AZ304, a novel dual BRAF inhibitor, exerts anti-tumour effects in colorectal cancer independently of BRAF genetic status

AZ304, a novel dual BRAF inhibitor, exerts anti-tumour effects in colorectal cancer independently of BRAF genetic status

AZ304, a novel dual BRAF inhibitor, exerts anti-tumour effects in colorectal cancer independently of BRAF genetic status, Published online: 14 May 2018; doi:10.1038/s41416-018-0086-x

AZ304, a novel dual BRAF inhibitor, exerts anti-tumour effects in colorectal cancer independently of BRAF genetic status

from Cancer via ola Kala on Inoreader https://ift.tt/2wDeO0X
via IFTTT

Predictive potential of tumour-stroma ratio on benefit from adjuvant bevacizumab in high-risk stage II and stage III colon cancer

Predictive potential of tumour-stroma ratio on benefit from adjuvant bevacizumab in high-risk stage II and stage III colon cancer

Predictive potential of tumour-stroma ratio on benefit from adjuvant bevacizumab in high-risk stage II and stage III colon cancer, Published online: 14 May 2018; doi:10.1038/s41416-018-0083-0

Predictive potential of tumour-stroma ratio on benefit from adjuvant bevacizumab in high-risk stage II and stage III colon cancer

from Cancer via ola Kala on Inoreader https://ift.tt/2Kg8OgL
via IFTTT

Tumour mutation status and melanoma recurrence following a negative sentinel lymph node biopsy

Tumour mutation status and melanoma recurrence following a negative sentinel lymph node biopsy

Tumour mutation status and melanoma recurrence following a negative sentinel lymph node biopsy, Published online: 14 May 2018; doi:10.1038/s41416-018-0088-8

Tumour mutation status and melanoma recurrence following a negative sentinel lymph node biopsy

from Cancer via ola Kala on Inoreader https://ift.tt/2IF7Ayv
via IFTTT

Health-related quality of life after treatment for bladder cancer in England

Health-related quality of life after treatment for bladder cancer in England

Health-related quality of life after treatment for bladder cancer in England, Published online: 14 May 2018; doi:10.1038/s41416-018-0084-z

Health-related quality of life after treatment for bladder cancer in England

from Cancer via ola Kala on Inoreader https://ift.tt/2wBGqUe
via IFTTT

Heterogeneous MYCN amplification in neuroblastoma: a SIOP Europe Neuroblastoma Study

Heterogeneous MYCN amplification in neuroblastoma: a SIOP Europe Neuroblastoma Study

Heterogeneous <i>MYCN</i> amplification in neuroblastoma: a SIOP Europe Neuroblastoma Study, Published online: 14 May 2018; doi:10.1038/s41416-018-0098-6

Heterogeneous MYCN amplification in neuroblastoma: a SIOP Europe Neuroblastoma Study

from Cancer via ola Kala on Inoreader https://ift.tt/2wCbe7w
via IFTTT

Endothelial Akt1 loss promotes prostate cancer metastasis via β-catenin-regulated tight-junction protein turnover

Endothelial Akt1 loss promotes prostate cancer metastasis via β-catenin-regulated tight-junction protein turnover

Endothelial Akt1 loss promotes prostate cancer metastasis via β-catenin-regulated tight-junction protein turnover, Published online: 14 May 2018; doi:10.1038/s41416-018-0110-1

Endothelial Akt1 loss promotes prostate cancer metastasis via β-catenin-regulated tight-junction protein turnover

from Cancer via ola Kala on Inoreader https://ift.tt/2IB9TCJ
via IFTTT

Safety, anti-tumour activity, and pharmacokinetics of fixed-dose SHR-1210, an anti-PD-1 antibody in advanced solid tumours: a dose-escalation, phase 1 study

Safety, anti-tumour activity, and pharmacokinetics of fixed-dose SHR-1210, an anti-PD-1 antibody in advanced solid tumours: a dose-escalation, phase 1 study

Safety, anti-tumour activity, and pharmacokinetics of fixed-dose SHR-1210, an anti-PD-1 antibody in advanced solid tumours: a dose-escalation, phase 1 study, Published online: 14 May 2018; doi:10.1038/s41416-018-0100-3

