[Perioperative safety of intraperitoneal aerosol chemotherapy : Analysis of our first 111 pressurized intraperitoneal aerosol chemotherapy (PIPAC) procedures]. / Perioperative Sicherheit der intraperitonealen Aerosolchemotherapie : Analyse unserer ersten 111 PIPAC("pressurized intraperitoneal aerosol chemotherapy")-Prozeduren.

BACKGROUND: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new tool in the treatment of patients with peritoneal carcinomatosis. The aerosol containing chemotherapeutic drugs is administered laparoscopically into the abdominal cavity to achieve a local treatment effect. This can be carried out in combination with systemic chemotherapy. MATERIAL AND METHODS: Within the framework of a register study, we prospectively documented and evaluated the data of our first 111 PIPAC procedures. The analysis focused on perioperative patient safety and safety at the workplace. Perioperative clinical patient data were analyzed and the platinum concentration in the operating room was checked by wipe samples. RESULTS: A total of 62 patients were scheduled for PIPAC and 121 operations were carried out. In 9 procedures a secure access to the abdomen could not be found and 54 patients received 111 PIPAC treatments. One patient died as a result of intestinal perforation, six bowel lesions were treated immediately and healed without further complications. A further patient developed a postoperative renal failure. Otherwise, there was no major complications and no cases of toxicity. CONCLUSION: The PIPAC procedure can be used as a supplement to systemic drug treatment for peritoneal carcinomatosis. An exact selection of suitable patients is important. The PIPAC is a low-risk procedure when performed under strict inclusion criteria and under standardized conditions, for the patients and also the surgical staff.

Intranasal deferoxamine affects memory loss, oxidation, and the insulin pathway in the streptozotocin rat model of Alzheimer's disease.

Accumulation of metal and the accompanying increase in oxidative stress and inflammation plays an important role in neurodegenerative disease. Deferoxamine (DFO) is a metal chelator found to be beneficial in several animal models of neurodegenerative disease and insult including Alzheimer's disease, Parkinson's disease, stroke, and subarachnoid hemorrhage. In this study, we determine whether intranasally (IN) administered DFO is beneficial in the intracerebroventricular streptozotocin (ICV STZ) rat model of sporadic Alzheimer's disease, which is different from previous models in that it exhibits dysregulation of insulin metabolism as well as oxidative stress and inflammation. Surgical induction of the model included ICV injections of either STZ or citrate buffer (sham in rats), which were treated IN with either saline or DFO (n=10-15/group). Treatment started either before or after injection of STZ to induce the model, and continued throughout the study. IN treatment continued three times per week for three weeks before behavior tests started followed by eventual euthanasia with tissue collection. Spatial memory tests with the Morris water maze showed that STZ rats treated with IN DFO both before and after model induction had significantly shorter escape latencies. Pre-treatment with IN DFO also significantly decreased footslips on the tapered balance beam test. Brain tissue analyses showed DFO treatment decreased oxidation as measured by oxyblot and increased insulin receptor expression. These results further support the potential of IN DFO for use as a treatment for Alzheimer's disease, and show benefit in a non-amyloid/tau rodent model.

Recurrence after endoscopic mucosal resection-therapy failure?

PURPOSE: To evaluate the success and complication rates of endoscopic mucosal resections (EMR) for large flat adenomas and to identify risk factors for adenoma recurrence. METHODS: We evaluated all consecutive patients treated with EMR at our institution between 2003 and 2005 that fulfilled the following criteria: >10-mm diameter, Paris 0-Is and 0-IIa-c, and endoscopic follow-up. We conducted univariate analysis and multivariate analysis using a non-stratified logistic regression model to identify possible influencing factors. RESULT: In a median follow-up period of 6 years, we analyzed 177 EMR procedures, with a mean size of 21 mm. The majority of the resections were in the right colon. Recurrence occurred in 29 patients. Further treatment of patients with recurrence was endoscopic in 27 patients, whereas 1 patient was treated with transanal endoscopic microsurgery and one underwent surgery. The variables influencing the multivariate model were resection technique, immediate complication age, and histology. CONCLUSIONS: We show that EMR can achieve a long-term clearance of large flat adenomas. A recurrence after EMR does not equal to failed therapy. The possibility of recurrence has to be considered in the clinical implementation of EMR. An important part of the stratifying factors for follow-up is the procedural assessment of the effectiveness of the resection and the resection technique.

Can age-related CNS taste differences be detected as early as middle age? Evidence from fMRI.

Middle-aged Americans have higher obesity rates than any other age group, yet little is known about age-related changes in central taste function during this critical time. Research on taste and aging has primarily focused on psychophysical responses, and on older adults. Central taste processing in middle-age has not been investigated. In the current study, we compared functional magnetic resonance imaging (fMRI) activation of young and middle-aged adults during hedonic evaluation of a sweet and a bitter taste. A 2 (age group) by 2 (tastant) analysis of variance (ANOVA) on fMRI activation revealed: (1) a main effect of age (young adults>middle-aged adults) in the bilateral anterior cingulate, lentiform nucleus, putamen, caudate, and right precentral gyrus; (2) a main effect of taste (sweet>bitter) in the bilateral pre- and postcentral gyri, anterior cingulate and right middle frontal gyrus; qualified by (3) an age-by-taste interaction. Further inspection of the age-by-taste interaction revealed that there was a significant effect of age (greater activation in young adults) in sensory (insula) and reward (lentiform nucleus) regions during hedonic evaluation of the sweet taste; however, there was no age effect in the bitter taste condition. Further, young adults had greater responses during hedonic evaluation of sucrose than of caffeine in several sensory and motor processing regions (pre- and postcentral gyri, insula), but there were no taste-related differences in activation in the middle-aged adults. We speculate that these results might reflect early age-related differences in central taste processing that occur prior to deficits in gustatory function observed in old age, and this might have important implications for weight changes that occur during middle-age.

