Detection of cholangiocarcinoma with magnetic resonance spectroscopy of bile in patients with and without primary sclerosing cholangitis

NRC publication: Ye

Efficacy of preoperative radiochemotherapy in patients with locally advanced pancreatic carcinoma

Background. The optimal care for patients with unresectable, non-metastatic pancreatic adenocarcinoma (PAC) is debated. We treated 17 consecutive cases with preoperative radiochemotherapy (RCT) as a means for downstaging their tumours and compared outcome with 35 patients undergoing direct surgery for primarily resectable PAC during the same time period. Methods. The patients had biopsy proven, unresectable, non-metastatic PAC which engaged >/=50% of the circumference of a patent mesenteric/portal vein for a distance >/=2 cm and/or <50% of the circumference of a central artery for <2 cm. The preop therapy included two courses of Xelox (oxaliplatin 130 mg/m(2) d1; capecitabine 2 000 mg/m(2) d1-14 q 3 w) followed by 3-D conformal radiotherapy (50.4 Gy; 1.8 Gy fractions) with reduced Xelox (d1-5 q 1 w X 6). Results. No incident of RCT-related CTC Grade 3-4 haematologic and six cases of non-haematologic side-effects were diagnosed. Sixteen patients completed the RCT and were rescanned with CT and reevaluated for surgery 4 weeks post-RCT. Five cases were diagnosed with new metastases to the liver. Eleven patients were accepted for surgery whereof eight underwent a curative R(0)-resection. The median overall survival for the latter group was 29 months, which compared favourably with our control group of patients undergoing direct curative surgery for primarily resectable PAC (median OS: 16 months; R(O)-rate: 75%). Perioperative morbidity was similar in the two cohorts but the duration of surgery was longer (576 vs. 477 min) and the op blood loss was greater (3288 vs. 1460 ml) in the RCT-cohort (p < 0.05). The 30-day mortality was zero in both groups. Conclusion. Preoperative RCT in patients with locally advanced PAC resulted in a high rate of curative resections and promising median survival in our treatment series. This trimodality approach merits further exploration in new studies, which are currently underway at our Department

Insulated spine boards for prehospital trauma care in a cold environment

Objectives: The aim of this study was to examine, during field conditions, what impact additional insulation on a spine board would have on thermoregulation. Method: The study was conducted outdoors, under field conditions in February in the north of Sweden. The subjects, all wearing standardised clothing, were immobilised on uninsulated (n=10) or insulated spine boards (n=9). Tympanic temperature as well as the subjects’ estimated sensation of cold and their estimated level of shivering were measured at five minute intervals during the trial. Statistical analysis of the data gathered for the first 55 minutes was performed. Results: There were no differences between the two groups regarding reduction in body core temperature or cold discomfort. There was, however, a statistically significant increase in estimated shivering for the subjects placed on uninsulated spine boards. Conclusion: Additional insulation on a spine board by the means of an insulation mat rendered a significantly reduced need for shivering in a cold environment. This is an effect that could be of great importance during protracted evacuations of injured, ill or otherwise compromised patients. In the light of these results we conclude that spine boards, as well as other materials used for prehospital transportation of patients in cold environments, should be well insulated. This is a measure that could be accomplished by such simple means as using an additional insulation mat

Fatal hypothermia : an analysis from a sub-arctic region

Objectives. To determine the incidence as well as contributing factors to fatal hypothermia. Study design. Retrospective, registry-based analysis. Methods. Cases of fatal hypothermia were identified in the database of the National Board of Forensic Medicine for the 4 northernmost counties of Sweden and for the study period 1992-2008. Police reports, medical records and autopsy protocols were studied. Results. A total of 207 cases of fatal hypothermia were noted during the study period, giving an annual incidence of 1.35 per 100,000 inhabitants. Seventy-two percent occurred in rural areas, and 93% outdoors. Many (40%) were found within approximately 100 meters of a building. The majority (75%) occurred during the colder season (October to March). Some degree of paradoxical undressing was documented in 30%. Ethanol was detected in femoral vein blood in 43% of the victims. Contributing co-morbidity was common and included heart disease, earlier stroke, dementia, psychiatric disease, alcoholism, and recent trauma. Conclusions. With the identification of groups at high risk for fatal hypothermia, it should be possible to reduce risk through thoughtful interventions, particularly related to the highest risk subjects (rural, living alone, alcohol-imbibing, and psychiatric diagnosis-carrying) citizens