Is Single-Dose Antibiotic Prophylaxis Sufficient for Any Surgical Procedure?

Abstract

The objective of perioperative prophylaxis is to prevent postoperative infections, which are the primary cause of morbidity and mortality in patients undergoing surgery today. One cannot predict with certainty when bacterial contamination at the operative site may occur during surgery. Furthermore, it has been suggested that the period of highest risk may actually be at the end, rather than at the beginning, of the operation. Therefore, the effect of antimicrobial prophylaxis ideally should cover the entire perioperative “period of risk”. It should be remembered that the period of risk for postoperative infection may last substantially longer than the actual surgical procedure. The duration of the risk period also may vary based on a number of other factors, such as the age and general condition of the patient, presence of concomitant disease, amount of blood loss during surgery, and number of blood transfusions required. Antimicrobial prophylaxis that provides coverage throughout the entire perioperative period of risk will reduce not only the risk of wound infections but may also reduce the danger of other types of infectious complications. Numerous clinical studies have clearly shown that appropriately-timed “single shot” prophylaxis is as effective as multiple-dose prophylaxis. This paper considers the evolution of this therapeutic intervention and reviews the opportunities available for antibiotic prophylaxis in surgery, with particular attention to the long-acting cephalosporin, ceftriaxone.     

Is there a role for a specialized follow-up clinic for survivors of pediatric cancer?

Due to advances in chemotherapy and supportive care, greater than 70% of patients with childhood cancer will survive 5 years. However, there are long-term physiological and psychological sequelae of these treatments that may not manifest until pediatric survivors are into adulthood. Various studies done in the long-term pediatric survivors have noted that they are at increased risk for poor health and for chronic health problems. One complicating factor in treating these patients for their health problems is that many childhood cancer survivors are unaware of their past medical history and what their past cancer treatment entailed. There are also a number of barriers to medical care in survivors of childhood cancer which include inadequate insurance coverage for many and lack of knowledge of long-term effects physicians. As pediatric cancer survivors age they usually transition to community physicians. This paper proposes different models for follow-up clinics for survivors of pediatric cancers so childhood cancer survivors are not be subjected to cost ineffective or excessive evaluations but rather medical screening tests that are risk and guidelines that are set forth by experts.     

Combined Small Cell Carcinoma of the Lung: Is It a Single Entity?

Background

SCLC accounts for 15% and 20% of all lung cancers, with combined SCLC (CSCLC) comprising 2% to 5%. Little is known about the clinical characteristics and molecular changes associated with the various histologic components.

602 Is There a Role for Allografting in Myeloma in the Era of New Drugs?: Long-Term Follow-Up of a Comparative Study

We conducted a trial where treatment depended on the presence of HLA-identical siblings. Induction included an autograft, followed by a non-myeloablative allograft or a second autograft. At a median of 7.1 years, OS and EFS were significantly longer in patients with HLA-matched siblings and in those who underwent the allograft.

Full Abstract

Before “new drugs” became readily available, we carried out a trial where treatment assignments were based only on the presence/absence of HLA-identical siblings (Bruno et al, NEJM 2007). Overall, 162/199 (81%) consecutive patients with siblings were HLA-typed. Induction included VAD-based regimens and a cytoreductive autograft, followed by a non-myeloablative allograft or a second melphalan-based autograft. We report an update at a median follow up of 7.1 years. Complete remissions (CR) were

     

Is There a Role for Bevacizumab in the Treatment of Glioblastoma?

Bevacizumab gained accelerated approval from the U.S. Food and Drug Administration for use as monotherapy in progressive glioblastoma, based on improved radiologic response rates observed with bevacizumab monotherapy in two single-arm or noncomparative phase II trials. Drs. Chi and Chamberlain discuss whether the available evidence supports the use of bevacizumab in glioblastomas.     

Is there a role for nontraditional resection of early gastric cancer?

