Renal Cell Carcinoma Associated with Tumor Thrombus in the Inferior Vena Cava: Surgical Strategies

The purpose of this study was to evaluate strategies used for surgical management of renal cell carcinoma with a tumoral thrombus extension in the inferior vena cava (IVC). From January 2000 to December 2001, urological and vascular surgeons jointly undertook surgical treatment on 10 patients with renal cell carcinoma and tumor thrombus in the IVC. There were five women and five men, with a mean age of 60.2 years. The limit of thrombus extension, classified according to the Neves and Zincke system, was level I (renal) in one patient, level II (infrahepatic) in one, level III (retrohepatic) in three, and level IV (atrial) in five. Exposure was achieved by chevron bilateral subcostal laparotomy associated with sternotomy in three patients, bilateral subcostal laparotomy in six, and median sternolaparotomy in one. Radical nephrectomy associated with caval thrombectomy was performed in all patients. Cardiopulmonary bypass was used in four of the five level IV patients. The fifth patient was contraindicated for cardiopulmonary bypass. Transesophageal echography (TEE)-guided endoluminal occlusion of the unobstructed infradiaphragmatic IVC was performed in patients with level III thrombus. Clamping of the IVC was performed in patients with levels I and II thrombus. All procedures were assisted by continuous TEE surveillance. No intraoperative gas or tumor emboli were detected by TEE. The mean number of red blood cell units transfused during the course of hospitalization was 9.7 (range 2-22, median 9). One patient died of multiple organ failure on the day 28 after the procedure. The mean duration of hospitalization was 16 days. The mean duration of follow-up was 9.7 months. During follow-up, two of the remaining nine patients died due to tumor recurrence. Tumor recurrence was also detected in one of the seven surviving patients. Surgery for renal cell carcinoma with tumor thrombus in the IVC must be carried out in a specialized facility with the assistance of TEE surveillance and, in some cases, cardiopulmonary bypass. Operative treatment improves the prognosis of renal cell carcinoma with tumor thrombus in the IVC. In patients with level III thrombus, TEE-guided endoluminal occlusion of the unobstructed infradiaphragmatic IVC simplifies surgical management by obviating the need for exposure of the retrohepatic and supradiaphragmatic IVC.Presented at the Seventeenth Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, May 29-31, 2002, Liege, Belgium.     

Validity of a V.O2 max prediction equation of the 2-km walk test in female seniors

Walking is a useful exercise mode for most adults due to its general ease, acceptability, and safety. Therefore, many field tests based on performance in walking have been developed to predict V.O (2 max). Even if these tests are much easier to perform than laboratory tests, field tests have to be valid. The objective of the paper was to explore the accuracy and bias of a V.O (2 max) prediction equation of the 2-km Walk Test, in an active female senior group (n=18, mean age: 66.1+/-4.4). V.O (2 max) (l . min (-1)) was measured during cycle ergometry by direct gas analysis from a maximal test (step: 30 W, time: 2 min 30). V.O (2 max) related to body mass was then calculated (ml . min (-1) . kg (-1)). Subjects completed also the 2-km Walk Test (UKK Institute). V.O (2 max) (ml . min (-1) . kg (-1)) was then predicted from age, sex, body mass index, heart rate, and walking time measured during the 2-km Walk Test. Predicted V.O (2 max) and measured V.O (2 max) were highly correlated (r=0.63, p<0.01). Predicted V.O (2 max) (20.5+/-6.1 ml . min (-1) . kg (-1)) was not significantly different from measured V.O (2 max) (18.7+/-3.4 ml . min (-1) . kg (-1)). Prediction equation bias with its 95 % limits of agreement was - 1.8+/-4.8 ml . min (-1) . kg (-1) with a coefficient of variation of 24.2 %. In an active female senior population, the 2-km Walk Test offers a fairly accurate V.O (2 max) prediction. The training and learning effects can be neglected because when the test was repeated no significant bias was observed between the two trials.     

