA ligation. METHODS:This is a retrospective multicenter collection of patients who underwent a modified LAA ligation approach. Using only a pigtail LAA angiogram, the LARIAT snare was guided over the pigtail catheter to perform LAA ligation. Periprocedural and 30-day adverse events were collected. Follow-up imaging was performed 6 weeks‒3 months post ligation to assess for leaks. RESULTS:Overall, 21 centers enrolled 104 patients (aged 71.7 ± 7.2 years; 70% male) who underwent attempted modified LAA ligation. Short-term complete LAA closure was achieved in 96.8% of patients (91/94). LAA ligation failed in 8 patients owing to adhesions. In 2 patients, ligations could not be performed with the modified pigtail approach and were converted to magnet wires, with 1 successful and 1 unsuccessful LAA ligation. The failed LAA ligation was due to a perforation of the magnet wires. There were no periprocedural complications (<7 days). In 3 patients, a delayed inflammatory pericardial effusion developed requiring pericardiocentesis, but 2 of these also underwent combined ablation. Among patients with follow-up imaging (90/104), complete LAA closure was achieved in 95.5% (86/90), and no leaks >3 mm were observed. CONCLUSION:The evolution of the pigtail-only modified LAA ligation approach is feasible, safe, and effective at LAA closure. Future studies are still needed to assess the long-term LAA closure efficacy of this modified LAA ligation approach.
ObjectiveTo review current pharmacologic strategies for Castleman disease (CD), integrating contemporary understanding of disease biology, diagnostic subclassification, and therapeutic approaches across unicentric Castleman disease (UCD); Human Herpesvirus-8 (HHV-8)-associated multicentric Castleman disease (MCD); polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma-cell disorder, skin changes (POEMS)-associated MCD; and idiopathic MCD (iMCD).Data SourcesA comprehensive search of PubMed, Embase, and the Cochrane Library (2000-2025) was performed, supplemented by manual review of references and guidelines from the Castleman Disease Collaborative Network (CDCN), the National Comprehensive Cancer Network (NCCN), and the American Society of Clinical Oncology (ASCO). Included literature encompassed clinical trials, natural-history studies, and mechanistic work relevant to CD.Data SummaryCD represents a biologically heterogeneous spectrum driven largely by dysregulated cytokine signaling, particularly interleukin-6 (IL-6). UCD is typically approached with surgical excision, whereas MCD requires subtype-specific systemic therapy. Rituximab remains the cornerstone of HHV-8-associated MCD. Management of POEMS-associated disease focuses on controlling the plasma-cell clone. In iMCD, IL-6-directed therapies (siltuximab or tocilizumab) represent first-line treatment, often supported by corticosteroids. Subtypes differ biologically: iMCD-idiopathic plasmacytic lymphadenopathy (iMCD-IPL) generally responds well to IL-6 blockade, whereas iMCD with thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly (iMCD-TAFRO) is aggressive and may require early escalation to cyclosporine, rituximab, or chemotherapy. Emerging data showing mTORC1 hyperactivation provide rationale for mTOR inhibition, while case-level responses to JAK-2 inhibitors warrant further study.ConclusionsCD is clinically and biologically diverse. IL-6 blockade, B-cell-directed therapy, and plasma-cell-targeted strategies anchor current management, while mTOR and JAK-2 inhibitors merit investigation in the relapsed/refractory setting.
INTRODUCTION:Adult secondary hemophagocytic lymphohistiocytosis (asHLH) is a fulminant hyperinflammatory condition triggered by cancers, infections, autoimmune conditions or drugs. The hallmark of its pathogenesis involves dysregulated immune effector cell activation and excessive cytokine release. AREAS COVERED:This narrative review updates the reader on modern treatment options for asHLH. The traditional one-size-fits-all strategy derived from the pediatric HLH-2004 protocol is increasingly viewed as outdated today. A significant shift toward a more individualized, trigger- directed treatment approach has occurred in the HLH literature of recent years. EXPERT OPINION:Apart from treating promptly the underlying trigger conditions, earlier incorporation of targeted anti-cytokine therapy such as anakinra is strongly favored these days. The cytotoxic etoposide shall be chiefly reserved for malignancy-associated HLH, including B-cell lymphomas, and refractory disease. Rituximab has led to superior outcomes when utilized to clear EBV-infected B-cell reservoirs. IVIG should be considered in infection-associated HLH. The anti-IFN-γ monoclonal antibody emapalumab has been approved for refractory HLH cases. The JAK 1/2 inhibitor ruxolitinib may prove useful in this space as well. The therapeutic arsenal is likely to evolve further in the direction of agents addressing specific pathophysiologic steps in asHLH. Targeting effector cytokines, their receptors, inflammasome pathways are promising future directions in asHLH therapeutics.
This letter responds to recent correspondence regarding the underwhelming media portrayal of an emergency medicine pharmacist on the television drama The Pitt . Rather than viewing a mundane introduction as a failure of representation, this piece utilizes foundational principles of narrative screenwriting and clinical training to reframe the character’s baseline as a necessary starting point for developmental growth. Using team sports and fine art analogies, the author argues that the modern emergency medicine pharmacist functions as a vital, silent safety net within high-stakes workflows—an essential clinical reality that is inherently non-dramatic on screen. Ultimately, the professional ethos of emergency pharmacy relies on the quiet responsibility of behind-the-scenes precision rather than public applause, aligning perfectly with a narrative trajectory from academic competence to professional entrustment.