Safety, anti-tumour activity, and pharmacokinetics of fixed-dose SHR-1210, an anti-PD-1 antibody in advanced solid tumours: a dose-escalation, phase 1 study

from Cancer via ola Kala on Inoreader https://ift.tt/2IGovRr
via IFTTT

Tumour buds determine prognosis in resected pancreatic ductal adenocarcinoma

Tumour buds determine prognosis in resected pancreatic ductal adenocarcinoma

Tumour buds determine prognosis in resected pancreatic ductal adenocarcinoma, Published online: 14 May 2018; doi:10.1038/s41416-018-0093-y

Tumour buds determine prognosis in resected pancreatic ductal adenocarcinoma

from Cancer via ola Kala on Inoreader https://ift.tt/2IBHWL8
via IFTTT

AZ304, a novel dual BRAF inhibitor, exerts anti-tumour effects in colorectal cancer independently of BRAF genetic status

AZ304, a novel dual BRAF inhibitor, exerts anti-tumour effects in colorectal cancer independently of BRAF genetic status

AZ304, a novel dual BRAF inhibitor, exerts anti-tumour effects in colorectal cancer independently of BRAF genetic status, Published online: 14 May 2018; doi:10.1038/s41416-018-0086-x

AZ304, a novel dual BRAF inhibitor, exerts anti-tumour effects in colorectal cancer independently of BRAF genetic status

https://ift.tt/2wDeO0X

Predictive potential of tumour-stroma ratio on benefit from adjuvant bevacizumab in high-risk stage II and stage III colon cancer

Predictive potential of tumour-stroma ratio on benefit from adjuvant bevacizumab in high-risk stage II and stage III colon cancer

Predictive potential of tumour-stroma ratio on benefit from adjuvant bevacizumab in high-risk stage II and stage III colon cancer, Published online: 14 May 2018; doi:10.1038/s41416-018-0083-0

Predictive potential of tumour-stroma ratio on benefit from adjuvant bevacizumab in high-risk stage II and stage III colon cancer

https://ift.tt/2Kg8OgL

Tumour mutation status and melanoma recurrence following a negative sentinel lymph node biopsy

Tumour mutation status and melanoma recurrence following a negative sentinel lymph node biopsy

Tumour mutation status and melanoma recurrence following a negative sentinel lymph node biopsy, Published online: 14 May 2018; doi:10.1038/s41416-018-0088-8

Tumour mutation status and melanoma recurrence following a negative sentinel lymph node biopsy

https://ift.tt/2IF7Ayv

Health-related quality of life after treatment for bladder cancer in England

Health-related quality of life after treatment for bladder cancer in England

Health-related quality of life after treatment for bladder cancer in England, Published online: 14 May 2018; doi:10.1038/s41416-018-0084-z

Health-related quality of life after treatment for bladder cancer in England

https://ift.tt/2wBGqUe

Heterogeneous MYCN amplification in neuroblastoma: a SIOP Europe Neuroblastoma Study

Heterogeneous MYCN amplification in neuroblastoma: a SIOP Europe Neuroblastoma Study

Heterogeneous <i>MYCN</i> amplification in neuroblastoma: a SIOP Europe Neuroblastoma Study, Published online: 14 May 2018; doi:10.1038/s41416-018-0098-6

Heterogeneous MYCN amplification in neuroblastoma: a SIOP Europe Neuroblastoma Study

https://ift.tt/2wCbe7w

Endothelial Akt1 loss promotes prostate cancer metastasis via β-catenin-regulated tight-junction protein turnover

Endothelial Akt1 loss promotes prostate cancer metastasis via β-catenin-regulated tight-junction protein turnover

Endothelial Akt1 loss promotes prostate cancer metastasis via β-catenin-regulated tight-junction protein turnover, Published online: 14 May 2018; doi:10.1038/s41416-018-0110-1

Endothelial Akt1 loss promotes prostate cancer metastasis via β-catenin-regulated tight-junction protein turnover

https://ift.tt/2IB9TCJ

Safety, anti-tumour activity, and pharmacokinetics of fixed-dose SHR-1210, an anti-PD-1 antibody in advanced solid tumours: a dose-escalation, phase 1 study

