Prolonged intraperitoneal infusion of 5-fluorouracil using a novel carrier solution.

A novel peritoneal carrier solution, Icodextrin 20 (7.5%), has allowed exploration of prolonged, intraperitoneal (i.p.) infusion of the cytotoxic drug 5-fluorouracil (5-FU). A phase I and pharmacokinetic study was performed to determine the toxicities and maximum tolerated dose of prolonged and continuous intraperitoneal 5-FU in patients with peritoneal carcinomatosis. Seventeen patients were entered into this study. Each patient had a Tenckhoff catheter placed into the peritoneal cavity under general anaesthetic. After initial flushing and gradual increase in exchange volumes with Icodextrin 20, 5-FU was administered daily from Monday to Friday, 50% as a bolus in the exchange bag and 50% in an elastomeric infusor device delivering continuous 5-FU to the peritoneal cavity at 2 ml h-1. Treatment was continued for 12 weeks or until intolerable toxicity developed. Abdominal pain and infective peritonitis proved to be the main dose-limiting toxicities. Initial problems with infective peritonitis were overcome by redesign of the delivery system, and it proved possible to deliver 300 mg m-2 5-FU daily (5 days per week) for 12 weeks. Pharmacokinetic studies showed i.p. steady-state 5-FU concentrations (mean 47 500 ng ml-1) that were > 1000-fold higher than systemic venous levels (mean 30 ng ml-1)

Reliability of measurements of the fractured clavicle: a systematic review

BACKGROUND: The objective of this systematic review was to evaluate the reliability and reproducibility of measurements of shortening in midshaft clavicle fractures (MSCF) using any available imaging technique. METHODS: Electronic databases (PubMed, EMBASE, and Cochrane) were searched. The 4-point-scale COSMIN checklist was used to evaluate the methodological quality of studies. RESULTS: Four studies on reliability of measurement of MSCF were identified. These studies were of fair and poor quality. The reported intrarater reliability varied between none to fair, and intrarater reliability was minimal. CONCLUSION: No definite conclusions could be drawn. In order to optimize future studies and the realization of comparable results, more research is necessary to identify a standardized method of imaging and measuring. Level of Evidence III

Influence of x-ray direction on measuring shortening of the fractured clavicle

Item does not contain fulltextBACKGROUND: Midshaft clavicle fractures are often associated with a certain degree of shortening. There is great variety in the imaging techniques and methods to quantify this shortening. This study aims to quantify the difference in measurements of shortening and length of fracture elements between 5 views of the fractured clavicle. Furthermore, the interobserver and intraobserver agreement between these views using a standardized method is evaluated. MATERIALS AND METHODS: Digitally reconstructed radiographs were created for 40 computed tomography datasets in the anteroposterior (AP), 15 degrees and 30 degrees craniocaudal, and 15 degrees and 30 degrees caudocranial views. A standardized method for measuring the length of fracture elements and the amount of shortening was used. Interobserver and intraobserver agreement for each of the 5 views was calculated. RESULTS: The interobserver and intraobserver agreement was excellent for all 5 views, with all intraclass correlation coefficient values greater than 0.75. The measured differences in relative and absolute shortening between views were statistically significant between the 30 degrees caudocranial view and all other views. The increase in median shortening measured between the commonly used 30 degrees caudocranial view (2.7 mm) and the AP view (8.5 mm) was 5.8 mm (P < .001). The relative median shortening between these views increased by 3.5% (P < .001). CONCLUSION: The length of fracture elements and the amount of shortening in the fractured clavicle can be reliably measured using a standardized method. The increase in absolute and relative shortening when comparing the caudocranial measurements with the AP and craniocaudal measurements may indicate that the AP and craniocaudal views provide a more accurate representation of the degree of shortening

Influence of radiographic projection and patient positioning on shortening of the fractured clavicle