Effect of Magnitude Estimation of Pleasantness and Intensity on fMRI Activation to Taste.

The goal of the present study was to investigate whether the psychophysical evaluation of taste stimuli using magnitude estimation influences the pattern of cortical activation observed with neuroimaging. That is, whether different brain areas are involved in the magnitude estimation of pleasantness relative to the magnitude estimation of intensity. fMRI was utilized to examine the patterns of cortical activation involved in magnitude estimation of pleasantness and intensity during hunger in response to taste stimuli. During scanning, subjects were administered taste stimuli orally and were asked to evaluate the perceived pleasantness or intensity using the general Labeled Magnitude Scale (Green 1996, Bartoshuk et al. 2004). Image analysis was conducted using AFNI. Magnitude estimation of intensity and pleasantness shared common activations in the insula, rolandic operculum, and the medio dorsal nucleus of the thalamus. Globally, magnitude estimation of pleasantness produced significantly more activation than magnitude estimation of intensity. Areas differentially activated during magnitude estimation of pleasantness versus intensity included, e.g., the insula, the anterior cingulate gyrus, and putamen; suggesting that different brain areas were recruited when subjects made magnitude estimates of intensity and pleasantness. These findings demonstrate significant differences in brain activation during magnitude estimation of intensity and pleasantness to taste stimuli. An appreciation for the complexity of brain response to taste stimuli may facilitate a clearer understanding of the neural mechanisms underlying eating behavior and over consumption.

Caring for patients with difficult-to-heal ulcers.

This article presents Coloplast's chronic wound care guide for community nurses, in which wound management is described in terms of assessment, treatment and reassessment. Choosing the optimal wound dressing is explained separately. Three case studies are used to demonstrate the use of the guide. Using the guide as a framework is straightforward and easily interpreted by health professionals with varying levels of wound care knowledge and experience, therefore enabling health care professionals to use evidence based practice to improve patient outcomes.

Preclinical evaluation of a radiosensitizing effect of gemcitabine in p53 mutant and p53 wild type bladder cancer cells.

OBJECTIVES: Despite clinical use, the radiosensitizing effect of gemcitabine (2'2'-difluorodeoxycytidine) in human transitional cell carcinoma (TCC) has not been shown to date. We investigated gemcitabine as a radiosensitizer for human TCC cells. METHODS: Monolayer cultures of RT112 (G1, p53 wild type), RT4 (G1-G2, p53 wild type), T24 (G3, p53, mutant type), and SUP (G4, p53 mutant type) cells were incubated in medium with gemcitabine. Electron beam radiation was applied alone, simultaneous, or 3, 6, 12, and 24 hours after gemcitabine. Jurkat leukemia cells were used as controls for radiation toxicity. Cell survival was determined 6, 12, 24, 48, and 72 hours after radiation by microculture tetrazolium assay. DNA damage was evaluated by flow cytometric assessment of poly(ADP-ribose) polymerase, and apoptosis was determined by terminal-deoxynucleotidyltransferase-mediated dUTP nick-end labeling and flow cytometric assessment after annexin-V and propidium iodide labeling. RESULTS: In all TCC cell lines, radiation alone caused only little and insignificant growth inhibitory effects at 10 Gy. Gemcitabine alone had a dose-dependent cytotoxic and apoptosis inducing effect on all TCC cell lines independent of p53 status. Assays combining radiation with gemcitabine in different dose and time schedules demonstrated no radiosensitizing effect in TCC cells. CONCLUSIONS: Gemcitabine is effective in TCC cell lines independent of p53 status. A radiosensitizing effect could not be demonstrated. Again, p53 status was not predictive of the radioresponse in the bladder cancer cell lines. Clinical studies with gemcitabine and radiotherapy might nevertheless yield different results but should be performed with utmost caution.

[Simulated surgery on a 3D model. Technic and applications]. / Chirurgie simulée en modèle 3D. Technique et applications.

Treatment planning for the correction of dentofacial deformities includes prediction tracing and model surgery. However, these conventional methods provide only limited information concerning the planned spatial displacement of skeletal structures. In cases of severe deformities we add simulated 3D model surgery in an individually processed life size polyurethane skull to our work-up. The basic steps of the 3D model surgery are described, the advantages outlined and the method discussed.

Determination of renal volume by ultrasound scanning.

In patients with renal hypertension, determination of renal volume may be valuable for evaluating possible compensatory hypertrophy for correlating renal size to renal function, and for evaluating the transplanted kidney in relation to rejection and its response to therapy. We performed parallel transverse ultrasonic scans through each kidney and computed volume based on the cross-sectional areas outlined on the scans. In 16 autopsy studies a highly significant correlation between calculated and true values were obtained, rs = 0.847, p less than 0.001. The 5th and 95th percentiles of the median divergence were -21 and 27 ml respectively. In 30 healthy subjects, double determinations showed 5th and 95th percentiles of the median interobserver variation of -7 and 3 ml respectively. There was no demonstrable difference between volumes of right and left kidneys, and no difference in relation to sex. Total renal volume was most accurate when correlated with the body weight, rs = 0.698, p less than 0.001. Normal values of total renal volume per kilogram of body weight were 4.3 to 8.0 ml/kg. In normal subjects, the smallest kidney's volume should not be less than 37% of the total renal volume.