Surgical delivery of drug releasing poly(lactic-co-glycolic acid)/poly(ethylene glycol) paste with in vivo effects against glioblastoma

Introduction

The median survival of patients with glioblastoma multiforme (astrocytoma grade 4) remains less than 18 months despite radical surgery, radiotherapy and systemic chemotherapy. Surgical implantation of chemotherapy eluting wafers into the resection cavity has been shown to improve length of survival but the current licensed therapy has several drawbacks. This paper investigates in vivo efficacy of a novel drug eluting paste in glioblastoma.

Methods

Poly(lactic-co-glycolic acid)/poly(ethylene glycol) (PLGA/PEG) self-sintering paste was loaded with the chemotherapeutic agent etoposide and delivered surgically into partially resected tumours in a flank murine glioblastoma xenograft model.

Results

Surgical delivery of the paste was successful and practical, with no toxicity or surgical morbidity to the animals. The paste was retained in the tumour cavity, and preliminary results suggest a useful antitumour and antiangiogenic effect, particularly at higher doses. Bioluminescent imaging was not affected significantly by the presence of the paste in the tumour.

Conclusions

Chemotherapy loaded PLGA/PEG paste seems to be a promising technology capable of delivering active drugs into partially resected tumours. The preliminary results of this study suggest efficacy with no toxicity and will lead to larger scale efficacy studies in orthotopic glioblastoma models.     

Singapore Paediatric Resuscitation Guidelines 2021

We present the 2021 Singapore Paediatric Resuscitation Guidelines. The International Liaison Committee on Resuscitation’s Pediatric Taskforce Consensus Statements on Science and Treatment Recommendations, which was published in October 2020, and the updated resuscitation guidelines from the American Heart Association and European Resuscitation Council, were reviewed and discussed by the committee. These recommendations were derived after deliberation of peer-reviewed evidence updates on paediatric resuscitation and took into consideration the local setting and clinical practice.     

Balloon dilatation of upper gastrointestinal tract strictures

Balloon dilatation has been performed in a series of 30 patients with strictures of the upper gastrointestinal tract over a period of 28 months. The technique of balloon dilatation is described and the results of follow-up are presented. Sixty per cent of patients have remained symptom-free following balloon dilatation. Twenty-seven per cent of patients have undergone regular repeated dilatations when symptoms have recurred. There were no complications from the technique. Balloon dilatation is a safe and acceptable alternative to conventional methods of bougienage in the management of upper gastrointestinal tract strictures.     

Case report: obstructive jaundice secondary to an intussuscepting duodenal villous adenoma.

Small intestinal tumours are rare, forming 1% of all gastrointestinal tumours; most occur in the duodenum. Villous adenomas form only a very small proportion of the duodenal tumours. They usually occur in the periampullary region and show a marked propensity for malignant change. The usual mode of presentation is with non-specific pain, jaundice or occult bleeding. Obstruction and pancreatitis are infrequent clinical presentations. Intussusception secondary to a duodenal tumour of any histological type is rarer still. A case of intussusception of a villous adenoma resulting in obstructive jaundice is described.