Safety, anti-tumour activity, and pharmacokinetics of fixed-dose SHR-1210, an anti-PD-1 antibody in advanced solid tumours: a dose-escalation, phase 1 study

Safety, anti-tumour activity, and pharmacokinetics of fixed-dose SHR-1210, an anti-PD-1 antibody in advanced solid tumours: a dose-escalation, phase 1 study, Published online: 14 May 2018; doi:10.1038/s41416-018-0100-3

Safety, anti-tumour activity, and pharmacokinetics of fixed-dose SHR-1210, an anti-PD-1 antibody in advanced solid tumours: a dose-escalation, phase 1 study

https://ift.tt/2IGovRr

Tumour buds determine prognosis in resected pancreatic ductal adenocarcinoma

Tumour buds determine prognosis in resected pancreatic ductal adenocarcinoma

Tumour buds determine prognosis in resected pancreatic ductal adenocarcinoma, Published online: 14 May 2018; doi:10.1038/s41416-018-0093-y

Tumour buds determine prognosis in resected pancreatic ductal adenocarcinoma

https://ift.tt/2IBHWL8

Aggressive fibromatosis response to tamoxifen: lack of correlation between MRI and symptomatic response

Abstract

Background

One of the commonly used systemic agents for the treatment of aggressive fibromatosis is the anti-oestrogen drug tamoxifen. However, data on efficacy and optimum methods of response assessment are limited, consisting mainly of small case series and reports.

Methods

A retrospective database was used to identify consecutive patients diagnosed with aggressive fibromatosis (AF) and treated with tamoxifen plus/minus non-steroidal anti-inflammatory drugs at our tertiary referral centre between 2007 and 2014. MRI and symptom changes were recorded.

Results

Thirty-two patients (13 male 19 female, median age 41 years) were included. Median duration of treatment with tamoxifen was 316 days. Of 9 patients with progressive disease by RECIST 1.1 (28%): 4 patients experienced worsening symptoms; 3 patients had improved symptoms and 2 had no change in symptoms. Of 22 patients with stable disease (69%): 11 had no change in symptoms; 6 had improved symptoms and 5 patients had worsening symptoms. One patient achieved a partial response with improved symptoms.

Conclusions

No relationship was identified between symptomatic benefit and response by RECIST 1.1 on MRI. Prospective studies in AF should incorporate endpoints focusing on patient symptoms.

https://ift.tt/2rEkAdb

Aggressive fibromatosis response to tamoxifen: lack of correlation between MRI and symptomatic response

Abstract

Background

One of the commonly used systemic agents for the treatment of aggressive fibromatosis is the anti-oestrogen drug tamoxifen. However, data on efficacy and optimum methods of response assessment are limited, consisting mainly of small case series and reports.

Methods

A retrospective database was used to identify consecutive patients diagnosed with aggressive fibromatosis (AF) and treated with tamoxifen plus/minus non-steroidal anti-inflammatory drugs at our tertiary referral centre between 2007 and 2014. MRI and symptom changes were recorded.

Results

Thirty-two patients (13 male 19 female, median age 41 years) were included. Median duration of treatment with tamoxifen was 316 days. Of 9 patients with progressive disease by RECIST 1.1 (28%): 4 patients experienced worsening symptoms; 3 patients had improved symptoms and 2 had no change in symptoms. Of 22 patients with stable disease (69%): 11 had no change in symptoms; 6 had improved symptoms and 5 patients had worsening symptoms. One patient achieved a partial response with improved symptoms.

