When should diclofenac be given in ambulatory surgery: preoperatively or postoperatively?

Study Objective: To determine the optimum time of administration of diclofenac in patients undergoing ambulatory knee arthroscopy: either preoperatively or postoperatively. Design: Randomized, double-blind study. Setting: Ambulatory surgical unit in a tertiary referral hospital. Patients: 127 ASA physical status I and II patients undergoing ambulatory knee arthroscopy. Interventions: Patients were randomized into three groups. The Preop group received 50 mg of potassium diclofenac orally 1 hour preoperatively and a placebo 30 minutes postoperatively. The Pre+postop group received 25 mg of potassium diclofenac 1 hour preoperatively and 25 mg diclofenac 30 minutes postoperatively. The Postop group received a placebo 1 hour before surgery and 50 mg of potassium diclofenac 30 minutes postoperatively. Measurements and Main Results: The Postop group received a placebo 1 hour preoperatively and 50 mg of potassium diclofenac 30 min postoperatively. Postoperatively, patients used intravenous patient-controlled analgesia (PCA) with fentanyl. Total fentanyl consumption was recorded. During the recovery period, pain was assessed using a visual analog scale (VAS) at 30-minute intervals. Pain was assessed in both legs at rest, on flexion, and extension of the knee. There were no significant differences in pain scores either at rest or on movement of the operative knee among the Preop, Pre+postop, and Postop groups. The consumption of fentanyl via PCA showed no significant differences among the groups. Conclusions: There is no difference in pain relief whether diclofenac is given preoperatively or postoperatively in patients undergoing unilateral ambulatory knee arthroscopy. Preoperative and postoperative treatment with diclofenac potassium is equally effective. Author Keywords: Ambulatory anesthesia; ambulatory surgery; analgesia, postoperative; nonsteroidal antiinflammatory drug

Routine chest roentgenography on admission to intensive care unit after heart operations: Is it of any value?

AbstractThe need for routine immediate postoperative chest roentgenography after heart operations has recently been questioned. In this study we investigated the impact of routine postoperative chest roentgenography on treatment instituted in the cardiovascular intensive care unit immediately after heart operations done via median sternotomy. A total of 404 random patients admitted to the cardiovascular intensive care unit underwent clinical (positioning of endotracheal tube, nasogastric tube, and pulmonary artery catheter) and laboratory (oxygenation) assessment by a cardiovascular intensive care unit physician according to a strict protocol. After clinical assessment, chest roentgenography was done for all admitted patients and the findings reviewed by the same physician. Pathologic conditions noted were recorded on the study form together with any required treatment. Eighteen patients (4.5%) out of 404 required intervention because of abnormalities detected by the chest x-ray film but not predicted by the initial physical and laboratory assessment. None of the pathologic conditions detected was life threatening. We conclude that chest roentgenography done on admission to the cardiovascular intensive care unit should be done only if clinical and laboratory assessment indicate the possibility of underlying pathologic conditions that can only be confirmed or diagnosed by chest roentgenography. (J Thorac Cardiovasc Surg 1997;113:130-3

Respiratory effects of intraoperative alfentanil infusion in post-abdominal hysterectomy patients: A comparison of high versus low dose

A number of reports have been published describing (recurrent) respiratory depression after the use of alfentanil intraoperatively. To evaluate the severity of respiratory depression after the administration of alfentanil, 49 patients undergoing general anaesthesia for abdominal hysterectomy were randomly allocated to one of three groups and studied in a double-blind manner. During surgery patients received no opioids (group 1), low dose (group 2) or high dose of alfentanil (group 3). Postoperatively patients were monitored with pulse oximetry and respiratory inductive plethysmography. Postoperative pain was managed with PCA morphine. Thirty-nine patients completed the study. Respiratory depressant effects were found in all three groups. A higher number of apnoeas (at 60 minutes in group 1: 3.3 ± 1.6; group 2: 3.5 ± 1.8; group 3: 12.2 ± 2.8) and a higher morphine consumption was found in group 2 when compared with group 1 and 3. No differences were found among the groups in the other respiratory parameters or in terms of the number of patients with respiratory depression at any one time. No cases of clear-cut recurrent respiratory depression were identified

Sunitinib in combination with docetaxel in patients with advanced solid tumors: a phase I dose-escalation study

