Vasopressin During Cardiopulmonary Resuscitation and Different Shock States

Vasopressin administration may be a promising therapy in the management of various shock states. In laboratory models of cardiac arrest, vasopressin improved vital organ blood flow, cerebral oxygen delivery, the rate of return of spontaneous circulation, and neurological recovery compared with epinephrine (adrenaline). In a study of 1219 adult patients with cardiac arrest, the effects of vasopressin were similar to those of epinephrine in the management of ventricular fibrillation and pulseless electrical activity; however, vasopressin was superior to epinephrine in patients with asystole. Furthermore, vasopressin followed by epinephrine resulted in significantly higher rates of survival to hospital admission and hospital discharge. The current cardiopulmonary resuscitation guidelines recommend intravenous vasopressin 40 IU or epinephrine 1mg in adult patients refractory to electrical countershock. Several investigations have demonstrated that vasopressin can successfully stabilize hemodynamic variables in advanced vasodilatory shock. Use of vasopressin in vasodilatory shock should be guided by strict hemodynamic indications, such as hypotension despite norepinephrine (noradrenaline) dosages >0.5 mug/kg/min. Vasopressin must never be used as the sole vasopressor agent. In our institutional routine, a fixed vasopressin dosage of 0.067 IU/min (i.e. 100 IU/50 mL at 2 mL/h) is administered and mean arterial pressure is regulated by adjusting norepinephrine infusion. When norepinephrine dosages decrease to 0.2 microg/kg/min, vasopressin is withdrawn in small steps according to the response in mean arterial pressure. Vasopressin also improved short- and long-term survival in various porcine models of uncontrolled hemorrhagic shock. In the clinical setting, we observed positive effects of vasopressin in some patients with life-threatening hemorrhagic shock, which had no longer responded to adrenergic catecholamines and fluid resuscitation. Clinical employment of vasopressin during hemorrhagic shock is experimental at this point in time.     

Prognostic value of monitoring tumour markers CA 15-3 and CEA during fulvestrant treatment

Background  

At many centres tumour markers are used to detect disease recurrence and to monitor response to therapy in patients with advanced disease, although the real value of serial observation of marker levels remains disputed. In this study, we evaluated the prognostic value of tumour markers for predicting response (partial response [PR], stable disease [SD] ≥ 6 months), de novo disease progression (PD) and secondary PD in patients receiving fulvestrant ('Faslodex') 250 mg/month for the treatment of metastatic breast cancer (MBC).     

Supportive care for women with gynecologic cancers

Supportive care is a multidimensional field, that involves caring for a patient's symptoms either during and/or after treatment. Ideally, once these supportive care needs are met, patients can enjoy an improved quality of life. Supportive care needs include all body systems, and are, therefore, difficult to manage, secondary to the fact that they require collaboration among multiple medical specialties. In this review, several components of supportive care are separated into two categories: tumor-related morbidities and treatment-related morbidities. Some of the themes discussed include nausea and vomiting, cancer pain, psychological distress, fatigue and anemia, small bowel obstruction and peripheral neuropathy. While all of these components are challenging to manage, it is perhaps the psychosocial realm that remains the most unmet need. Regardless, the oncologist must act as a facilitator who addresses these needs and, if unable to address the issue alone, knows how to steer the patient toward the appropriate provider. As these needs are met, the goal is for quality of life to improve; and with the improvement in quality of life we may expect to see improved survival outcomes.     

Sialendoscopy of the salivary glands

INTRODUCTION: Sialoendoscopy is a simple efficient mode of treatment for major salivary gland sialoliths and strictures. METHODS: Sialendoscopy procedure requires specific devices, diagnostic and therapeutic sialendocopes, minigrasping forceps, wire baskets, lasers, balloons and stents. The sialendoscopy procedure is divided in three steps: the duct introduction step (through the papilla or through the duct wall); the diagnostic step (from main duct to third or fourth salivary division branches) and the therapeutic step (stone removal with a Dormia basket or miniforceps and stenosis balloon dilatation). The feasibility of stone removal depends on the size, the position, the mobility and the shape of the stone. The only contraindication is acute sialadenitis. DISCUSSION: Sialendoscopy complications are minor. Its success rate for stone removal is greater than 90%, and it has dramatically reduced the rate of sialadenectomy (to less than 5%).     

