Consensus Recommendations for the Diagnosis and Management of Pancreatic Neuroendocrine Tumors: Guidelines from a Canadian National Expert Group

Annals of Surgical Oncology - Pancreatic neuroendocrine tumors (pNETs) are rare heterogeneous tumors that have been steadily increasing in both incidence and prevalence during the past few decades....     

Laparoscopy in the evaluation of gynecologic cancer.

Laparoscopy was used to evaluate 60 patients with a variety of known or suspected gynecologic neoplasms. Diagnostic laparoscopy was performed on 18 patients to confirm benign or malignant pelvic masses or to confirm peritoneal carcinomatosis. Ten of these 18 patients (56%) were found to have unresectable carcinomatosis or benign disease which did not require further surgery. Staging laparoscopy was performed on 13 patients of which 3 had clinically unsuspected intraperitoneal spread of their disease. Surveillance laparoscopy was performed on 29 patients to determine the remission, regression, or progression of their disease following treatment; 8 (27%) had progressive or unresectable persistent disease. Despite the fact that the study comprised a high-risk group of previously operated on or irradiated patients, there was only one major complication. There was, however, a 10% incidence of laparoscopic failure from inadequate visualization. Twenty-one of the study patients (35%) were spared a laparotomy by the use of laparoscopy. The findings of this investigation help to identify those gynecologic oncology patients who should benefit most from the use of laparoscopy as an adjunct to the diagnosis, staging, or surveillance of intraabdominal malignant tumors.     

Infant growth and later body composition: evidence from the 4-component model

BACKGROUND: Rapid weight gain in infancy is associated with higher body mass index in later life, but its relation with individual body-composition components remains unclear. OBJECTIVE: We aimed to investigate associations between weight gain during different periods in infancy and later fat mass (FM) and fat-free mass (FFM). DESIGN: Body composition was assessed by using the 4-component model, dual-energy X-ray absorptiometry, and anthropometry in 234 healthy UK children and adolescents (105 boys; x +/- SD age: 11.4 +/- 3.8 y). Early growth measurements were prospective in 52 subjects and retrospective in 182. Relative weight gain was calculated as change in SD score (SDS) during different periods. RESULTS: Relative weight gain from 0 to 3 mo and from 3 to 6 mo showed positive relations with childhood FM, waist circumference, and trunk FM that were equivalent to increases in FMI (FM/height(2)) of 0.24 SDS (95% CI: 0.04, 0.44) and 0.50 SDS (0.25, 0.75) per 1-SDS increase in early weight and that were comparable to the effect of current obesity risk factors. Relative weight gain from 0 to 3 mo was also positively associated with later FFMI (FFM/height(2)). Relative weight gain from 6 to 12 mo was not associated with later body composition. Associations were independent of birth weight, sex, puberty, physical activity, socioeconomic class, ethnicity, and parental body mass index. CONCLUSIONS: In this Western population, greater relative weight gain during early infancy was positively associated with later FM and central fat distribution and with FFM. Rapid weight gain in infancy may be a risk factor for later adiposity. Early infancy may provide an opportunity for interventions aimed at reducing later obesity risk.     

Endothelial Dysfunction: Associations with Exposure to Ambient Fine Particles in Diabetic Individuals

Background

Exposure to fine airborne particulate matter [≤2.5 μm in aerodynamic diameter (PM_2.5)] has been associated with cardiovascular and hematologic effects, especially in older people with cardiovascular disease. Some epidemiologic studies suggest that adults with diabetes also may be a particularly susceptible population.

Objectives

The purpose of this study was to analyze the short-term effects of ambient PM_2.5 on markers of endothelial function in diabetic volunteers.

Methods

We conducted a prospective panel study in 22 people with type 2 diabetes mellitus in Chapel Hill, North Carolina (USA), from November 2004 to December 2005. We acquired daily measurements of PM_2.5 and meteorologic data at central monitoring sites. On 4 consecutive days, we measured endothelial function by brachial artery ultrasound in all participants and by pulsewave measurements in a subgroup. Data were analyzed using additive mixed models with a random participant effect and adjusted for season, day of the week, and meteorology.

Results

Flow-mediated dilatation decreased in association with PM_2.5 during the first 24 hr, whereas small-artery elasticity index decreased with a delay of 1 and 3 days. These PM_2.5-associated decrements in endothelial function were greater among participants with a high body mass index, high glycosylated hemoglobin A1c, low adiponectin, or the null polymorphism of glutathione S-transferase M1. However, high levels of myeloperoxidase on the examination day led to strongest effects on endothelial dysfunction.

Conclusions

These data demonstrate that PM_2.5 exposure may cause immediate endothelial dysfunction. Clinical characteristics associated with insulin resistance were associated with enhanced effects of PM on endothelial function. In addition, participants with greater oxidative potential seem to be more susceptible.     