PURPOSE: Sunitinib in combination with docetaxel enhances antitumor activity in xenograft models of human breast and non-small cell lung cancer. We assessed the maximum tolerated doses (MTDs), safety, pharmacokinetic profiles, and preliminary efficacy of sunitinib plus docetaxel in patients with advanced solid tumors. METHODS: In this phase I study, successive patient cohorts received sunitinib 25, 37.5, or 50 mg/day for 4 weeks of a 6-week cycle (Schedule 4/2, 4 weeks on, 2 weeks off) or for 2 weeks of a 3-week cycle (Schedule 2/1, 2 weeks on, 1 week off) with docetaxel 60 or 75 mg/m(2) IV q21d to determine the MTDs of this treatment combination. RESULTS: Fifty patients enrolled: 10 on Schedule 4/2 and 40 on Schedule 2/1. MTDs were established as sunitinib 25 mg on Schedule 4/2 with docetaxel 60 mg/m(2) q21d, and as sunitinib 37.5 mg on Schedule 2/1 with docetaxel 75 mg/m(2) q21d. On Schedule 2/1, the most frequent dose-limiting toxicity was neutropenia (±fever; grade [G]3/4, n = 5) and the most common G3/4 non-hematologic adverse event (AE) was fatigue (G3, n = 8). Hematologic AEs were managed with growth factor support in 11 of 23 (48%) patients treated at Schedule 2/1 MTD. Three patients achieved a partial response at the Schedule 2/1 MTD. There were no pharmacokinetic drug–drug interactions with either schedule. CONCLUSIONS: Oral sunitinib 37.5 mg/day on Schedule 2/1 with docetaxel 75 mg/m(2) IV q21d is a clinically feasible regimen with a manageable safety profile, no pharmacokinetic drug–drug interactions, and shows antitumor activity in patients with advanced solid tumors

Systemic Therapy of Bronchioloalveolar Carcinoma: Results of the First IASLC/ASCO Consensus Conference on Bronchioloalveolar Carcinoma

Introduction:Bronchioloalveolar carcinoma (BAC) is a subtype of adenocarcinoma of the lung with unique pathological, clinical, and molecular characteristics.Methods:This consensus conference group reviewed studies performed specifically in BAC and data from patients with BAC who were included in clinical trials of all non–small-cell lung cancer (NSCLC) subtypes.Results:Although BAC as defined by the World Health Organization represents less than 5% of adenocarcinomas, as many as 20% of adenocarcinomas have BAC features. These latter tumors are more likely to have mutations in the epidermal growth factor receptor (EGFR) gene and to be sensitive to the EGFR tyrosine kinase inhibitors gefitinib and erlotinib. Although most patients are men and have a history of smoking cigarettes, proportionally more are women and never smokers. Patients with BAC are routinely treated with drugs and regimens appropriate for patients with all subtypes of adenocarcinoma of the lung; four studies have been performed specifically in this disease.Conclusions:There is insufficient evidence to confirm or refute the assertion that the sensitivity of BAC to chemotherapy is different from that of other lung cancer histologic types. The unique clinical and molecular characteristics associated with BAC led this panel to conclude that future clinical trials should be designed specifically for persons with BAC. Recommendations for trial design and research questions are proposed

DETERMINANTS OF ADJUVANT OXALIPLATIN RECEIPT AMONG OLDER STAGE II AND III COLORECTAL CANCER PATIENTS

Controversy exists regarding adjuvant oxaliplatin treatment among older stage II and III colorectal cancer (CRC) patients. We sought to identify patient/tumor, physician, hospital, and geographic factors associated with oxaliplatin use among older patients

IMpower030: Phase III study evaluating neoadjuvant treatment of resectable stage II-IIIB non-small cell lung cancer (NSCLC) with atezolizumab (atezo) + chemotherapy

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A Road Map for the Exploration of Neighboring Planetary Systems (ExNPS)

A brown dwarf star having only 20-50 times the mass of Jupiter is located below and to the left of the bright star GL 229 in this image from the Hubble Space Telescope. At the 19 light year distance to GL 229, the 7.7-arcsec separation between the star and the brown dwarf corresponds to roughly the separation between Pluto and the Sun in our Solar System. The goal of the program described in this report is to detect and characterize Earth-like planets around nearby stars where conditions suitable for life might be found. For a star like the Sun located 30 light years away, the appropriate star-planet separation would be almost 100 times closer than seen here for GL 229B

Comparative Effectiveness of Oxaliplatin Versus 5-flourouricil in Older Adults: An Instrumental Variable Analysis

Oxaliplatin was rapidly adopted for treatment of stage III colon cancer after FDA approval in November 2004, thus providing an opportunity to use calendar time as an instrumental variable (IV) in nonexperimental comparative effectiveness research. Assuming instrument validity, IV analyses account for unmeasured confounding and are particularly valuable in sub-populations of unresolved effectiveness such as older individuals

Dependencies in language: On the causal ontology of linguistic systems

Dependency is a fundamental concept in the analysis of linguistic systems. The many if-then statements offered in typology and grammar-writing imply a causally real notion of dependency that is central to the claim being made—usually with reference to widely varying timescales and types of processes. But despite the importance of the concept of dependency in our work, its nature is seldom defined or made explicit. This book brings together experts on language, representing descriptive linguistics, language typology, functional/cognitive linguistics, cognitive science, research on gesture and other semiotic systems, developmental psychology, psycholinguistics, and linguistic anthropology to address the following question: What kinds of dependencies exist among language-related systems, and how do we define and explain them in natural, causal terms