Monday, March 31, 2014

Fractionated radiotherapy is the main stimulus for the induction of cell death and of Hsp70 release of p53 mutated glioblastoma cell lines

Fractionated radiotherapy is the main stimulus for the induction of cell death and of Hsp70 release of p53 mutated glioblastoma cell lines
Radiation Oncology

Background: Glioblastoma multiforme (GBM) is the most common primary brain tumor in adults. Despite a multimodal therapy consisting of resection followed by fractionated radiotherapy (RT) combined with the chemotherapeutic agent (CT) temozolomide (TMZ), its recurrence is almost inevitable. Since the immune system is capable of eliminating small tumor masses, a therapy should also aim to stimulate anti-tumor immune responses by induction of immunogenic cell death forms. The histone deacetylase inhibitor valproic acid (VPA) might foster this. Methods: Reflecting therapy standards, we applied in our in vitro model fractionated RT with a single dose of 2Gy and clinically relevant concentrations of CT. Not only the impact of RT and/or CT with TMZ and/or VPA on the clonogenic potential and cell cycle of the glioblastoma cell lines T98G, U251MG, and U87MG was analyzed, but also the resulting cell death forms and release of danger signals such as heat-shock protein70 (Hsp70) and high-mobility group protein B1 (HMGB1). Results: The clonogenic assays revealed that T98G and U251MG, having mutated tumor suppressor protein p53, are more resistant to RT and CT than U87MG with wild type (WT) p53. In all glioblastoma cells lines, fractionated RT induced a G2 cell cycle arrest, but only in the case of U87MG, TMZ and/or VPA alone resulted in this cell cycle block. Further, fractionated RT significantly increased the number of apoptotic and necrotic tumor cells in all three cell lines. However, only in U87MG, the treatment with TMZ and/or VPA alone, or in combination with fractionated RT, induced significantly more cell death compared to untreated or irradiated controls. While necrotic glioblastoma cells were present after VPA, TMZ especially led to significantly increased amounts of U87MG cells in the radiosensitive G2 cell cycle phase. While CT did not impact on the release of Hsp70, fractionated RT resulted in significantly increased extracellular concentrations of Hsp70 in p53 mutated and WT glioblastoma cells. Conclusions: Our results indicate that fractionated RT is the main stimulus for induction of glioblastoma cell death forms with immunogenic potential. The generated tumor cell microenvironment might be beneficial to include immune therapies for GBM in the future.

Original Article: http://www.ro-journal.com/content/9/1/89

[Comment] Stereotactic radiosurgery for more than four brain metastases

[Comment] Stereotactic radiosurgery for more than four brain metastases
The Lancet Oncology

Whole-brain radiotherapy (WBRT) had been the standard treatment for patients with newly diagnosed brain metastases, irrespective of histology and number of tumours. In view of the concerns about neurocognitive and memory deficits after WBRT, attempts have been made to treat patients with one to four brain metastases using stereotactic radiosurgery alone. showed superior retention of neurocognitive function assessed by the Hopkins Verbal Learning Test (HVLT). The current American Society for Radiation Oncology evidence-based guideline for newly diagnosed brain metastases supports the use of stereotactic radiosurgery alone for patients with four or fewer tumours.

Original Article: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70076-2/fulltext?rss=yes

[Cancer and Society] International Cancer Control Partnership

[Cancer and Society] International Cancer Control Partnership
The Lancet Oncology

Since the 2011 UN High Level Summit on non-communicable diseases, cancer has been increasingly recognised as a major global health issue by the broader international health community. With a smattering of partners the Union for International Cancer Control has now launched its own International Cancer Control Partnership web portal. This portal has an extensive selection of links and downloads covering topics as diverse as advocacy, education, and training through to surveillance and statistics.

Original Article: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70149-4/fulltext?rss=yes

[Articles] Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study

[Articles] Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study
The Lancet Oncology

Our results suggest that stereotactic radiosurgery without WBRT in patients with five to ten brain metastases is non-inferior to that in patients with two to four brain metastases. Considering the minimal invasiveness of stereotactic radiosurgery and the fewer side-effects than with WBRT, stereotactic radiosurgery might be a suitable alternative for patients with up to ten brain metastases.