Conclusions

No relationship was identified between symptomatic benefit and response by RECIST 1.1 on MRI. Prospective studies in AF should incorporate endpoints focusing on patient symptoms.

from Cancer via ola Kala on Inoreader https://ift.tt/2rEkAdb
via IFTTT

Significance and implications of FDA approval of pembrolizumab for biomarker-defined disease

Abstract

The U.S. Food and Drug Administration (FDA) recently approved pembrolizumab, an anti- programmed cell death protein 1 cancer immunotherapeutic, for use in advanced solid tumors in patients with the microsatellite-high/DNA mismatch repair-deficient biomarker. This is the first example of a tissue-agnostic FDA approval of a treatment based on a patient's tumor biomarker status, rather than on tumor histology. Here we discuss key issues and implications arising from the biomarker-based disease classification implied by this historic approval.

https://ift.tt/2KYkbv1

Significance and implications of FDA approval of pembrolizumab for biomarker-defined disease

Abstract

The U.S. Food and Drug Administration (FDA) recently approved pembrolizumab, an anti- programmed cell death protein 1 cancer immunotherapeutic, for use in advanced solid tumors in patients with the microsatellite-high/DNA mismatch repair-deficient biomarker. This is the first example of a tissue-agnostic FDA approval of a treatment based on a patient's tumor biomarker status, rather than on tumor histology. Here we discuss key issues and implications arising from the biomarker-based disease classification implied by this historic approval.

from Cancer via ola Kala on Inoreader https://ift.tt/2KYkbv1
via IFTTT

AZ304, a novel dual BRAF inhibitor, exerts anti-tumour effects in colorectal cancer independently of BRAF genetic status

from Cancer via ola Kala on Inoreader https://ift.tt/2IDgY5v
via IFTTT

Predictive potential of tumour-stroma ratio on benefit from adjuvant bevacizumab in high-risk stage II and stage III colon cancer

from Cancer via ola Kala on Inoreader https://ift.tt/2KmuPKZ
via IFTTT

Tumour mutation status and melanoma recurrence following a negative sentinel lymph node biopsy

from Cancer via ola Kala on Inoreader https://ift.tt/2IAs1wu
via IFTTT

Health-related quality of life after treatment for bladder cancer in England

from Cancer via ola Kala on Inoreader https://ift.tt/2wExHRd
via IFTTT

Heterogeneous MYCN amplification in neuroblastoma: a SIOP Europe Neuroblastoma Study

from Cancer via ola Kala on Inoreader https://ift.tt/2IB9JLD
via IFTTT

Endothelial Akt1 loss promotes prostate cancer metastasis via β-catenin-regulated tight-junction protein turnover

from Cancer via ola Kala on Inoreader https://ift.tt/2wD4Htn
via IFTTT

Safety, anti-tumour activity, and pharmacokinetics of fixed-dose SHR-1210, an anti-PD-1 antibody in advanced solid tumours: a dose-escalation, phase 1 study

from Cancer via ola Kala on Inoreader https://ift.tt/2IDyLtr
via IFTTT

Tumour buds determine prognosis in resected pancreatic ductal adenocarcinoma

from Cancer via ola Kala on Inoreader https://ift.tt/2wD4wyd
via IFTTT

AZ304, a novel dual BRAF inhibitor, exerts anti-tumour effects in colorectal cancer independently of BRAF genetic status

https://ift.tt/2IDgY5v

Predictive potential of tumour-stroma ratio on benefit from adjuvant bevacizumab in high-risk stage II and stage III colon cancer

https://ift.tt/2KmuPKZ

Tumour mutation status and melanoma recurrence following a negative sentinel lymph node biopsy

https://ift.tt/2IAs1wu

Health-related quality of life after treatment for bladder cancer in England

https://ift.tt/2wExHRd

Heterogeneous MYCN amplification in neuroblastoma: a SIOP Europe Neuroblastoma Study

https://ift.tt/2IB9JLD

Endothelial Akt1 loss promotes prostate cancer metastasis via β-catenin-regulated tight-junction protein turnover

https://ift.tt/2wD4Htn

Safety, anti-tumour activity, and pharmacokinetics of fixed-dose SHR-1210, an anti-PD-1 antibody in advanced solid tumours: a dose-escalation, phase 1 study

https://ift.tt/2IDyLtr

Tumour buds determine prognosis in resected pancreatic ductal adenocarcinoma

https://ift.tt/2wD4wyd

A 37-year-old Nigerian woman with Apert syndrome – medical and psychosocial perspectives: a case report

Apert syndrome is a rare genetic disease that presents a diagnostic dilemma because of its similarity with other craniosynostosis syndromes. Currently, there is paucity of reports about adult patients in Afric...