EAU Guidelines on Assessment and Nonsurgical Management of Urinary Incontinence

Context

The previous European Association of Urology (EAU) guidelines on urinary incontinence comprised a summary of sections of the 2009 International Consultation on Incontinence. A decision was made in 2010 to rewrite these guidelines based on an independent systematic review carried out by the EAU guidelines panel, using a sustainable methodology.

Objective

We present a short version of the full guidelines on assessment, diagnosis, and nonsurgical treatment of urinary incontinence, with the aim of increasing their dissemination.

Evidence acquisition

Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches, based on Population, Intervention, Comparator, Outcome questions. Appraisal of papers was carried out by an international panel of experts, who also collaborated on a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system.

Evidence summary

The full version of the guidelines is available online (http://www.uroweb.org/guidelines/online-guidelines/). The guidelines include algorithms that refer the reader back to the supporting evidence, and they are more immediately useable in daily clinical practice.

Conclusions

These new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where such evidence does not exist, they present a consensus of expert opinion.     

A shared biomechanical environment for bone and posture development in children

Background Context

In each specific habitual standing posture, gravitational forces determine the mechanical setting provided to skeletal structures. Bone quality and resistance to physical stress is highly determined by habitual mechanical stimulation. However, the relationship between bone properties and sagittal posture has never been studied in children.

A randomized comparison of conventional vs articulating laparoscopic needle-drivers for performing standardized suturing tasks by laparoscopy-naive subjects

Associate Editor Ash Tewari Editorial Board Ralph Clayman, USA Inderbir Gill, USA Roger Kirby, UK Mani Menon, USA

OBJECTIVES

To compare the efficacy of conventional and articulating laparoscopic needle‐drivers for performing standardized laparoscopic tasks by medical students with no previous surgical experience.

SUBJECTS AND METHODS

Twenty medical students with no surgical experience were randomly assigned to two equal groups, one using a conventional laparoscopic needle‐holder (Karl Storz, Tuttlingen, Germany) and the other using a first‐generation articulating laparoscopic needle‐holder (Cambridge Endo, Framingham, MA, USA). Each student performed a series of four standardized laparoscopic tasks, during which speed and accuracy were assessed. The tasks tested needle passage through rings (1), an oblique running suture model (2), a urethrovesical anastomosis model (3) and a model simulating renal parenchymal reconstruction following partial nephrectomy (4).

RESULTS

Tasks 1 and 3 were completed significantly more quickly by those using the conventional instruments (P < 0.05), but there was no statistically significant difference for task 2 and 4 (P > 0.05). Those using conventional instruments were significantly more accurate in all of the tasks than those using the articulated instruments (P < 0.05).

CONCLUSIONS

The conventional laparoscopic needle‐driver allowed laparoscopy‐naive medical students to complete a series of standardized suturing tasks more rapidly and accurately than with the novel articulating needle‐driver. Laparoscopic suturing with first‐generation articulating needle‐drivers might be more difficult to learn, secondary to the complexity of physical manoeuvres required for their use.     

Traumatic brain injury biomarkers in pediatric patients: a systematic review

Neurosurgical Review - Traumatic brain injury (TBI) is the main cause of pediatric trauma death and disability worldwide. Recent studies have sought to identify biomarkers of TBI for the purpose of...     

Adding Bupivacaine to High-potassium Cardioplegia Improves Function and Reduces Cellular Damage of Rat Isolated Hearts after Prolonged, Cold Storage

Background: Bupivacaine retards myocardial acidosis during ischemia. The authors measured function of rat isolated hearts after prolonged storage to determine whether bupivacaine improves cardiac protection compared with standard cardioplegia alone.

Methods: After measuring cardiac function on a Langendorff apparatus, hearts were perfused with cardioplegia alone (controls), cardioplegia containing 500 [mu]m bupivacaine, or cardioplegia containing 2 mm lidocaine; were stored at 4[degrees]C for 12 h; and were then reperfused. Heart rate and left ventricular developed pressures were measured for 60 min. Maximum positive rate of change in ventricular pressure, oxygen consumption, and lactate dehydrogenase release were also measured.

Results: All bupivacaine-treated, four of five lidocaine-treated, and no control hearts beat throughout the 60-min recovery period. Mean values of heart rate, left ventricular developed pressure, maximum positive rate of change in ventricular pressure, rate-pressure product, and efficiency in bupivacaine-treated hearts exceeded those of the control group (P < 0.001 at 60 min for all). Mean values of the lidocaine group were intermediate. Oxygen consumption of the control group exceeded the other groups early in recovery, but not at later times. Lactate dehydrogenase release from the bupivacaine group was less than that from the control group (P < 0.001) but did not differ from baseline.