Original Article: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70061-0/abstract?rss=yes

Wednesday, March 26, 2014

Brain metastases associated with germ cell tumors may be treated with chemotherapy alone

Brain metastases associated with germ cell tumors may be treated with chemotherapy alone
Cancer

BACKGROUND

The management of brain metastases in patients with germ cell tumors remains controversial. The authors assessed the outcome in this patient group after the introduction of GAMEC chemotherapy (14-day cisplatin, high-dose methotrexate, etoposide, and actinomycin-D with filgrastim support) and cessation of the routine use of cranial irradiation.

METHODS

Data were recorded prospectively from 39 patients with germ cell tumors and concurrent brain metastases who received treatment before and after the advent of GAMEC after they relapsed on conventional cisplatin-based chemotherapy. Neurosurgery was offered to selected patients. Radiotherapy generally was used only as a salvage therapy after chemotherapy failure. The primary outcome measure was overall survival and was depicted using a Kaplan-Meier plot.

RESULTS

The 3-year overall survival rates were 38% for the whole cohort, 69% for those who presented with brain metastases at diagnosis (group 1), and 21% and 0% for those who developed metastases after initial chemotherapy (group 2) and while receiving chemotherapy (group 3), respectively. For the whole cohort, the median overall survival was 10.6 months (range, 5.5 months to not evaluable); and, for groups 1, 2, and 3 individually, the overall survival was not yet reached (range, from 7.4 months to not evaluable), 6.2 months (range, 2.1-15.3 months), and 2.7 months (range, from 0.6 months to not evaluable), respectively. The 3-year survival rate for those who received GAMEC chemotherapy was 56% compared with 27% for those who received chemotherapy pre-GAMEC.

CONCLUSIONS

The prognosis for patients with germ cell tumors and brain metastases seems less bleak than previously thought. It is possible to achieve long-term survival with chemotherapy alone. Cancer 2014. © 2014 American Cancer Society.



Original Article: http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1002/cncr.28629

Medical Apps – iOS and Android

Medical Apps – iOS and Android
Neurosurgery Blog

The Neurosurgery Blog group is developing a series of apps dedicated to medicine and more specifically neuroscience.

This is a space created to divulge our apps. You can found more information about than by clicking in the apps logos.

Let us know about your opinion, critics, suggestions or ideas in the "Contact us" space. With your help we may improve the apps you adquired and create new ones!

We hope you enjoy!

More apps are coming soon!

Now we have more than 60,000 downloads (English and Portuguese)  more than 130 countries !

 

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Neurosurgery Blog iOS (click here)

Neurosurgery Blog app  Android (Click Here)

 

 

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Traumatic Brain Injury (Click here)iPad and iPhone

Traumatismo Cranio-encefalico (Click here) iPad and iPhone

Traumatic Brain Injury (Click here) Android

Traumatismo Cranio-encefalico (Click here) Android

 

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Hedache apps (Click here) iPad and iPhone

Dor de cabeça ( Click here) iPad and iPhone

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Dor de cabeça ( Click here) Android


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Neuro Exam App iOS ( Only English and Spanish)

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Neurointensive Care (APPSTORE CLICK HERE English/Portuguese)

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Neuroinfect App ( Portuguese and English) Click here Android
Neuroinfect App ( Portuguese and English) Click here iOS

 

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Craniotomy (Portuguese and English) CLICK HERE Android

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The post Medical Apps – iOS and Android appeared first on NEUROSURGERY BLOG.



Original Article: http://neurocirurgiabr.com/medical-apps-ios-and-android/?utm_source=rss&utm_medium=rss&utm_campaign=medical-apps-ios-and-android

A randomized, open-label clinical trial of tasisulam sodium versus paclitaxel as second-line treatment in patients with metastatic melanoma

A randomized, open-label clinical trial of tasisulam sodium versus paclitaxel as second-line treatment in patients with metastatic melanoma
Cancer

BACKGROUND

Tasisulam sodium (hereafter referred to as tasisulam) is a novel, highly albumin-bound agent that demonstrated activity in a phase 2 melanoma study.

METHODS

In this open-label phase 3 study, patients with AJCC stage IV melanoma received tasisulam (targeting an albumin-corrected exposure of 1200-6400 h (hour).μg/mL on day 1) or paclitaxel (80 mg/m2 on days 1, 8, and 15) every 28 days as second-line treatment.