https://ift.tt/2rFAxjc

In Response

No abstract available

https://ift.tt/2rDkpzy

A Contemporary Analysis of Medicolegal Issues in Obstetric Anesthesia Between 2005 and 2015

BACKGROUND: Detailed reviews of closed malpractice claims have provided insights into the most common events resulting in litigation and helped improve anesthesia care. In the past 10 years, there have been multiple safety advancements in the practice of obstetric anesthesia. We investigated the relationship among contributing factors, patient injuries, and legal outcome by analyzing a contemporary cohort of closed malpractice claims where obstetric anesthesiology was the principal defendant. METHODS: The Controlled Risk Insurance Company (CRICO) is the captive medical liability insurer of the Harvard Medical Institutions that, in collaboration with other insurance companies and health care entities, contributes to the Comparative Benchmark System database for research purposes. We reviewed all (N = 106) closed malpractice cases related to obstetric anesthesia between 2005 and 2015 and compared the following classes of injury: maternal death and brain injury, neonatal death and brain injury, maternal nerve injury, and maternal major and minor injury. In addition, settled claims were compared to the cases that did not receive payment. χ2, analysis of variance, Student t test, and Kruskal-Wallis tests were used for comparison between the different classes of injury. RESULTS: The largest number of claims, 54.7%, involved maternal nerve injury; 77.6% of these claims did not receive any indemnity payment. Cases involving maternal death or brain injury comprised 15.1% of all cases and were more likely to receive payment, especially in the high range (P = .02). The most common causes of maternal death or brain injury were high neuraxial blocks, embolic events, and failed intubation. Claims for maternal major and minor injury were least likely to receive payment (P = .02) and were most commonly (34.8%) associated with only emotional injury. Compared to the dropped/denied/dismissed claims, settled claims more frequently involved general anesthesia (P = .03), were associated with delays in care (P = .005), and took longer to resolve (3.2 vs 1.3 years; P

https://ift.tt/2wCkbO4

The Perioperative Care of the Transgender Patient

An estimated 25 million people identify as transgender worldwide, approximately 1 million of whom reside in the United States. The increasing visibility and acceptance of transgender people makes it likely that they will present in general surgical settings; therefore, perioperative health care providers must develop the knowledge and skills requisite for the safe management of transgender patients in the perioperative setting. Extant guidelines, such as those published by the World Professional Association for Transgender Health and the University of California San Francisco Center of Excellence for Transgender Health, serve as critical resources to those caring for transgender patients; however, they do not address their unique perioperative needs. It is essential that anesthesia providers develop the knowledge and skills necessary for safely managing transgender patients in the perioperative setting. This review provides an overview of relevant terminology, the imperative for the provision of culturally sensitive care, and guidelines for preoperative, intraoperative, and postoperative management of the transgender patient. Accepted for publication February 27, 2018 Funding: This research was funded in part through the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748. The authors declare no conflicts of interest. All authors were substantial contributors to the conception of the article, were active participants in the drafting and revision of the article, approved the final version of the article, and agree to be accountable for all aspects of the work. Enhancing the QUAlity and Transparency Of health Research (EQUATOR) guidelines: This article adheres to the appropriate EQUATOR guidelines Standards for QUality Improvement Reporting Excellence (SQUIRE) 2.0. Reprints will not be available from the authors. Address correspondence to Luis Etienne Tollinche, MD, FASA, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065. Address e-mail to tollincl@mskcc.org. © 2018 International Anesthesia Research Society

https://ift.tt/2rEgUZA

Effects of Intraoperative Opioid Use on Recurrence-Free and Overall Survival in Patients With Esophageal Adenocarcinoma and Squamous Cell Carcinoma

