Equal Incidence Research Articles

12-Month Controlled Study in the United States of the Safety and Efficacy of a Permanent 2.5% Polyacrylamide Hydrogel Soft-Tissue Filler

To evaluate the safety and efficacy of a 2.5% polyacrylamide hydrogel in the aesthetic enhancement of nasolabial folds. The safety and efficacy of a polyacrylamide hydrogel were compared with those of nonanimal stabilized hyaluronic acid (NASHA) in 315 subjects in a double-blind, randomized, multicenter, noninferiority trial with a 12-month follow-up. The primary efficacy end point was mean change in Wrinkle Assessment Scale (WAS) scores at 6 months. The primary safety end point was rate of serious adverse events (AEs) through 12 months after treatment. Polyacrylamide hydrogel was as effective as NASHA, and effectiveness persisted throughout the 12-month follow-up. Treatment-related AEs occurred with equal incidence; most were mild to moderate, transient, and related to injection procedure. One serious AE (infection) was thought to be related to treatment with polyacrylamide hydrogel; it resolved within 5 days after appropriate treatment. This 2.5% polyacrylamide hydrogel offers promise as a long-lasting soft tissue filler. It is well tolerated, as effective as NASHA in correction of nasolabial folds, and persistent. Longer evaluation is required to evaluate longer-term safety and demonstrate duration of effect beyond 12 months. This

Aquagenic Wrinkling of the Palms in an Adult Cystic Fibrosis Population

Background: Aquagenic wrinkling of the palms (AWP) is a rare condition characterised by the development of oedema and excessive wrinkling of the palms following exposure to water. It has frequently been associated with cystic fibrosis (CF). Early reports of AWP have only been case reports or small case series; there has only been one reported prevalence study of AWP in a CF population. Objective: To determine the incidence and characteristics of AWP in the adult CF population in Northern Ireland. Methods: 105 CF patients were interviewed. The patients were asked whether they noticed excess wrinkling of the hands when exposed to water. If they answered ‘yes’, further questions were asked regarding clinical characteristics. The atopic status, CF genotype and drug history were recorded for each patient. Formal testing of 7 patients was carried out. Results: Out of the 105 patients who were interviewed, 43 (41%) described AWP. Of the 43 patients with AWP, 20 were male and 23 were female. There was no association of AWP with genotype, atopy or concomitant drug intake. Conclusion: AWP appears to have an equal sex incidence, and the high number of cases in the population studied would suggest that this condition is underreported.

Fusarium graminearum as a dry rot pathogen of potato in the USA: prevalence, comparison of host isolate aggressiveness and factors affecting aetiology

A 2004–2005 survey of potatoes from stores in the north‐central potato‐producing region of the USA showed that the predominant causes of dry rot were Fusarium graminearum and Fusarium sambucinum. Isolates of F. graminearum originally isolated from potato tubers with dry rot (n = 15), wheat kernels with scab (n = 15), and sugarbeet tap roots with decay (n = 5) were tested for aggressiveness to potato tubers. There were no significant differences in aggressiveness among isolates of F. graminearum, regardless of original host, as measured by their ability to cause dry rot. These findings may have implications for survival of F. graminearum inoculum since potatoes, wheat and sugarbeets are frequently used in crop rotation in the region. Fusarium graminearum required larger wounds for infection of potato tubers than F. sambucinum. Plug‐removal injury, simulating a stolon‐removal injury, resulted in equal incidence of dry rot caused by the two Fusarium species, whereas abrasion and bruising injury were sufficient for infection and dry rot development by F. sambucinum, but not F. graminearum. A change in harvest practices from vine‐killing prior to harvest to mechanical vine‐killing on the day of harvest may be a factor affecting the onset of dry rot caused by F. graminearum, since this process often causes large wounds at the stem end of the tubers when the stolon is forcibly removed.