RESULTS

The study was placed on clinical hold after randomization of 336 patients when a safety review indicated an imbalance of possibly drug-related deaths in the tasisulam arm. Efficacy results for tasisulam versus paclitaxel revealed a response rate of 3.0% versus 4.8%, a median progression-free survival of 1.94 months versus 2.14 months (P = .048), and a median overall survival of 6.77 months versus 9.36 months (P = .121). The most common drug-related grade ≥3 laboratory toxicities (graded according to Common Terminology for Adverse Events [version 3.0]) were thrombocytopenia (18.9%) for patients treated with tasisulam and neutropenia/leukopenia (8.7%) among those receiving paclitaxel. There were 13 possibly related deaths reported to occur on the study, with the majority occurring during cycle 2 in the setting of grade 4 myelosuppression, all in the tasisulam arm. Investigation of the unexpectedly high rate of hematologic toxicity revealed a subset of patients with low tasisulam clearance, leading to drug accumulation and high albumin-corrected exposure in cycle 2.

CONCLUSIONS

Although the study was stopped early because of safety issues in the tasisulam arm, tasisulam was considered unlikely to be superior to paclitaxel, and paclitaxel activity in the second-line treatment of melanoma was much lower than expected. The toxicity imbalance was attributed to an unexpectedly low tasisulam clearance in a subset of patients, underscoring the importance of pharmacokinetic monitoring of compounds with complex dosing, even in late-phase studies. Cancer 2014. © 2014 American Cancer Society.



Original Article: http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1002/cncr.28635

Sunday, March 23, 2014

Após um Tumor Cerebral (Book Trailer)

Após um Tumor Cerebral (Book Trailer)
Neurosurgery Blog

Book Trailer: Após um tumor cerebral

http://www.youtube.com/watch?v=xavgoXENg7c

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Onde Comprar o Livro:
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Saraiva – http://goo.gl/zKprGU
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Skoob: http://goo.gl/WpkpvU
Bertrant (Portugal): http://goo.gl/hEjdxU

The post Após um Tumor Cerebral (Book Trailer) appeared first on NEUROSURGERY BLOG.



Original Article: http://neurocirurgiabr.com/apos-um-tumor-cerebral-book-trailer/?utm_source=rss&utm_medium=rss&utm_campaign=apos-um-tumor-cerebral-book-trailer

Use of High-Field Intraoperative Magnetic Resonance Imaging to Enhance the Extent of Resection of Enhancing and Nonenhancing Gliomas

Use of High-Field Intraoperative Magnetic Resonance Imaging to Enhance the Extent of Resection of Enhancing and Nonenhancing Gliomas
Neurosurgery - Current Issue

imageBACKGROUND: Intraoperative magnetic resonance imaging (IoMRI) is used to improve the extent of resection of brain tumors. Most previous studies evaluating the utility of IoMRI have focused on enhancing tumors. OBJECTIVE: To report our experience with the use of high-field IoMRI (1.5 T) for both enhancing and nonenhancing gliomas. METHODS: An institutional review board–approved retrospective review was performed of 102 consecutive glioma patients (104 surgeries, 2010-2012). Pre-, intra-, and postoperative tumor volumes were assessed. Analysis was performed with the use of volumetric T2 images in 43 nonenhancing and 13 minimally enhancing tumors and with postcontrast volumetric magnetization-prepared rapid gradient-echo images in 48 enhancing tumors. RESULTS: In 58 cases, preoperative imaging showed tumors likely to be amenable to complete resection. Intraoperative electrocorticography was performed in 32 surgeries, and 14 cases resulted in intended subtotal resection of tumors due to involvement of deep functional structures. No further resection (complete resection before IoMRI) was required in 25 surgeries, and IoMRI showed residual tumor in 79 patients. Of these, 25 surgeries did not proceed to further resection (9 due to electrocorticography findings, 14 due to tumor in deep functional areas, and 2 due to surgeon choice). Additional resection that was performed in 54 patients resulted in a final median residual tumor volume of 0.21 mL (0.6%). In 79 patients amenable to complete resection, the intraoperative median residual tumor volume for the T2 group was higher than for the magnetization-prepared rapid gradient-echo group (1.088 mL vs 0.437 mL; P = .049), whereas the postoperative median residual tumor volume was not statistically significantly different between groups. CONCLUSION: IoMRI enhances the extent of resection, particularly for nonenhancing gliomas. ABBREVIATIONS: 5-ALA, 5-aminolevulinic acid CRDT, complete resection of the detectable tumor CRET, complete resection of the enhancing tumor EBRT, external beam radiation therapy ECoG, electrocorticography FLAIR, fluid-attenuated inversion recovery GBM, glioblastoma multiforme IoMRI, intraoperative magnetic resonance imaging KPS, Karnofsky Performance Status LGG, low-grade glioma MP-RAGE, magnetization-prepared rapid gradient-echo