BACKGROUND: Perioperative opioid use is associated with poor survival in patients with esophageal squamous cell carcinoma. The most common histological type of esophageal cancer in western countries is adenocarcinoma. The objective of this study was to evaluate the association between intraoperative opioid consumption and survival in patients with adenocarcinoma and squamous cell carcinoma of the esophagus. METHODS: Records of patients who had undergone esophageal cancer surgery between January 2000 and January 2017 were reviewed. Comparisons were made between patients who received high versus low intraoperative doses of opioids. Groups were divided using the recursive partitioning method. Multicovariate Cox proportional hazards models were fitted to evaluate the impact of intraoperative opioid use on recurrence-free survival (RFS) and overall survival (OS). RESULTS: For patients with esophageal squamous cell carcinoma, the univariable analysis indicated that lower opioid dosages (

https://ift.tt/2KlbeuH

Misconceptions Surrounding Penicillin Allergy: Implications for Anesthesiologists

Administration of preoperative antimicrobial prophylaxis, often with a cephalosporin, is the mainstay of surgical site infection prevention guidelines. Unfortunately, due to prevalent misconceptions, patients labeled as having a penicillin allergy often receive alternate and less-effective antibiotics, placing them at risk of a variety of adverse effects including increased morbidity and higher risk of surgical site infection. The perioperative physician should ascertain the nature of previous reactions to aid in determining the probability of the prevalence of a true allergy. Penicillin allergy testing may be performed but may not be feasible in the perioperative setting. Current evidence on the structural determinants of penicillin and cephalosporin allergies refutes the misconception of cross-reactivity between penicillins and cefazolin, and there is no clear evidence of an increased risk of anaphylaxis in cefazolin-naive, penicillin-allergic patients. A clinical practice algorithm for the perioperative evaluation and management of patients reporting a history of penicillin allergy is presented, concluding that cephalosporins can be safely administered to a majority of such patients. Accepted for publication March 30, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Leon Vorobeichik, MD, Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Room M3-200, Toronto, ON M4N 3M5, Canada. Address e-mail to l.vorobeichik@mail.utoronto.ca. © 2018 International Anesthesia Research Society

https://ift.tt/2rFkFxW

A modified CO2/O2 Guedel airway improves capnographic accuracy compared with a CO2/O2 nasal cannula: An infant manikin study

BACKGROUND Capnography via a CO2/O2 nasal cannula is commonly used for respiratory monitoring during sedation. However, signal disturbances are frequently encountered, especially in young children. OBJECTIVE Sampling ports placed closer to the trachea have been shown to result in improved signal quality. In a manikin model of a 6-month-old infant we compared capnography from a modified Guedel airway with a CO2 port located at the tip with that from a CO2/O2 nasal cannula. DESIGN A comparison study using an artificial model of a breathing 6-month-old infant. SETTING Department of Paediatrics, Inselspital Bern, Switzerland, from March 2016 to June 2016. MATERIAL Modified CO2/O2 Guedel airway. INTERVENTIONS Capnography using a modified CO2/O2 Guedel airway or a CO2/O2 nasal cannula was performed for tidal volumes of 20 to 80 ml (in steps of 20 ml), respiratory rates of 20 to 60 min−1 (in steps of 10 min−1) and with different O2 flows (0 to 2 l min−1, in steps of 0.5 l). MAIN OUTCOME MEASURES Comparison of differences between tracheal and device CO2. Secondary outcomes included the effect of various respiratory settings and O2 flows on the CO2 difference. RESULTS The tracheal to device CO2 difference was significantly smaller when using a modified CO2/O2 Guedel airway vs. a CO2/O2 nasal cannula: Mean ± SD, 16.8 ± 4.9 vs. 24.1 ± 5.9 mmHg, P less than 0.0001. An O2 flow of 0.5 to 2 l min−1 did not influence the tracheal to device CO2 difference with the modified CO2/O2 Guedel airway in contrast to the CO2/O2 nasal cannula where there were significant differences (P 

https://ift.tt/2rFYneL

Duration of the action of rocuronium in patients with BMI of less than 25: An observational study

BACKGROUND The duration of rocuronium in patients with BMI more than 30 kg m−2 is prolonged. Whether the reverse is true when BMI is less than 18.5 kg m−2 is unclear. OBJECTIVE The objective of this study was to investigate whether a BMI less than 25 kg m−2 affects the duration of rocuronium in doses adjusted for actual body weight. DESIGN A prospective, observational, single-centre study. SETTING The operating room of a teaching hospital from 1 June 2008 to 30 June 2015. PATIENTS Thirty patients with American Society of Anesthesiologists physical status I or II who were scheduled to undergo elective surgery (BMI 

https://ift.tt/2IdARkr

Placebo versus low-dose ketamine infusion in addition to remifentanil target-controlled infusion for conscious sedation during oocyte retrieval: A prospective, double-blinded, randomised controlled trial

