Sentinel Node Biopsy Should Not be Routine in Older Patients with ER-Positive HER2-Negative Breast Cancer Who Are Willing and Able to Take Hormone Therapy

Annals of Surgical Oncology - The SSO Choosing Wisely campaign recommended selective sentinel lymph node biopsy (SLNB) in clinically node-negative women aged ≥ 70 years with ER+ breast...     

Respiratory controversies in the critical care setting. Should heliox be used for mechanically ventilated patients?

Helium is an inert gas with a very low density (0.18 g/L), which allows it to pass through narrowed passages with less turbulence than nitrogen or oxygen. For many years, helium-oxygen mixture (heliox) has been used for patients with severe airway obstruction. However, the data supporting the clinical application of heliox are few and clearly nondefinitive. This article reviews the medical literature on whether heliox should be used for mechanically ventilated patients. No definitive randomized studies have attempted to answer this question. Studies both support and contest the benefit of heliox during mechanical ventilation. Most studies agree that heliox is extremely safe; no adverse effects have been reported. However, heliox must be administered with vigilance and continuous monitoring to avoid technical complications. As is the case with all therapies that have not been definitively studied, the risk/benefit ratio for an individual patient must be assessed by the clinical care team.     

Heliox administration in the pediatric intensive care unit: an evidence-based review.

OBJECTIVE: To provide a comprehensive, evidence-based review of helium-oxygen gas mixtures (heliox) in the management of pediatric respiratory diseases. Data Source: A thorough, computerized bibliographic search of the preclinical and clinical literature regarding the properties of helium and its application in pediatric respiratory disease states. DATA SYNTHESIS: After an overview of the potential benefits and technical aspects of helium-oxygen gas mixtures, the role of heliox is addressed for asthma, aerosolized medication delivery, upper airway obstruction, postextubation stridor, croup, bronchiolitis, and high-frequency ventilation. The available data are objectively classified based on the value of the therapy or intervention as determined by the study design from which the data are obtained. CONCLUSIONS: Heliox administration is most effective during conditions involving density-dependent increases in airway resistance, especially when used early in an acute disease process. Any beneficial effect of heliox should become evident in a relatively short period of time. The medical literature supports the use of heliox to relieve respiratory distress, decrease the work of breathing, and improve gas exchange. No adverse effects of heliox have been reported. However, heliox must be administered with vigilance and continuous monitoring to avoid technical complications.     

Neonatal thyrotoxicosis and persistent pulmonary hypertension necessitating extracorporeal life support

We report a case of neonatal Graves' disease involving an infant with severe persistent pulmonary hypertension (PPHN) associated with neonatal thyrotoxicosis that necessitated extracorporeal membrane oxygenation. Hyperthyroidism, although uncommon in the newborn period, has been associated with pulmonary hypertension among adults. The exact mechanisms responsible for this effect on pulmonary vascular pressure are not well understood. Recent studies have provided evidence that thyrotoxicosis has direct and indirect effects on pulmonary vascular maturation, metabolism of endogenous pulmonary vasodilators, oxygen economy, vascular smooth muscle reactivity, and surfactant production, all of which may contribute to the pathophysiologic development of PPHN. Therefore, because PPHN is a significant clinical entity among term newborns and the symptoms of hyperthyroidism may be confused initially with those of other underlying disorders associated with PPHN (eg, sepsis), it would be prudent to perform screening for hyperthyroidism among affected newborns.