Age differences in human skeletal muscle fatigue during high-intensity intermittent exercise

It has been shown at similar relative work rates that children have higher resistance to fatigue than adults during repeated bouts of high-intensity exercise. This age-related difference in fatigue resistance may be explained by factors including muscle mass, muscle morphology, energy metabolism and neuromuscular activation.

Conclusion: During high-intensity intermittent exercise, recovery periods play an important role in limiting fatigue. Age-related differences in fatigue resistance could also be explained by differences in the rates of resynthesis of some energetic substrates and the rates of removal of various muscle metabolites.     

Technology evaluation: omalizumab,Genentech/Novartis/Tanox

Genentech, Novartis and Tanox have co-developed Genentech's anti-IgE humanized monoclonal antibody omalizumab for the treatment of allergic rhinitis and asthma. The antibody is currently undergoing phase II clinical trials for allergic rhinitis in Canada and phase III clinical trials for both indications in Japan. Omalizumab is at the pre-registration stage for both indications in the US, New Zealand, Switzerland and Western Europe, and is currently registered for both indications in Australia.     

SB-656933, a novel CXCR2 selective antagonist, inhibits ex vivo neutrophil activation and ozone-induced airway inflammation in humans

AIMS

To determine the safety and tolerability of a novel selective CXCR2 antagonist and assess its pharmacodynamic effects using measures of neutrophil activation and function, including CD11b expression in whole blood and ozone-induced airway inflammation in healthy subjects.

METHODS

Flow cytometric determination of ex vivo CXCL1-induced CD11b expression on peripheral blood neutrophils was performed following single dose oral administration of SB-656933 (dose range 2–1100 mg). A subsequent randomized study (placebo, 50 mg and 150 mg) was performed to explore the dose–response for ozone-induced airway inflammation, as measured by sputum biomarkers.

RESULTS

Oral administration of SB-656933 resulted in significant inhibition of CXCL1-induced CD11b expression on peripheral blood neutrophils at single doses greater than or equal to 50 mg. Maximum inhibition (70%) relative to placebo was observed following administration of SB-656933 400 mg (95% CI 60%, 77%). This was sustained up to a dose of 1100 mg. Single doses of SB-656933 reduced ozone-induced airway inflammation in a dose-dependent manner. Relative to placebo, there were 55% (95% CI 20%, 75%) and 74% (95% CI 55%, 85%) fewer neutrophils in the sputum of subjects after a single dose of 50 mg or 150 mg, respectively. There was a corresponding reduction in myeloperoxidase concentrations in the sputum supernatant of 32.8% (95% CI 9.2, 50.3) and 50.5% (95% CI 33.3, 63.3). SB-656933 was safe and well-tolerated at all doses.

CONCLUSIONS

SB-656933 is a CXCR2 antagonist that demonstrates dose-dependent effects on neutrophil activation and recruitment within a well-tolerated dose range. These data suggest that SB-656933 may be an effective agent in neutrophil-predominant diseases.     

Therapeutic hypothermia for coma after cardiorespiratory arrest caused by hanging

We report a case in which mild therapeutic hypothermia was used successfully in a patient with coma after cardiorespiratory arrest induced by hanging.     

Airway smooth muscle as a regulator of immune responses and bronchomotor tone

The traditional view of airway smooth muscle (ASM) in asthma, as a purely contractile tissue, seems to be inadequate. Compelling evidence now suggests that ASM plays an important role in regulating bronchomotor tone, in perpetuating airway inflammation, and in remodeling of the airways. This article reviews three distinct functions of ASM cells: the process of excitation-contraction coupling, with a particular focus on the role of cytokines in modulating calcium responses; the processes of smooth muscle cell proliferation and migration; and the synthetic and immunomodulatory function of ASM cells. This article also discusses how altered synthetic function contributes to airway remodeling.