Decreased radioiodine uptake of FRTL-5 cells after 131I incubation in vitro: molecular biological investigations indicate a cell cycle-dependent pathway

PURPOSE: In radioiodine therapy the "stunning phenomenon" is defined as a reduction of radioiodine uptake after diagnostic application of (131)I. In the current study, we established an in vitro model based on the "Fisher rat thyrocyte cell line no. 5" (FRTL-5) to investigate the stunning. METHODS: TSH-stimulated FRTL-5 cells were incubated with (131)I. Time-dependent (131)I uptake and the viability of FRTL-5 cells were evaluated at 4-144 h after radioiodine application. All data was corrected for number of viable cells, half life and (131)I concentration. Sodium iodide symporter (NIS) and the housekeeping gene (beta-actin, GAPDH) levels were quantified by quantitative polymerase chain reaction (qPCR). Additionally, immunohistochemical staining (IHC) of NIS on the cell membrane was carried out. RESULTS: FRTL-5 monolayer cell cultures showed a specific maximum uptake of (131)I 24-48 h after application. Significantly decreased (131)I uptake values were observed after 72-144 h. The decrease in radioiodine uptake was correlated with decreasing mRNA levels of NIS and housekeeping genes. In parallel, unlike in controls, IHC staining of NIS on FRTL-5 cells declined significantly after (131)I long-term incubation. CONCLUSIONS: It could be demonstrated that during (131)I incubation of FRTL-5 cells, radioiodine uptake decreased significantly. Simultaneously decreasing levels of NIS mRNA and protein expression suggest a NIS-associated mechanism. Since mRNA levels of housekeeping genes decreased, too, the reduced NIS expression might be provoked by a cell cycle arrest. Our investigations recommend the FRTL-5 model as a valuable tool for further molecular biological investigations of the stunning phenomenon.     

Quality of life in children with obstructive sleeping disorder after tonsillectomy, tonsillotomy or adenotomy

BACKGROUND: To study the effectiveness of adenotomy (AT), adenotonsillectomy (ATE) and adenotonsillotomy (ATT) with respect to the quality of life improvement in children with obstructive sleep disorders (OSD), OSA 18 survey and Brouillette score were used. METHODS: Prospectively, 92 children with an age ranging from 2 to 6 years with OSD underwent AT, ATE or ATT at the University hospital of Ulm (Germany), respectively. 30 age-matched children served as controls. Caregivers were requested to complete the Brouillette score and the OSA 18 survey, which are validated instruments for detecting symptoms and quality of life change in children with OSDs, at the initial office visit prior to surgery (BS/1 and OSA 18/1) and 7 - 14 months after surgery (BS/2 and OSA 18/2). RESULTS: The mean total score of the OSA 18 survey for AT, ATE and ATT was reduced significantly after these operations (p < 0.001). Similar results were also observed in the Brouillette score (p < 0.002). The improvement of life quality in the AT group was less effective than in the ATE and ATT group. CONCLUSION: ATE and ATT have about the same effectiveness to improve life quality for children with OSD. Children after ATE or ATT have a comparable life quality as healthy children (Mann Whitney U-test; p approximately 0.15), while children who only received AT have a slightly lower life quality after the operation. In summary, ATT was recommend.     

Antifungal antibiotics and breakthrough bacteremias.

Patients with fever and neutropenia are at high risk for infection ( approximately 50%) and bacteremia ( approximately 20%). As a result, most are treated with antibacterial prophylaxis until their absolute neutrophil count exceeds 500 cells/mm(3) and their temperature returns to normal. The 1997 guidelines of the Infectious Diseases Society of America suggested 1 of 3 regimens: vancomycin plus ceftazidime, monotherapy with ceftazidime or imipenem (possibly cefepime or meropenem), or dual therapy with an aminoglycoside plus an antipseudomonal beta-lactam.