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/04000/Use_of_High_Field_Intraoperative_Magnetic.9.aspx

Using Higher Isodose Lines for Gamma Knife Treatment of 1 to 3 Brain Metastases Is Safe and Effective

Using Higher Isodose Lines for Gamma Knife Treatment of 1 to 3 Brain Metastases Is Safe and Effective
Neurosurgery - Current Issue

imageBACKGROUND: Higher isodose lines (IDLs) in Gamma Knife (GK) Perfexion treatment of brain metastases (BMet) could result in lower local control (LC) or higher radiation necrosis (RN) rates, but reduce treatment time. OBJECTIVE: To assess the impact of the heterogeneity index (HI) and conformality index (CFI) ion local failure (LF) for patients treated with GK for 1 to 3 BMet. METHODS: From an institutional review board—approved database, 320 patients with 496 BMet were identified, treated for 1 to 3 BMet from July 2007 to April 2011 on GK Perfexion. Cox proportional hazards regression was used to analyze significance of HI, CFI, IDL, dose, tumor diameter, recursive partitioning analysis class, tumor radioresistance, primary, smoking history, metastasis location, and whole-brain radiation therapy (WBRT) history with LF and RN. RESULTS: Median follow-up by lesion was 6.8 months (range, 0-49.6). The series median survival was 14.2 months. Per RECIST, 9.5% of lesions failed, 33.9% were stable, 38.3% partially responded, 17.1% responded completely, and 1.2% could not be assessed. The 12-month LC rate was 87.3%. On univariate analysis, a dose less than 20 Gy (hazard ratio [HR]: 2.940, P < .001); tumor size (HR: 1.674, P < .001); and cerebellum/brainstem location vs other (HR: 1.891, P = .043) were significant for LF. Non-small cell lung cancer (HR: 0.333, P = .0097) was associated with better LC. On multivariate analysis, tumor size (HR: 1.696, P < .001) and cerebellum/brainstem location vs other (HR: 1.959, P = .033) remained significant for LF. Variables not significant for LF included CI, IDL, and HI. CONCLUSION: Our study of patients with 1 to 3 BMet treated with GK demonstrated no difference in LC or RN with varying HI, indicating that physicians can treat to IDL at 70% or higher IDL to reduce treatment time without increased LF or RN. ABBREVIATIONS: BMet, brain metastases CFI, conformality index CI, confidence interval CR, complete response GK, Gamma Knife HI, heterogeneity index HR, hazard ratio IDL, isodose line LC, local control LF, local failure MVA, multivariate analysis NSCLC, non-small cell lung cancer PR, partial response RECIST, Response Evaluation Criteria in Solid Tumors RN, radiation necrosis RTOG, Radiation Therapy Oncology Group SD, stable disease SRS, stereotactic radiosurgery UVA, univariate analysis

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/04000/Using_Higher_Isodose_Lines_for_Gamma_Knife.11.aspx

Proton Beam Stereotactic Radiosurgery for Pediatric Cerebral Arteriovenous Malformations

Proton Beam Stereotactic Radiosurgery for Pediatric Cerebral Arteriovenous Malformations
Neurosurgery - Current Issue

