Igf system components as prognostic markers in breast cancer

The insulin-like growth factor (IGF) family of ligands, receptors, and binding proteins can regulate breast cancer cell proliferation in vitro, and interruption of these pathways inhibits IGF-mediated cell proliferation. If the IGF family members are key regulators of breast cancer growth and progression in vivo, we would expect their expression to be an indicator of the prognosis of the disease. Thus, measurement of IGF expression may provide an indicator of the growth effect within a tumor, and provide new targets for treatment of the disease. In this review we will summarize the data generated thus far indicating that IGF family members are indicators of prognosis of breast cancer, and that measurement of the whole IGF family in concert may provide useful information for treatment strategies of breast cancer.     

Sedative doses of remifentanil have minimal effect on ECoG spike activity during awake epilepsy surgery.

The use of remifentanil for sedation during awake epilepsy surgery has been described in a case report. However, little information is available regarding the effect of remifentanil on the quality of intraoperative electrocorticography (ECoG). This study was designed to investigate the effect of sedative doses of remifentanil on ECoG interictal spike activity among patients undergoing awake anterior temporal lobectomy for refractory epilepsy. Ten adult patients were studied prospectively. After baseline EcoG recordings were obtained, remifentanil was administered as a continuous infusion at 0.1 microg/kg/min and the ECoG recorded continuously for 15 minutes. Recordings obtained before and during the administration of remifentanil were compared with respect to spike frequency and location. A trend toward a small decrease in spike frequency was observed as patients became increasingly somnolescent and background ECoG activity slowed. The difference was not statistically significant. Blood pressure and heart rate were not adversely affected by the administration of remifentanil. Respiratory rates decreased in all patients (mean decrease, 8 breaths/min) and one patient transiently developed a respiratory rate of 4 breaths per minute that elicited a decrease in the rate of remifentanil administration. Remifentanil administered at sedation doses does not adversely affect intraoperatively recorded interictal spike activity. Further investigation of the use of this drug during awake epilepsy surgery is warranted.     

Editorial – Changes in your Journal

As you will have realised from the flyer sent out with the August 2002 issue of the Health Promotion Journal of Australia, the editorial team of the Journal has changed. After three years Rob Moodie (Editor‐in‐Chief) and Chris Borthwick (Managing Editor) have passed on the editorial role to an interim editorial group. This group comprises Adrian Bauman, Jeanne Daly, Damien Jolley and Chris Rissel.     

Pulmonary Arteriovenous Fistula: Presentation, Diagnosis, and Treatment

Pulmonary arteriovenous fistulas (PAVFs) are rare vascular malformations of the lung. There is a strong association with Rendu-Osler-Weber disease. Although most patients are asymptomatic, PAVFs can cause dyspnea from a right-to-left shunt. They can also bleed and result in hemoptysis and hemothorax. Because of paradoxical emboli, various central nervous system complications have been described including stroke, and brain abscess. Currently, spiral computed tomography offers the most practical method for establishing the presence of PAVFs. Most patients should be treated. Therapeutic options include angiographic embolization with metal coils or balloon occlusion and surgical excision. Angiographic treatment has become the mainstay of therapy for most patients during the last decade. It is less invasive and can be repeated easily. Surgery, which usually consists of a conservative lung resection, is associated with low morbidity and a low recurrence rate. Both therapeutic approaches are discussed. The Mayo Clinic surgical experience of the last 20 years for PAVFs is presented.     

Cerebral Palsy: Results of Surgical Releases Augmented with Electrical Stimulation: A Case Study

The purpose of this case study was to evaluate a patient with diplegic cerebral palsy who underwent soft tissue lengthening augmented with intramuscular electrical stimulation. This is a prospective case study, pre‐ and post‐test design. The patient underwent soft tissue lengthenings of the lower extremities, augmented with placement of intramuscular neuromuscular electrodes. Baseline, 4‐, 8‐, and 12‐month follow‐up data were obtained which included range of motion, manual muscle strength testing, motion analysis, oxygen consumption, Gross Motor Function Measure, and Pediatric Evaluation of Disability Inventory. All measured parameters, except knee extensor strength, improved during the postoperative period (baseline to 4‐month follow‐up) and continued to improve during the rehabilitative period (4–12 month follow‐up), despite no formal therapy or home exercise program during this period. We conclude that surgical releases augmented with electrical stimulation resulted in a satisfactory clinic outcome, and may offer a new approach to the treatment of patients with cerebral palsy.     

Lightwand & Glidescope vs. Macintosh for potential C-spine injury

Canadian Journal of Anesthesia/Journal canadien d'anesthésie -