BACKGROUND Currently, there is no gold standard for monitored anaesthesia care during oocyte retrieval. OBJECTIVE In our institution, the standard is a conscious sedation technique using a target-controlled infusion (TCI) of remifentanil, titrated to maintain a visual analogue pain score less than 30 mm. This protocol is well accepted by patients but is associated with frequent episodes of respiratory depression. The main objective of this study was to evaluate whether the addition of a continuous intravenous infusion of ketamine could reduce these episodes. DESIGN Controlled, randomised, prospective, double-blinded study. SETTING The current study was conducted in a tertiary-level hospital in Brussels (Belgium) from December 2013 to June 2014. PATIENTS Of the 132 women undergoing oocyte retrieval included, 121 completed the study. INTERVENTION After randomisation, patients received either a ketamine infusion (40 μg kg−1 min−1 over 5 min followed by 2.5 μg kg−1 min−1) or a 0.9% saline infusion in addition to the variable remifentanil TCI. MAIN OUTCOME MEASURES The primary outcome was the number of respiratory depression episodes. Effect site target remifentanil concentrations, side effects, pain score, patient satisfaction and incidence of pregnancy were also recorded. RESULTS No significant difference in the incidence of respiratory events was noted (pulse oximetry oxygen saturation 

https://ift.tt/2rEPAcW

Copyright

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2





https://ift.tt/2KYKmBx

Contributors

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2





https://ift.tt/2GcbnxY

Contents

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2





https://ift.tt/2jUt9gm

Forthcoming Issues

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2





https://ift.tt/2GbLDSq

Practice Management: Successfully Guiding Your Group into the Future

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2
Author(s): Amr E. Abouleish, Stanley W. Stead




https://ift.tt/2jUt1xo

Overlapping Surgery

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2
Author(s): Amanda J. Morris, Joseph A. Sanford, Edward J. Damrose, Samuel H. Wald, Bassam Kadry, Alex Macario

Teaser

A keystone of operating room (OR) management is proper OR allocation to optimize access, safety, efficiency, and throughput. Access is important to surgeons, and overlapping surgery may increase patient access to surgeons with specialized skill sets and facilitate the training of medical students, residents, and fellows. Overlapping surgery is commonly performed in academic medical centers, although recent public scrutiny has raised debate about its safety, necessitating monitoring. This article introduces a system to monitor overlapping surgery, providing a surgeon-specific Key Performance Indicator, and discusses overlapping surgery as an approach toward OR management goals of efficiency and throughput.


https://ift.tt/2Gdpseq

Quality Reporting

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2
Author(s): DeLaine Schmitz, Matthew T. Popovich

Teaser

Since the 1990s, the use of quality measures in healthcare has grown exponentially. Practices must maintain current knowledge of measures that affect their clinicians locally and understand how assessment of these medical professionals affects the priorities and quality activities of practices and facilities. Because quality measures are increasingly used by hospital administrators, health plans, and payers, practices are being asked to shoulder the additional burdens of collecting and reporting data to various entities. Part of the solution to this increased burden often includes contracting with vendors and outside experts, as well as identifying effective local physician and practice champions.


https://ift.tt/2rCk1kU

Comprehensive Preoperative Assessment and Global Optimization

Publication date: June 2018
Source:Anesthesiology Clinics, Volume 36, Issue 2
Author(s): Neil N. Shah, Thomas R. Vetter

Teaser

To successfully deliver greater perioperative value-based care and to effectively contribute to sustained and meaningful perioperative population health management, the scope of existing preoperative management and its associated services and care provider skills must be expanded. New models of preoperative management are needed, which rely extensively on continuously evolving evidence-based best practice, as well as telemedicine and telehealth, including mobile technologies and connectivity. Along with conventional comorbidity optimization, prehabilitation can effectively promote enhanced postoperative recovery. This article focuses on the opportunities and mechanisms for delivering value-based, comprehensive preoperative assessment and global optimization of the surgical patient.


https://ift.tt/2KlxILN

Transsplenic splenoportography and portal venous interventions in pediatric patients

Abstract

Background

Data regarding transsplenic portal venous access for diagnostic imaging and endovascular intervention in children are limited, possibly due to concerns regarding high bleeding risks and resultant underutilization.

