Reduced mortality after severe head injury will increase the demands for rehabilitation services

Primary objective : In 1989, a new therapy to reduce intracranial pressure in severely head-injured patients was introduced in Lund. The new treatment reduced mortality significantly. The present study describes the quality of life for the survivors Methods and procedures : The study includes 53 patients treated during 1989?1994, according to a new treatment protocol for increased intracranial pressure (?Lund concept' group). During 1982?1986, 38 patients were managed according to a protocol including high dose thiopentone (?Thiopentone' group). The two groups are compared regarding neurophysical and psychiatric symptoms as well as aspects regarding the patient's role, performance, interpersonal relationship, frictions, feelings and satisfaction in work, areas of social and leisure activities, and extended family. Results : Mortality was reduced from 47% to 8%, but the number of patients with a persistent vegetative state and/or remaining severe disability did not increase. However, the number of patients with persisting emotional and intellectual deficits increased significantly. Conclusion : The new treatment regime has dramatically increased the number of survivors after severe head trauma. Although most patients have a favourable outcome, there are more patients with remaining sequelae and disabilities, and the demand for qualified rehabilitation has increased.     

Optimal Follow-Up to Curative Colon and Rectal Cancer Surgery: How and for How Long?

In 2009, the projected incidence for colon and rectal cancers in the United States was 106,100 and 40,870, respectively, and approximately 75% of these patients were treated with curative intent. Surveillance or follow-up after colon and rectal cancer resection serves multiple purposes; however, the primary argument supporting the validity of surveillance is the detection of metachronous and recurrent cancers amenable to curative treatment. The surveillance may provide some comfort for cancer survivors who can be informed that they have no evidence of disease.     

Neoadjuvant chemotherapy for locally advanced breast cancer: A review of the literature and future directions

Background

Most patients with locally advanced primary breast cancer have micrometastases at the time of presentation. Randomised trials on the use of neoadjuvant chemotherapy have not been carried out specifically in a population of breast cancer patients with locally advanced disease (LAPC). Despite this, its use for cytoreduction in these patients is an established option which may facilitate excision of the primary tumour and local lymph node metastasis for local control. Significant improvements in local disease control have been seen with recent advances in systemic chemotherapy regimens although thus far this has not shown in randomised trials to translate into overall survival benefits.

Methods

In this review, all studies where a large proportion (approximately 70%) of included patients with LAPC, were selected. A search of Medline and PubMed databases was performed. Specifically, the different chemotherapy regimens and their relation to oncological outcomes was assessed.

Results and conclusion

The studies assessed were heterogeneous with regard to patient selection and chemotherapy regimens used. A complete pathological response is the strongest predictor of disease-free and overall survival. Recent studies on the use of targeted biological therapies in addition to chemotherapy suggest that rates of complete pathological response may be significantly increased when compared to chemotherapy alone. Furthermore, improvements in localisation and imaging techniques, used in conjunction with the increasing use of oncoplastic breast-conserving techniques, highlight the possibility that a subgroup of these patients may safely be treated with breast conservation.     

Propofol-fentanyl anesthesia compared to thiopental-halothane with special reference to recovery and vomiting after pediatric strabismus surgery.

Forty-four children, ASA physical status I or II, aged 1.5-14 years and admitted for strabismus surgery, were studied. The study compared the postoperative condition after two different anesthesia methods. All children were premedicated with midazolam rectally, received glycopyrrolate i.v. and were then randomised to one of two anesthetic methods: 1) induction with thiopental, maintenance with halothane or 2) induction with propofol supplemented with fentanyl, maintenance with propofol infusion. In both groups, tracheal intubation was performed after vecuronium i.v. and the children were ventilated manually. Peroperatively, patients receiving propofol/fentanyl had more episodes of bradycardia (P less than 0.001). Times to spontaneous breathing and extubation were shorter in the propofol/fentanyl group (P less than 0.05) and there was also a lesser degree of sedation during the first 2 h postoperatively (P less than 0.01). Fewer children in the propofol/fentanyl group vomited postoperatively (P less than 0.05). The apprehension score was higher in the propofol/fentanyl group compared to the thiopental/halothane group (P less than 0.05). We conclude that children undergoing strabismus surgery anesthetized with propofol/fentanyl had more episodes of peroperative bradycardia, a lower incidence of postoperative vomiting and a shorter recovery time, and were more apprehensive during the initial postoperative period than children anesthetized with thiopental/halothane.