imageBACKGROUND: For cerebral arteriovenous malformations (AVMs) determined to be high risk for surgery or endovascular embolization, stereotactic radiosurgery (SRS) is considered the mainstay of treatment. OBJECTIVE: To determine the outcomes of pediatric patients with AVMs treated with proton SRS. METHODS: We reviewed the records of 44 consecutively treated pediatric patients (younger than 18 years of age) who underwent proton SRS at our institution from 1998 to 2010. The median target volume was 4.5 ± 5.9 mL (range, 0.3-29.0 mL) and the median maximal diameter was 3.6 ± 1.5 cm (range, 1-6 cm). Radiation was administered with a median prescription dose of 15.50 ± 1.87 CGE to the 90% isodose. RESULTS: At a median follow-up of 52 ± 25 months, 2 patients (4.5%) had no response, 24 patients (59.1%) had a partial response, and 18 patients (40.9%) experienced obliteration of their AVM. The median time to obliteration was 49 ± 26 months, including 17 patients who underwent repeat proton radiosurgery. Four patients (9%) experienced hemorrhage after treatment at a median time of 45 ± 15 months. Univariate analysis identified modified AVM scale score (P = .045), single fraction treatment (0.04), larger prescription dose (0.01), larger maximum dose (<0.001), and larger minimum dose (0.01) to be associated with AVM obliteration. CONCLUSION: High-risk AVMs can be safely treated with proton radiosurgery in the pediatric population. Because protons deposit energy more selectively than photons, there is the potential benefit of protons to lower the probability of damage to healthy tissue in the developing brain. ABBREVIATIONS: AVM, arteriovenous malformation GyRBE, Gray radiobiologic equivalent PSRS, proton beam stereotactic radiosurgery SRS, stereotactic radiosurgery

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/04000/Proton_Beam_Stereotactic_Radiosurgery_for.12.aspx

The impact of pathologic staging on the long-term oncologic outcomes of patients with clinically high-risk prostate cancer

The impact of pathologic staging on the long-term oncologic outcomes of patients with clinically high-risk prostate cancer
Cancer

BACKGROUND

In the prostate-specific antigen (PSA) screening era, approximately 15% of US men still present with clinically high-risk prostate cancer (PC). However, high-risk PC may be downgraded/downstaged at radical prostatectomy (RP), making additional therapy unnecessary. The authors tested the oncologic outcomes in men with clinically high-risk disease stratified on RP pathology.

METHODS

A total of 611 men with high-risk PC (PSA level > 20 ng/mL, biopsy Gleason sum [bGS] ≥ 8, or clinical classification of ≥ T3) underwent RP and pelvic lymphadenectomy between 1998 and 2011. Outcomes included biochemical disease recurrence (BCR), receipt of androgen deprivation therapy (ADT), metastases, and PC-specific and overall survival. RP pathology was classified as unfavorable (pathologic Gleason sum ≥ 8, pathologic classification of ≥ T3, or lymph node-positive disease), or favorable (no unfavorable features). Multivariable analyses tested oncologic outcomes stratified by pathologic classification.

RESULTS

Overall, 527 men had complete pathologic data and were included in the current analysis. Of the cohort, 206 of 527 men (39%) had favorable pathology. This finding was more common in men with only 1 clinical high-risk feature, and a lower body mass index, PSA level, bGS, and percentage positive biopsy cores. Favorable pathology was associated with decreased BCR (hazards ratio [HR], 0.34), metastases (HR, 0.17), and PC death (HR, 0.17). After a median follow-up of 82 months (range, 49 months-131 months), 193 of the 527 men (37%) received ADT, including only 35 of the 206 men with favorable pathology (17%). Unfavorable pathology was associated with early (≤ 5 years) but not late treatment with ADT.

CONCLUSIONS

In a large cohort of men with high-risk PC who were managed with RP, 39% had favorable pathology and superior oncologic outcomes. Cancer 2014. © 2014 American Cancer Society.



Original Article: http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1002/cncr.28647

Saturday, March 22, 2014

Linac-based stereotactic radiotherapy and radiosurgery in patients with meningioma

Linac-based stereotactic radiotherapy and radiosurgery in patients with meningioma
Radiation Oncology - Latest Articles