Objective

To investigate the safety and utility of transsplenic splenoportography and portal venous interventions in children.

Materials and methods

A retrospective review was performed of all pediatric patients undergoing percutaneous transsplenic portal venous access and intervention at two large tertiary pediatric institutions between January 2012 and April 2017 was performed. Parameters assessed included procedural indications, procedural and relevant prior imaging, technical details of the procedures, laboratory values and clinical follow-up.

Results

Transsplenic portal venous access was achieved in all patients. Diagnostic transsplenic splenoportography was performed in 22 patients and was 100% successful at providing the desired anatomical and functional information. Four transsplenic portal venous interventions were performed with 100% success: meso-Rex shunt angioplasty, snare targeted transjugular intrahepatic portosystemic shunt (TIPS) creation through cavernous transformation, pharmacomechanical thrombectomy for acute thrombosis, and transplant portal vein angioplasty. Intraperitoneal bleeding occurred in 2/26 (7.7%) and one case required transfusion (3.8%). No cases of hemorrhage were observed when transsplenic access size was 4 Fr or smaller.

Conclusion

Transsplenic splenoportography in children is safe and effective when noninvasive imaging methods have yielded incomplete information. Additionally, a transsplenic approach has advantages for complex portal interventions. Bleeding risks are proportional to tract access size and may be mitigated by tract embolization.

https://ift.tt/2GbX38F

Transsplenic splenoportography and portal venous interventions in pediatric patients

Abstract

Background

Data regarding transsplenic portal venous access for diagnostic imaging and endovascular intervention in children are limited, possibly due to concerns regarding high bleeding risks and resultant underutilization.

Objective

To investigate the safety and utility of transsplenic splenoportography and portal venous interventions in children.

Materials and methods

A retrospective review was performed of all pediatric patients undergoing percutaneous transsplenic portal venous access and intervention at two large tertiary pediatric institutions between January 2012 and April 2017 was performed. Parameters assessed included procedural indications, procedural and relevant prior imaging, technical details of the procedures, laboratory values and clinical follow-up.

Results

Transsplenic portal venous access was achieved in all patients. Diagnostic transsplenic splenoportography was performed in 22 patients and was 100% successful at providing the desired anatomical and functional information. Four transsplenic portal venous interventions were performed with 100% success: meso-Rex shunt angioplasty, snare targeted transjugular intrahepatic portosystemic shunt (TIPS) creation through cavernous transformation, pharmacomechanical thrombectomy for acute thrombosis, and transplant portal vein angioplasty. Intraperitoneal bleeding occurred in 2/26 (7.7%) and one case required transfusion (3.8%). No cases of hemorrhage were observed when transsplenic access size was 4 Fr or smaller.

Conclusion

Transsplenic splenoportography in children is safe and effective when noninvasive imaging methods have yielded incomplete information. Additionally, a transsplenic approach has advantages for complex portal interventions. Bleeding risks are proportional to tract access size and may be mitigated by tract embolization.

from Cancer via ola Kala on Inoreader https://ift.tt/2GbX38F
via IFTTT

A Case of Medialized Lateral Maxillary Sinus Wall: A Pillar of Support

The number of maxillofacial trauma (MFT) cases attended in the Emergency Department is progressively increasing in trend, owing to the rising statistics of motor-vehicle accidents (MVAs) and urban assaults in addition to occupational-related injuries. Prompt and thorough assessment is important for accurate diagnosis and paramount treatment plans. We will be discussing a case of unusual presentation of an orbital floor fracture post-MVA which was treated conservatively based on the clinical assessments during follow-ups, supported by radiological findings. We will also briefly discuss the different radiological modalities available in assessing MFT and late presentation of enophthalmos.

https://ift.tt/2jRE6PO