Current trends in the treatment of gastric cancer indicate the emergence of a more sophisticated approach, with tailored therapy applied to individual cases. Treatment includes a broader spectrum of therapeutic options (Fig. 3), including EMR, laparoscopic or laparoscopy-assisted surgery, modified radical surgery, and typical radical surgery with lymph node dissections. Precise characterization of the lesions, especially the depth of invasion in the gastric wall, its size, histology and whether there is ulceration, is the key to successful treatment of N0 mucosal cancer. Micrometastasis and metastasis at the molecular level are issues that require further investigation. Laparoscopic surgery may be more widely accepted. The limitations of nodal dissection based on the concept of a sentinel node should be carefully evaluated in future studies. [figure: see text] Many treatment options, ranging from minimally invasive surgery to D2 node dissection, are available to the surgical oncologist who is treating EGC. As more information is gathered, surgeons will be better able to select patients who are good candidates for minimal surgical procedures.     

Is there still a role for the uniscale assessment of quality of life?

AIMS AND BACKGROUND: To obtain proof of external validity of the visual analogue scale and re-evaluate the use of this instrument in assessing cancer patients' quality of life. METHODS: Consecutive patients attending 79 Italian medical oncology and radiotherapy centers over a period of 1 week were asked to fill out both a questionnaire concerning the presence of 19 problems and a 100-mm linear visual analogue scale evaluating their quality of life. Quality of life was rated as "good" and "bad" when given a score of 70-100 and 0-30, respectively. Multifactorial logistic models were used where good and bad quality of life were correlated with explanatory variables including patient and disease characteristics and the presence or absence of the 19 problems. RESULTS: Gender, level of education, treatment setting, Karnofsky performance status, disease extent, and the presence of 12 out of 19 problems were found to be correlated with good quality of life. A similar pattern of correlations was found with bad quality of life. CONCLUSIONS: Due to the difficulties in attaining reliable assessment of quality of life using psychometric questionnaires, the further proof of validity obtained in this study allows us to propose the re-evaluation of the role of the uniscale in measuring the quality of life of cancer patients.     

Is digitalis a therapy for breast carcinoma?

We have previously reported effects on breast carcinoma by digitalis on patients in vivo with significant effects on cytometric features and recurrence rate. Increased attention is now paid to the anti-proliferative and apoptosis inducing effect on cancer cells in vitro by glycosides from foxglove as well as by some other glycosides. The present study is a long-term follow-up (22.3 years) of 175 patients with breast carcinoma, of which 32 were on digitalis treatment, when they acquired their breast carcinoma. There was a lower death rate (6%) from breast carcinoma among the patients on digitalis, when compared with patients not on digitalis (34%). Also proliferation/aneuploidy was less pronounced of the tumors in patients on digitalis. These observations were statistically significant although the statistical analysis was hampered in the life-table analysis by the fact that only 2/32 patients on digitalis died from breast cancer. Serious consideration should be given to the effects of digitalis derivatives on cancer cells in cancer drug design. This field of research is not sufficiently explored and holds promise to contain drugs superior to present-day adjuvant therapy both with respect to effects and side-effects.     

Is there a role for complementary therapy in the management of leukemia?

Patients with leukemia often seek additional treatments not prescribed by their oncologist in an effort to improve their cancer treatment outcome or to manage symptoms. Complementary therapies are used in conjunction with traditional cancer treatments to decrease symptoms and side effects associated with cancer or cancer treatment, and to improve patients’ overall quality of life. Complementary therapies are distinct from so-called ‘alternative’ therapies, which are unproven, ineffective and may postpone or interfere with mainstream cancer treatment. Complementary therapies are pleasant, inexpensive, nonpharmacologic and effective. For patients with leukemia, the complementary therapies that are always appropriate include mind–body interventions, such as self-hypnosis, meditation, guided imagery and breath awareness. Massage and reflexology (foot massage) decrease symptoms with effects lasting at least 2 days following treatment. Acupuncture is very beneficial for symptom management without adverse consequences. Physical fitness with regular exercise and healthy dietary habits can significantly decrease side effects of cancer treatments and may prolong survival. Botanical extracts and vitamin supplements may interfere with active cancer treatments, and should be discussed with the oncologist or pharmacist before use.