Background: It was our purpose to analyze long-term clinical outcome and to identify prognostic factors after Linac-based fractionated stereotactic radiotherapy (Linac-based FSRT) and stereotactic radiosurgery (SRS) in patients with intracranial meningiomas.Materials and methods: Between 10/1995 and 03/2009, 297 patients with a median age of 59 years were treated with FSRT for intracranial meningioma. 50 patients had a Grade I meningioma, 20 patients had a Grade II meningioma, 12 patients suffered from a Grade III tumor, and in 215 cases no histology was obtained (Grade 0). Of the 297 patients, 144 underwent FSRT as their primary treatment and 158 underwent postoperative FSRT. 179 patients received normofractionated radiotherapy (nFSRT), 92 patients received hypofractionated FSRT (hFSRT) and 26 patients underwent SRS. Patients with nFSRT received a mean total dose of 57.31 +/- 5.82 Gy, patients with hFSRT received a mean total dose of 37.6 +/- 4.4 Gy and patients who underwent SRS received a mean total dose of 17.31 +/- 2.58 Gy. Results: Median follow-up was 35 months. Overall progression free survival (PFS) was 92.3% at 3 years, 87% at 5 years and 84.1% at 10 years. Patients with adjuvant radiotherapy showed significantly better PFS-rates than patients who had been treated with primary radiotherapy. There was no significant difference between PFS-rates of nFSRT, hFSRT and SRS patients. PFS-rates were independent of tumor size. Patients who had received nFSRT showed less acute toxicity than those who had received hFSRT. In the Grade 0/I group the rate of radiologic focal reactions was significantly lower than in the atypical/malignant histology group. Conclusion: This large study showed that FSRT is an effective and safe treatment modality with high PFS-rates for intracranial meningioma. We identified "pathological grading" and and "prior surgery" as significant prognostic factors.

Original Article: http://www.ro-journal.com/content/9/1/78

FDA OKs Cochlear Device for Sensorineural Hearing Loss

FDA OKs Cochlear Device for Sensorineural Hearing Loss
Medscape Today- Medscape

The Nucleus Hybrid L24 Cochlear Implant System combines the functions of a cochlear implant and a hearing aid.
FDA Approvals

Original Article: http://www.medscape.com/viewarticle/822380?src=rss

Wednesday, March 19, 2014

Acquiring Procedural Skills in ICUs: A Prospective Multicenter Study*

Acquiring Procedural Skills in ICUs: A Prospective Multicenter Study*
Critical Care Medicine - Current Issue

imageObjectives:Providing appropriate training of procedural skills to residents while ensuring patient safety through trainee supervision is a difficult and constant challenge. We sought to determine how effective and safe procedural skill acquisition is in French ICUs and to identify failure and complication risk factors. Design:Multicenter prospective observational study. Invasive procedures performed by residents were recorded during two consecutive semesters. Setting:Eighty-four residents. Subjects:Eighty-four residents. Intervention:None. Measurements and Main Results:Number of invasive procedures performed, failure and complication rates, supervision, and assistance provided. Five thousand six hundred seventeen procedures were prospectively studied: 1,007 tracheal intubations, 1,272 arterial and 2,586 central venous catheter insertions, 457 fiberoptic bronchoscopies, and 295 chest tube insertions. During the semesters, residents performed a median of 10 intubations, 14 arterial catheter insertions, and 26 central venous catheter insertions. Complication rates were low, similar to those in the literature: 8.6% desaturation and 7.4% esophageal placement during intubation; 0.4% and 2.3% pneumothorax with jugular and subclavian central venous catheter insertions, respectively. We identified risk factors for failure and complications. Higher rates of failure and complications for intubation were associated with residents with no or little previous experience (p < 0.001); failure of internal jugular vein catheterization was associated with left-side insertion (p = 0.005) and absence of mechanical ventilation (p = 0.007). Supervision and assistance were more frequent at the beginning of the semester and for intubation and chest tube insertion. Finally, residents had less access to fiberoptic bronchoscopy and chest tube insertion. Conclusion:Procedural skills acquisition by residents in the ICU appears feasible and safe with complication rates comparable to what has previously been reported. We identified specific procedures and situations associated with higher failure and complication rates that could require proactive training. Questions still remain regarding minimal numbers of procedures to attain competence and how best to provide procedural training.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/04000/Acquiring_Procedural_Skills_in_ICUs__A_Prospective.15.aspx

Tuesday, March 18, 2014

Surgical Treatment of Subependymal Giant Cell Astrocytoma in Tuberous Sclerosis Complex Patients

Surgical Treatment of Subependymal Giant Cell Astrocytoma in Tuberous Sclerosis Complex Patients
Pediatric Neurology