Contains fulltext : 229743.pdf (Publisher’s version ) (Open Access)BACKGROUND: Radiographic measurements of shortening and vertical displacement in the fractured clavicle are subject to a variety of factors such as patient positioning and projection. The aims of this study were (1) to quantify differences in shortening and vertical displacement in varying patient positions and X-ray projections, (2) to identify the view and patient positioning indicating the largest amount of shortening and vertical displacement, and (3) to identify and quantify the inter- and intraobserver agreement. METHODS: A prospective clinical measurement study of 22 acute Robinson type 2B1 clavicle fractures was performed. Each patient underwent 8 consecutive standardized and calibrated X-rays in 1 setting. RESULTS: In the upright patient position, the difference of absolute shortening was 4.5 mm (95% confidence interval [CI]: 3.0-5.9, P < .0001) larger than in the supine patient position. For vertical displacement, the odds of being scored a category higher in the upright patient position were 4.7 (95% CI: 2.2-9.8) times as large as the odds of being scored a category higher in supine position. The odds of being scored a category higher on the caudocranial projection were 5.9 (95% CI: 2.8-12.6) times as large as the odds of being scored a category higher on the craniocaudal projection. CONCLUSION: Absolute shortening, relative shortening, and vertical displacement were found to be the greatest in the upright patient positioning with the arm protracted orientation on a 15° caudocranial projection. No statistically significant differences were found for a change in position of the arm between neutral and protracted

The prognostic significance of intraperitoneal growth characteristics in epithelial ovarian carcinoma

Maximal cytoreductive surgery in advanced epithelial ovarian carcinoma (EOC) has become commonplace in management despite the inability of prospective trials to demonstrate a convincing improvement in long‐term survival. Optimal cytoreduction is only possible in 23–77% of cases, perhaps due to differences in tumor biology. In a retrospective analysis of 219 women, we have investigated one possible variable in tumor biology, namely the pattern of intraperitoneal spread. Median survival in the study group was 15.2 months (CI: 13.2–17.3). One hundred women had predominantly localized bulky spread and 119 had seedling spread to the peritoneum. The number of optimally debulked patients in the two groups was not significantly different (P = 0.9). Fifteen patients with bulky disease, had complete macroscopic clearance. Residual disease and performance status were highly significant prognostic factors. On univariate analysis, patients with seedling spread had a significantly poorer prognosis. Multivariate analysis showed that if for like cases: stage, residual disease, performance status, age, histology and differentiation were compared, the tumors with bulky spread carried a better prognosis than those with seedling spread. It has been demonstrated in this analysis that the pattern of spread is an independent prognostic factor of clinical significance

Time factors associated with CT scan usage in trauma patients

INTRODUCTION: While computed tomography (CT) scan usage in acute trauma patients is currently part of the standard complete diagnostic workup, little is known regarding the time factors involved when CT scanning is added to the standard workup. An analysis of the current time factors and intervals in a high-volume, streamlined level-1 trauma center can potentially expose points of improvement in the trauma resuscitation phase. MATERIALS AND METHODS: During a 5-week period, data on current time factors involved in CT scanned trauma patients were prospectively collected. All consecutive trauma patients seen in the Emergency Department following severe trauma, or inter-hospital transfer following initial stabilizing elsewhere, and that underwent CT scanning, were included. Patients younger than 16 years of age were excluded. For all eligible patients, a complete time registration was performed, including admission time, time until completion of trauma series, time until CT imaging, and completion of CT imaging. Subgroup analyses were performed to differentiate severity of injury, based on ISS, and on primary or transfer presentations, surgery, and ICU admittance. RESULTS: Median time between the arrival of the patient and completion of the screening X-ray trauma series was 9min. Median start time for the first CT scan was 82min. The first CT session was completed in a median of 105min after arrival. Complete radiological workup was finished in 114min (median). In 62% of all patients requiring CT scanning, a full body CT scan was obtained. Patients with ISS >15 had a significant shorter time until CT imaging and time until completion of CT imaging. CONCLUSION: In a high-volume level-1 trauma center, the complete radiological workup of trauma patients stable enough to undergo CT scanning, is completed in a median of 114min. Patients that are more severely injured based on ISS were transported faster to CT, resulting in faster diagnostic imagin