Accessory navicular: A heritable accessory bone of the human foot

AbstractThe accessory navicular is a supernumerary bone of the human foot located medial to the navicular tuberosity and represents a secondary center of ossification that has failed to fuse to the main body of the navicular. Three forms of the accessory bone have been identified: Type I is an independent ossicle that is often embedded within the tibialis posterior tendon; Type II is a triangular accessory bone that attaches to the navicular tuberosity by means of a cartilaginous or fibrocartilaginous bridge; and Type III represents a fused Type II, which forms a hook‐like protuberance extending from the tuberosity. The Type II accessory navicular is the most common of the three forms and is the most readily identifiable in skeletal material since it causes the navicular tuberosity to become abnormally flattened and porous. The purpose of this study was to describe the various manifestations of the accessory navicular in dry bone, to present and compare frequency data for several skeletal populations, and to consider questions of laterality and sex bias in trait expression. In total, the skeletons of 497 Danes, 460 Euro‐Americans, 300 African Americans, 100 Japanese, and 205 Europeans were examined for the presence of the Type II accessory navicular. Overall frequencies for the five groups ranged from 2% in the African American sample to 5% in the Japanese sample. Since several family pedigrees have documented the accessory navicular as being an inherited skeletal defect, the relatively low frequency found in the present study makes this trait a potentially useful indicator of genetic relatedness within archaeological cemeteries. In addition, the trait was found to occur more often unilaterally than bilaterally and there was nearly equal incidence among males and females. Copyright © 2010 John Wiley & Sons, Ltd.

Variations of ostiomeatal complex and its applied anatomy: a CT scan study

Stenosis of the ostiomeatal complex, from either the anatomical configuration or hypertrophied mucosa can cause obstruction and stagnation of secretions that may then become infected or perpetuate infection. The surgical interventions of the functional endoscopic sinus surgery are designed to remove the ostiomeatal blockage and to restore normal sinus ventilation and mucociliary function. Hence, the present study was taken up to study the variations in the ostiomeatal complex and its clinical significance. For CT analysis coronal sections of 40 paranasal sinus CT films were collected from the department of ENT. Lateral deviation of the uncinate process was more common with equal incidence in both sexes and with higher incidence on right side. Nasal septum was deviated to the right side more commonly with equal incidence in both sexes. Nearly half of the cases showed agger nasi with higher frequency in males. Concha bullosa was the least common ostiomeatal variant with higher incidence in males with equal incidence on both sides. Preoperative planning for FESS requires high resolution computed tomography (CT) to provide detailed maps, which are used for navigation and the visualization of the anatomical variants that result in sinus disease. As a result, it has become imperative for radiologist and clinicians to improve understanding of ostiomeatal unit. Keywords: Ostiomeatal complex, paranasal sinuses, sinusitis, computed tomography imaging, agger nasi.

Variations of ostiomeatal complex and its applied anatomy: a CT scan study

Stenosis of the ostiomeatal complex, from either the anatomical configuration or hypertrophied mucosa can cause obstruction and stagnation of secretions that may then become infected or perpetuate infection. The surgical interventions of the functional endoscopic sinus surgery are designed to remove the ostiomeatal blockage and to restore normal sinus ventilation and mucociliary function. Hence, the present study was taken up to study the variations in the ostiomeatal complex and its clinical significance. For CT analysis coronal sections of 40 paranasal sinus CT films were collected from the department of ENT. Lateral deviation of the uncinate process was more common with equal incidence in both sexes and with higher incidence on right side. Nasal septum was deviated to the right side more commonly with equal incidence in both sexes. Nearly half of the cases showed agger nasi with higher frequency in males. Concha bullosa was the least common ostiomeatal variant with higher incidence in males with equal incidence on both sides. Preoperative planning for FESS requires high resolution computed tomography (CT) to provide detailed maps, which are used for navigation and the visualization of the anatomical variants that result in sinus disease. As a result, it has become imperative for radiologist and clinicians to improve understanding of ostiomeatal unit.