Abstract: Background: Subependymal giant cell astrocytoma is a brain tumor associated with tuberous sclerosis complex. There are two treatment options for subependymal giant cell astrocytomas: surgery or mammalian target of rapamycin inhibitor. The analysis of outcome of subependymal giant cell astrocytoma surgery may help characterize the patients who may benefit from pharmacotherapy.Methods: Sixty-four subependymal giant cell astrocytoma surgeries in 57 tuberous sclerosis complex patients with at least a 12-month follow-up were included in the study. The tumor size, age of the patients, mutation in the TSC1 or TSC2 gene, indication for the surgery, and postsurgical complications were analyzed.Results: The mean age of patients at surgery was 9.7 years. Mean follow-up after surgery was 63.7 months. Thirty-seven (57.8%) tumors were symptomatic and 27 (42.2%) were asymptomatic. Patients with TSC2 mutations developed subependymal giant cell astrocytoma at a significantly younger age than individuals with TSC1 mutations. Four patients (6.2% of all surgeries) died after surgery. Surgery-related complications were reported in 0%, 46%, 83%, 81%, and 67% of patients with tumors <2 cm, between 2 and 3 cm, between 3 and 4 cm, >4 cm, and bilateral subependymal giant cell astrocytomas, respectively, and were most common in children younger than 3 years of age. The most common complications included hemiparesis, hydrocephalus, hematoma, and cognitive decline.Conclusions: Our study indicates that subependymal giant cell astrocytoma surgery is associated with significant risk in individuals with bilateral subependymal giant cell astrocytomas, tumors bigger than 2 cm, and in children younger than 3 years of age. Therefore, tuberous sclerosis complex patients should be thoroughly screened for subependymal giant cell astrocytoma growth, and early treatment should be considered in selected patients.

Original Article: http://www.pedneur.com/article/S0887-8994(13)00718-2/abstract?rss=yes

Sunday, March 16, 2014

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THOUGHTS FROM THE HOSPITAL ( Ebook)

THOUGHTS FROM THE HOSPITAL

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THOUGHTS FROM THE HOSPITAL

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Friday, March 14, 2014

AANS Grand Rounds



The effect of multileaf collimator leaf width on the radiosurgery planning for spine lesion treatment in terms of the modulated techniques and target complexity

The effect of multileaf collimator leaf width on the radiosurgery planning for spine lesion treatment in terms of the modulated techniques and target complexity
Radiation Oncology

Purpose: We aim to evaluate the effects of multileaf collimator (MLC) leaf width (5 mm vs. 2.5 mm) on the radiosurgery planning for the treatment of spine lesions according to the modulated techniques (intensity-modulated radiotherapy [IMRT] vs. volumetric-modulated arc therapy [VMAT]) and the complexity of the target shape. Methods: For this study, artificial spinal lesions were contoured and used for treatment plans. Three spinal levels (C5, T5, and L2 spines) were selected, and four types of target shapes reflecting the complexity of lesions were contoured. The treatment plans were performed using 2.5-mm and 5-mm MLCs, and also using both static IMRT and VMAT. In total, 48 treatment plans were established. The efficacy of each treatment plan was compared using target volume coverage (TVC), conformity index (CI), dose gradient index (GI), and V30%. Results: When the 5-mm MLC was replaced by the 2.5-mm MLC, TVC and GI improved significantly by 5.68% and 6.25%, respectively, while CI did not improve. With a smaller MLC leaf width, the improvement ratios of the TVC were larger in IMRT than VMAT (8.38% vs. 2.97%). In addition, the TVC was improved by 14.42-16.74% in target type 4 compared to the other target types. These improvements were larger in IMRT than in VMAT (27.99% vs. 6.34%). The V30% was not statistically different between IMRT and VMAT according to the MLC leaf widths and the types of target. Conclusion: The smaller MLC leaf width provided improved target coverage in both IMRT and VMAT, and its improvement was larger in IMRT than in VMAT. In addition, the smaller MLC leaf width was more effective for complex-shaped targets.

Original Article: http://www.ro-journal.com/content/9/1/72

Surgical Safety Checklist Use Shows Slow Progress in Ontario

Surgical Safety Checklist Use Shows Slow Progress in Ontario
Medscape Today- Medscape

Study showed slow progress from surgical checklist use in Ontario, but checklist advocates say give what amounts to cultural change a chance to work.
Medscape Medical News

Original Article: http://www.medscape.com/viewarticle/821910?src=rss


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