Efficacy of Ondansetron as a Prophylactic Anti-Hypotensive Pharmacologic Intervention Among Obese Parturients Undergoing Spinal Anesthesia for Cesarean Delivery

Background and PurposeObesity has been identified as a risk factor for hypotension after spinal anesthesia among parturients undergoing cesarean delivery. Although researchers have demonstrated prophylactic administration of ondansetron as efficacious in attenuating maternal hypotension following spinal anesthesia, no studies have examined the efficacy of prophylactic ondansetron in the high risk population of obese parturients. The primary objective of this study was to assess the efficacy of the novel application of ondansetron as a prophylactic anti-hypotensive pharmacologic intervention among obese parturients in order to facilitate practice recommendations that aim to reduce maternal-fetal risk associated with the administration of spinal anesthesia for cesarean delivery. MethodsRetrospective chart analyses of 46 patients with BMI > 30 were conducted between August 1, 2014 and May 10, 2015 to determine whether the intravenous administration of 4 mg ondansetron prior to the induction of spinal anesthesia reduced frequency of vasopressor administration during cesarean section. ResultsThe incidence of vasopressor administration among patients who received prophylactic ondansetron was 35.7%, whereas 46.9% of patients who did not receive prophylactic ondansetron required vasopressor administration (χ2 = 0.144, df = 1, p = 0.704).ConclusionsObese parturients undergoing spinal anesthesia for cesarean delivery demonstrated improvements in hemodynamic stability when prophylactically treated with ondansetron.

Preoperative spinal tumor embolization: an institutional experience with Onyx.

BACKGROUND: Preoperative embolization has the potential to decrease intraoperative blood loss and facilitate spinal cord decompression and tumor resection. OBJECTIVE: We report our institutional experience with the embolization of hypervascular extradural spinal tumors with Onyx as well as earlier embolic agents in a series of 28 patients. METHODS: A retrospective case review was conducted on patients undergoing preoperative transarterial embolization of a spinal tumor between 1995 and 2012 at our institution. RESULTS: Twenty-eight patients met the inclusion criteria, with a mean age of 60.6 years. Twenty-eight patients had metastatic tumors. In 14 (50%) patients the metastases were from renal cell carcinomas. Fifty-four vessels were embolized using PVA, NBCA, Onyx, coils, or embospheres. Sixteen patients were treated with Onyx, 6 patients with PVA, 3 patients with embospheres, 2 patients with NBCA, and 3 patients with a combination of embolic agents. The average decrease in tumor blush was 97.8% with Onyx versus 92.7% with the rest of the embolic agents (p=0.08). The estimated blood loss was 1616ml (range 350-5000ml). Blood loss was 750cm(3) on average with Onyx versus 1844 with the rest of the embolic agents (p=0.14). The mean length of stay was 16 days. The mortality rate was zero. Pre- and post-operative modified Rankin Score (mRS) did not differ significantly in the series (3.12 versus 3.10, respectively, p=0.9). CONCLUSION: In our experience, the use of transarterial tumor embolization as an adjunct for spinal surgery is a safe and feasible option

Implications of a high-definition multileaf collimator (HD-MLC) on treatment planning techniques for stereotactic body radiation therapy (SBRT): a planning study

<p>Abstract</p> <p>Purpose</p> <p>To assess the impact of two multileaf collimator (MLC) systems (2.5 and 5 mm leaf widths) on three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and dynamic conformal arc techniques for stereotactic body radiation therapy (SBRT) of liver and lung lesions.</p> <p>Methods</p> <p>Twenty-nine SBRT plans of primary liver (n = 11) and lung (n = 18) tumors were the basis of this study. Five-millimeter leaf width 120-leaf Varian Millennium (M120) MLC-based plans served as reference, and were designed using static conformal beams (3DCRT), sliding-window intensity-modulated beams (IMRT), or dynamic conformal arcs (DCA). Reference plans were either re-optimized or recomputed, with identical planning parameters, for a 2.5-mm width 120-leaf BrainLAB/Varian high-definition (HD120) MLC system. Dose computation was based on the anisotropic analytical algorithm (AAA, Varian Medical Systems) with tissue heterogeneity taken into account. Each plan was normalized such that 100% of the prescription dose covered 95% of the planning target volume (PTV). Isodose distributions and dose-volume histograms (DVHs) were computed and plans were evaluated with respect to target coverage criteria, normal tissue sparing criteria, as well as treatment efficiency.</p> <p>Results</p> <p>Dosimetric differences achieved using M120 and the HD120 MLC planning were generally small. Dose conformality improved in 51.7%, 62.1% and 55.2% of the IMRT, 3DCRT and DCA cases, respectively, with use of the HD120 MLC system. Dose heterogeneity increased in 75.9%, 51.7%, and 55.2% of the IMRT, 3DCRT and DCA cases, respectively, with use of the HD120 MLC system. DVH curves demonstrated a decreased volume of normal tissue irradiated to the lower (90%, 50% and 25%) isodose levels with the HD120 MLC.</p> <p>Conclusion</p> <p>Data derived from the present comparative assessment suggest dosimetric merit of the high definition MLC system over the millennium MLC system. However, the clinical significance of these results warrants further investigation in order to determine whether the observed dosimetric advantages translate into outcome improvements.</p

Successful outcome of six-level cervicothoracic corpectomy and circumferential reconstruction: case report and review of literature on multilevel cervicothoracic corpectomy

The authors report the successful outcome of a six-level corpectomy across the cervico-thoracic spine with circumferential reconstruction in a patient with extensive osteomyelitis of the cervical and upper thoracic spine. To the authors’ knowledge, this is the first report of a corpectomy extending across six levels of the cervico-thoracic spine. Clinical relevance: the authors recommend anterior cage and plate-assisted reconstruction and additional posterior instrumentation using modern spinal surgical techniques and implants

A model of management academics' intentions to influence values

Business schools face increased criticism for failing in the teaching of management studies to nurture their students’ values. Assuming that individual academics play an important role in shaping the value-related influence of business schools, I model management academics’ intentions to influence values. The suggested model encompasses academics’ economic and social values as internal variables, as well as perceived support for attempting to influence values and academic tenure as social and structural variables. A test with empirical data from 1,254 management academics worldwide reveals that perceived external support is most relevant for explaining intentions. Moreover, academics’ social values, but not their economic ones, contribute to an explanation of their intentions to influence values. The results reveal how important it is for academics to believe that their colleagues, higher education institutions, and other stakeholders support their value-related behavioral intentions