Usefulness of colonoscopy in ischemic colitis

the ischemic colitis is intestinal the most frequent cause of ischemia. With this work we determine the demographic and clinical characteristics, and the usefulness of the colonoscopy in the patients with ischemic colitis diagnosed in our centre in relation to a change of therapeutic attitude. retrospective study in which were selected 112 patients diagnosed with ischemic colitis by colonoscopy and biopsy, in a period of five years. It was analyzed: age, sex, reason for examination, factors of cardiovascular risk, endoscopic degree of ischemia, change in the therapeutic attitude, treatment and outcome. the average age was of 73.64 + or - 12.10 years with an equal incidence in women (50.9%) and the men (49.1%). The associated factors were the HTA (61.1%), tobacco (37.2%) and antecedents of cardiovascular episode (52.2%). The most frequent reason for colonoscopy was rectorrhagia (53.6%) followed of the abdominal pain (30.4%), being urgent the 65.3%. Colonoscopy allowed a change in the therapeutic attitude in the 50 increasing in the urgent one to the 65.75%. Global mortality was of 27.67%. The serious ischemic colitis (25%) was more frequent in men (64.3%) in urgent indication (85.71%) and attends with high mortality (53.57%). Surgical treatment in the 57.14% was made with a good evolution in the 50%, whereas the patients with mild or moderate ischemic colitis had a better prognosis (favourable evolution in 80.95%) with smaller requirement of the surgical treatment (4.76%), p < 0.05. the colitis ischemic are more frequent in the older age. The most frequent symptoms are the rectorrhagia and the abdominal pain. The colonoscopy is a useful technique to evaluate the gravity and it induces a change of attitude according to the result of the same one. The evidence of a serious colitis supposed an increase of the necessity of surgery and worse prognosis.

Revisiting Appendicular Lump

Appendicular lump is a well known sequalae of acute appendicitis encountered in 2-6% of patients. Successful management of appendicular lump is controversial with different approaches. As many controversies are arising regarding management of appendicular lump. The aim of this study was to find out the outcome and evaluate possible need of changing our management strategy of appendicular lump. A retrospective analysis of the patients managed with appendicular lump were done. All the patients admitted with diagnosis of appendicular lump and managed between, over two and half years, were included in the study. All age groups and both sex were included. Any patients whose diagnosis was changed after initial diagnosis of appendicular lump were excluded from the study. Total 75 patients had appendicular lump suggesting 10% incidence. Age varied between 11-83 years with nearly equal incidence in both sexes. Majority had onset of symptoms between 2 to 14 days with an average of 4 days. Average stay was 3 to 4 days. During study period, 12 (16%) came with recurrence and 13 (17%) cases came for elective appendectomy. Based on our finding, it is not sufficient to change our classical management strategy of appendicular lump and suggests a need for long term prospective study in this very common clinical condition.

Multiple primary malignancies in patients with Merkel cell carcinoma1

Merkel cell carcinoma (MCC) is a rare malignant cutaneous tumour, the incidence of which is increasing. Second malignancies have been reported to occur with high incidence in these patients. We report the rate and nature of multiple malignancies in patients with MCC treated over a 10 year period in Addenbrooke's Hospital in Cambridge, United Kingdom, as well as the temporal relationship of these additional malignancies to the diagnosis of MCC. The 27 patients had an approximately equal sex incidence with a median age at diagnosis of 79 years. Seventy percent (n=19) of patients had a second primary malignant tumour; and 7 of these patients had two or more tumours in addition to the MCC. Eighteen patients had additional cutaneous malignancies: melanoma, squamous cell carcinoma and basal cell carcinoma, and 8 patients presented non-cutaneous malignancy including colorectal, haematological and breast tumours. Of the 28 additional tumours in our patients, half were diagnosed prior to presentation of MCC, 32% within 6 months of diagnosis, and 18% between 6 months and 3 years after diagnosis. Possible reasons for the high rate of additional tumours in this population are discussed. Our figures reflect a higher incidence of multiple malignancies in those with Merkel cell tumour than has previously been reported. This has important implications for the care and surveillance of these patients.

Tobacco smoke induced lung lesions persist post exposure in spontaneously hypertensive rats

To access tobacco smoke (TS) effects on lung cancer, reversibility of airway and parenchymal lesions, and cardiac disease, we performed a lifetime study of spontaneously hypertensive (SH) rats. Male SH rats were exposed to filtered air or TS (average of 60 mg/m3) for 6 hr./day, 3 days/week for 39 weeks after which all animals were allowed to live out their lifespan. We developed survival curves, quantitated airway mucous substance, estimated cell division rates (BrdU) and subjectively evaluated lung lesions. Rats previously exposed to TS had a four‐fold increase in airway mucous substances, modest but not significant increases in BrdU incorporation, and persistent mucous and squamous metaplasia in large airways. TS exposed rats had accumulations of large pigmented alveolar macrophages, some of which progressed to fibrosing granulomas. Lung lesions consistent with congestive heart failure developed with equal incidence in both control and TS exposed rats. While we found no evidence of dysplasia or neoplasia, we conclude that both metaplastic airway lesions and alveolar inflammation elicited by TS persist long after cessation of exposure. Supported by Philip Morris and NIEHS ES011634.

Auditing the attitude and knowledge of parents of children with febrile seizures

Introduction Febrile seizures are the most common seizure disorder in children. Most studies on the knowledge, attitude and practice towards children with febrile seizures have been taken in western countries. Little is known on the knowledge, attitude and practice of mothers regarding febrile seizures in Tripoli, Libya. Aims Most parents witnessing their child’s first febrile seizures find it a frightening experience and a significant number think that their child is going to die. In their panic parent’s initial reaction are often inappropriate. It is recommended that parents should be taught how to cope with the recurrence by explaining the pathophysiology of the condition and give written information about the condition and its managements. The aim of the audit is to assess the attitude and knowledge of parents of children with febrile seizures before and after the introduction of the information leaflets regarding febrile seizures. Method The parents of all children in the study period (2007 & 2008) admitted to Paediatric ward Al-Khadra hospital Tripoli, Libya with diagnostic code for febrile seizures were interviewed. A well prepared questionnaire was completed by parents of each child admitted with diagnostic code for febrile seizures. Total number of children admitted to the Pediatric ward in 2007 was 1506 of which 126 were diagnosed as Febrile Seizures (7.9%), and were selected randomly. Total number of children admitted to the Pediatric ward in 2008 were 1849 of which 113 were diagnosed as Febrile Seizures (6.1%), and were selected randomly. 11 out of 113 had recurrent episodes of febrile seizures. An organized and comparative prospective study was done to obtain the results before and after the introduction of the information leaflet. Results The population sample was generally a mixture of urban and rural civilians with average level of education and employment. The majority of febrile seizure cases that were admitted to our department in 2007 & 2008 were found to be of equal sex incidence. The peak age for febrile seizures in patients that were included in this study were found to be between 5-12 months representing (44%) in 2007 & (29%) in 2008. The attitude of mothers before and after the introduction of the information leaflet did not change significantly. Their practice, however, were still inappropriate. Conclusion Parents of children being treated for febrile seizures had a variety of different answers when asked to describe their action when their child had a fit. Our study suggests clues regarding parent’s anxiety and fear when witnessing a seizure. These include: Lack of Knowledge about the disease and lack of education regarding first aid and basic life support. This study is limited by the relatively small sample size. The study results do however describe prevalent views of the disease and provide indications regarding the connection between education, knowledge, and attitude of parents of children with febrile seizures.

Colorectal cancer in familial adenomatous polyposis: Are there clinical predictive factors?

BackgroundFamilial Adenomatous Polyposis (FAP) is a hereditary disorder with multiple colorectal polyps that exhibit an almost inevitable risk of colorectal cancer (CRC) in untreated patients. GoalsTo evaluate clinical features related to CRC risk at diagnosis. Material and methodsCharts from 88 patients were reviewed to collect information regarding age, family history, symptoms, polyposis severity and association with CRC. Results41 men (46.6%) and 47 women (53.4%) were assisted. CRC was detected in 53 patients (60.2%), with a frequency of 9.1% under 20 years, 58% between 21–40 and 85% over 41 years of age. Average age of patients without CRC was lower at treatment (29.5 vs 40.0 years; P=.001). Family history was reported by 58 patients (65.9%), whose average age did not differ from those who didn’t report it (33.4 vs 34.4; P=.17). Asymptomatic patients comprised 10.2% of the total; in this group, CRC incidence was much lower when compared to those presenting symptoms (1.1% vs 65.8%; P=.001). Patients without CRC presented a shorter length of symptoms (15.2 vs 26.4 months; P=.03) and less frequent weight loss (11.4% vs 33.9%; P=.01). At colonoscopy, polyposis was classified as attenuated in 12 patients (14.3%), who presented greater average age (48.2 vs 33.3 years; P=.02) and equal CRC incidence (58.3% vs 58.3%; P=.6) when compared to those with classic polyposis. ConclusionsThe risk of CRC in FAP patients 1) increases significantly after the second decade; 2) is associated with higher age, weight loss, presence and duration of simptomatology; 3) is similar in patients with attenuated or classic phenotype.

Peanut Yield Response to Conservation Tillage, Winter Cover Crop, Peanut Cultivar, and Fungicide Applications1

Abstract Strip tillage with various crop covers in peanut (Arachis hypogaea, L.) production has not shown a clear yield advantage over conventional tillage, but has been found to reduce yield losses from some diseases. This study was conducted to determine pod yield and disease incidence between two tillage practices, five winter cover crops, three peanut cultivars, and three fungicide programs. Conventional and strip tillage treatments were implemented on a Greenville sandy loam (fine, kaolinitic, thermic Rhodic Kandiudults) near Shellman, GA. Five winter cereal grain cover crops (strip tillage) and a no-cover crop treatment were sprayed at recommended (1R), half recommended (0.5R) or untreated (0R) fungicide programs. Within peanut cultivars, leaf spot (Cercospora arachidicola Hori) intensity decreased as the number of fungicide applications increased; however, stem rot (Sclerotium rolfsii) incidence was the same for the 1R and 0.5R fungicide programs but increased 0R program. Conventional tilled peanuts developed more leaf spot compared with strip tillage. There was no difference in leaf spot ratings among winter crop covers. There was no difference in stem rot incidence with tillage or winter cover crop. There was no yield difference with peanut cultivar. Pod yield was the same for the 1R and 0.5R fungicide program (3867 kg/ha) but decreased at the 0R fungicide program (2740 kg/ha). Pod yield was greater with conventional tillage and strip tillage with black oats (Avena sativa L.) (3706 kg/ha) compared with strip tillage of other winter crop cover treatments (3358 kg/ha). Conventional tillage had more leaf spot, equal incidence of stem rot, and higher yield compared with strip tillage. The 0.5R fungicide program had the same yield compared with the 1R fungicide program implying a possible 50% savings on fungicide applications on well rotated fields with lower disease risk.

A Matched Case-Control Study of Preoperative Biliary Drainage in Patients with Pancreatic Adenocarcinoma: Routine Drainage Is Not Justified

BackgroundPreoperative biliary drainage (PBD) prior to pancreaticoduodenectomy (PD) continues to be routine in many centers despite retrospective and randomized data showing that PBD increases perioperative infectious complications. MethodsReview of a prospectively maintained database identified 340 consecutive patients with pancreatic adenocarcinoma who underwent PD between 2000 and 2005. From this cohort, 94 PBD and 94 nonstented (no-PBD) patients were matched for age, gender, preoperative albumin, and bilirubin levels (PBD group: prestent bilirubin; no-PBD group: preoperative bilirubin). ResultsThe majority of PBD patients (89%) underwent internal endoscopic biliary drainage. Stent-related complications occurred in 46 patients (23%) and resulted in a significant delay in time to resection. In the matched-pair comparison, there was more operative blood loss in PBD patients, but similar operative times, transfusions, and hospital stay. Bile cultures were positive in 82% of PBD patients versus 7% no PBD. There was a statistically significant increase in infectious complications including wound infections and intra-abdominal abscess in PBD patients, but equal incidence of anastomotic leak. ConclusionsIn this case-matched control study, PBD was associated with a stent-related complication rate of 23% and resulted in a twofold increase in postpancreatectomy infectious complications. The routine use of PBD remains unjustified.

4105 Is institution a prognostic factor in adolescent and young adult patients with osteosarcoma?b

Nomenclature for the three recognized forms of rhabdoid tumor reflect their anatomic localization and include malignant rhabdoid tumor of the kidney (MRTK), extrarenal extracranial rhabdoid tumor (EERT), and atypical teratoid rhabdoid tumor (ATRT) involving the central nervous system. A strikingly simple karyotype belies the fact that rhabdoid tumors are among the most lethal human cancers, and now early strides are beginning to elucidate their molecular pathogenesis. Rhabdoid tumors are largely confined to the pediatric population, where they occur preferentially during infancy. Given the rarity of this tumor, international consensus on best treatment has only recently been achieved in conjunction with the establishment of the European Rhabdoid Tumor Registry. Between 1986 and 2013, 25 pediatric patients were diagnosed with rhabdoid tumor in the Republic of Ireland. Of these patients, 13 presented with ATRT, eight had MRTK, and four had EERT. The mean age at diagnosis was 38.8 months, with an equal sex incidence. Because of the lack of a standardized treatment strategy for rhabdoid tumors, these patients have been treated largely according to anatomic site, based on sarcoma, renal, or brain tumor protocols contemporary to their diagnoses. Of the patients, 84% received chemotherapy, 80% underwent surgery, and 44% had radiation therapy. The outcome overall was poor, independent of anatomic location. The overall survival rate was 24%, and mean time to death was just under 9 months.

Homeostatic Role of Transforming Growth Factor-β in the Oral Cavity and Esophagus of Mice and Its Expression by Mast Cells in These Tissues

Transforming growth factor-beta (TGF-beta) is a pleiotropic growth factor; its overexpression has been implicated in many diseases, making it a desirable target for therapeutic neutralization. In initial safety studies, mice were chronically treated (three times per week) with high doses (50 mg/kg) of a murine, pan-neutralizing, anti-TGF-beta antibody. Nine weeks after the initiation of treatment, a subset of mice exhibited weight loss that was concurrent with decreased food intake. Histopathology revealed a unique, nonneoplastic cystic epithelial hyperplasia and tongue inflammation, as well as dental dysplasia and epithelial hyperplasia and inflammation of both the gingiva and esophagus. In an effort to determine the cause of this site-specific pathology, we examined TGF-beta expression in these tissues and saliva under normal conditions. By immunostaining, we found higher expression levels of active TGF-beta1 and TGF-beta3 in normal tongue and esophageal submucosa compared with gut mucosal tissues, as well as detectable TGF-beta1 in normal saliva by Western blot analysis. Interestingly, mast cells within the tongue, esophagus, and skin co-localized predominantly with the TGF-beta1 expressed in these tissues. Our findings demonstrate a novel and restricted pathology in oral and esophageal tissues of mice chronically treated with anti-TGF-beta that is associated with basal TGF-beta expression in saliva and by mast cells within these tissues. These studies illustrate a previously unappreciated biological role of TGF-beta in maintaining homeostasis within both oral and esophageal tissues.

Follow-Up Paradigms for Stable Aortic Dissection

While limited data exist on which follow-up paradigms for chronic aortic dissections can be based, what information is present suggests that long-term follow-up is mandatory. In spite of the treatment modality, deaths from aortic disease continue to accrue and repeat interventions are often required over long-term follow-up. The only prospective trial data available indicate a roughly equal incidence of secondary interventions during the first and second year. Recent studies with longer follow-up suggest that the likelihood of a need for intervention ultimately diminishes. With increasing time after presentation, it may be possible to decrease the frequency of follow-up interrogations. Definitive recommendations in this regard, however, must await the availability of longer-term data.

Hepatocellular carcinoma in the Asia pacific region

Primary liver cancer, particularly hepatocellular carcinoma (HCC) remains a significant disease worldwide. It is among the top three causes of cancer death in the Asia Pacific region because of the high prevalence of its main etiological agents, chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. In this region, the incidence of HCC has been static over recent decades. Older age is a major risk factor; the incidence increasing sharply after age 40 years. There is a male predilection, with male to female ratio of 3:1, except in elderly Japanese with equal sex incidence or female predominance. In most Asia-Pacific countries, chronic HBV infection accounts for 75-80% of cases; Japan, Singapore and Australia/New Zealand are exceptions because of higher prevalence of HCV infection. In spite of advances in surgery, liver transplantation and newer pharmaco/biological therapies, the survival rate has improved only slightly over recent decades, and this could be attributable to earlier diagnosis ('lead-time bias'). The majority of patients present with advanced diseases, hence reducing the chance of curative treatment. The importance of HCC may decrease in two to three decades when the prevalence of chronic HBV infection decreases as a result of the universal HBV vaccination programs implemented in late 1980s in most Asia-Pacific countries, and because of reduced incidence of medical transmission of HCV. However, transmission of HCV by injection drug use, and rising prevalence of obesity and diabetes, both independent risk factors for HCC, may partly offset this decline.

Thoracic epidural analgesia in post-thoracotomy patients: comparison of three different concentrations of levobupivacaine and sufentanil

Relative effects of dosage, volume and concentration of local anaesthetics used for postoperative thoracic epidural analgesia are still under debate. In this randomized, prospective, double-blinded study, we evaluated the incidence of side-effects such as changes in arterial pressure, postoperative nausea, vomiting, and pruritus in patients admitted for thoracic surgery during continuous thoracic epidural infusion using levobupivacaine and sufentanil mixture in three different volumes. We studied 150 patients who underwent thoracotomy with a thoracic epidural catheter placed between T4 and T7. The patients were randomized into three groups which received 10 mg h(-1) of levobupivacaine at three different concentrations (0.5%, 0.25%, and 0.15%), in combination with sufentanil at 2.6 microg h(-1). Haemodynamic effects, pruritus, nausea, vomiting, sensory and motor block, pain score, additional analgesic requirement, sedation, and patient satisfaction were registered immediately after the surgical operation and on the first, second, and third postoperative days. We did not detect any differences in the incidence of side-effects such as changes in arterial pressure, and also postoperative nausea, vomiting, and pruritus. The three groups were also similar with regard to patient characteristics, sensory and motor block, pain score, analgesic rescue dose, sedation, and patient satisfaction. The same dose of a mixture of levobupivacaine and sufentanil administered in three different volumes and concentrations during continuous thoracic epidural infusion for thoracotomy provided an equal incidence of adverse haemodynamic effects, nausea, vomiting, or pruritus.

Monoclonal antibodies in the treatment of pancreatic cancer.

Human pancreatic cancer is a malignant disease with almost equal incidence and mortality. Effective diagnostic and therapeutic strategies are still urgently needed to improve its survival rate. With advances in structural and functional genomics, recent work has focused on targeted molecular therapy using monoclonal antibodies. This review summarizes the target molecules on the tumor cell surface and normal tissue stroma, which are related to pancreatic cancer oncogenesis, tumor growth or resistance to chemotherapy, as well as molecules involved in regulating inflammation and host immunoresponses. Targeted molecules include cell-surface receptors, such as the EGF receptor, HER2, death receptor 5 and IGF-1 receptor. Effects of monoclonal antibodies against these target molecules alone or in combination with chemotherapy, small-molecule signal transduction inhibitors, or radiation therapy are also discussed. Also discussed are the use of toxin or radioisotope conjugates, and information relating to the use of these targeting agents in pancreatic cancer clinical trials. Although targeted molecular therapy with monoclonal antibodies has made some progress in pancreatic cancer treatment, especially in preclinical studies, its clinical application to improve the survival rate of pancreatic cancer patients requires further investigation.