Abnormal Intraprosthetic Regurgitation After Tricuspid Valve Replacement With a Mechanical Prosthesis.

No abstract available

http://ift.tt/2iVTDv3

The Effect of Deep Versus Moderate Neuromuscular Block on Surgical Conditions and Postoperative Respiratory Function in Bariatric Laparoscopic Surgery: A Randomized, Double Blind Clinical Trial.

BACKGROUND: In recent literature, it has been suggested that deep neuromuscular block (NMB) improves surgical conditions during laparoscopy; however, the evidence supporting this statement is limited, and this was not investigated in laparoscopic bariatric surgery. Moreover, residual NMB could impair postoperative respiratory function. We tested the hypotheses that deep NMB could improve the quality of surgical conditions for laparoscopic bariatric surgery compared with moderate NMB and investigated whether deep NMB puts patients at risk for postoperative respiratory impairment compared with moderate NMB. METHODS: Sixty patients were evenly randomized over a deep NMB group (rocuronium bolus and infusion maintaining a posttetanic count of 1-2) and a moderate NMB group (rocuronium bolus and top-ups maintaining a train-of-four count of 1-2). Anesthesia was induced and maintained with propofol and remifentanil. The primary outcome measures were the quality of surgical conditions assessed by a single surgeon using a 5-point rating scale (1 = extremely poor, 5 = optimal), the number of intra-abdominal pressure increases >18 cmH2O and the duration of surgery. Secondary outcome measure was the postoperative pulmonary function assessed by peak expiratory flow, forced expiratory volume in 1 second, and forced vital capacity, and by the need for postoperative respiratory support. Data are presented as mean +/- standard deviation with estimated treatment effect (ETE: mean difference [95% confidence interval]) for group comparisons. RESULTS: There was no statistically significant difference in the surgeon's rating regarding the quality of the surgical field between the deep and moderate NMB group (4.2 +/- 1.0 vs 3.9 +/- 1.1; P = .16, respectively; ETE: 0.4 [-0.1, 0.9]). There was no difference in the proportional rating of surgical conditions over the 5-point rating scale between both groups (P = .91). The number of intra-abdominal pressure increases >18 cmH2O and the duration of surgery were not statistically different between the deep and moderate NMB group (0.2 +/- 0.9 vs 0.3 +/- 1.0; P = .69; ETE: -0.1 [-0.5, 0.4] and 61.3 +/- 15.1 minutes vs 70.6 +/- 20.8 minutes; P = .07, ETE: -9.3 [-18.8, 0.1], respectively). All the pulmonary function tests were considerably impaired in both groups when compared with baseline (P

http://ift.tt/2jJilD6

Incidental Detection of an Intracardial Floating Thrombus by Echocardiography During Coronary Artery Bypass Surgery.

No abstract available

http://ift.tt/2iVLnew

Symptom burden and dysphagia associated with osteoradionecrosis in long-term oropharynx cancer survivors: A cohort analysis

Publication date: March 2017
Source:Oral Oncology, Volume 66
Author(s): Angela T.T. Wong, Stephen Y. Lai, G. Brandon Gunn, Beth M. Beadle, Clifton D. Fuller, Martha P. Barrow, Theresa M. Hofstede, Mark S. Chambers, Erich M. Sturgis, Abdallah Sherif Radwan Mohamed, Jan S. Lewin, Katherine A. Hutcheson
ObjectiveThe purpose is to examine the relationship between mandibular osteoradionecrosis (ORN) and chronic dysphagia in long-term oropharynx cancer (OPC) survivors, and to determine the perceived symptom burden associated with ORN.Materials and methodsMedical records of 349 OPC patients treated with bilateral IMRT and systemic therapy were reviewed. ORN was graded using a published 4-point classification schema. Patients were considered to have chronic dysphagia if they had aspiration pneumonia, stricture or aspiration detected by fluoroscopy or endoscopy, and/or feeding tube dependence in long-term follow-up ⩾1year following radiotherapy. MD Anderson Symptom Inventory – Head and Neck Module (MDASI-HN) scores were analyzed in a nested cross-sectional survey sample of 118 patients.Results34 (9.7%, 95% CI: 6.8–13.3%) patients developed ORN and 45 (12.9%, 95% CI: 9.6–16.9%) patients developed chronic dysphagia. Prevalence of chronic dysphagia was significantly higher in ORN cases (12/34, 35%) compared to those who did not develop ORN (33/315, 11%, p<0.001). ORN grade was also significantly associated with prevalence of dysphagia (p<0.001); the majority of patients with grade 4 ORN requiring major surgery (6 patients, 75%) were found to have chronic dysphagia. Summary MDASI-HN symptom scores did not significantly differ by ORN grade. Significantly higher symptom burden was reported, however, among ORN cases compared to those without ORN for MDASI-HN swallowing (p=0.033), problems with teeth and/or gums (p=0.016) and change in activity (p=0.015) item scores.ConclusionsORN is associated with excess burden of chronic dysphagia and higher symptom severity related to swallowing, dentition and activity limitations.



http://ift.tt/2j5U8WU

Validation of the ICON-S staging for HPV-associated oropharyngeal carcinoma using a pre-defined treatment policy

Publication date: March 2017
Source:Oral Oncology, Volume 66
Author(s): Sandro V Porceddu, Rob Milne, Elizabeth Brown, Anne Bernard, Reza Rahbari, Bena Cartmill, Matthew Foote, Margaret McGrath, Jermaine Coward, Benedict Panizza
ObjectivesTo determine whether the International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S) for HPV associated oropharyngeal carcinoma (HPV+OPC) is a better discriminator of overall survival (OS), compared with the 7th edition (7th Ed) AJCC/UICC TNM staging following curative radiotherapy (RT).Material and methodsThe 5-year OS for all patients with non-metastatic (M0) p16-confirmed OPC treated between 2005 and 2015 was determined and grouped based on the 7th Ed AJCC/UICC TNM and ICON-S staging.ResultsA total of 279 patients met the inclusion criteria. The 5-year OS with the 7th Ed TNM classification were Stage I/II 88.9% (95% CI; 70.6–100%), Stage III 93.8% (95% CI; 85.9–100%), Stage IVa 86.4% (95% CI; 81.6–91.5%) and Stage IVb 62.3% (95% CI; 46.8–82.8%). On multivariate Cox regression analysis there was no statistically significant OS difference when comparing Stage I/II with, Stage III (p=0.98, HR=0.97, 95% CI; 0.11–8.64), IVa (p=0.67, HR=1.56, 95% CI; 0.2–11.94) and IVb (p=0.11, HR=5.54, 95% CI; 0.69–44.52), respectively.The 5-year OS with ICON-S staging were Stage I 93.6% (95% CI; 89.4–98.0%), Stage II 81.9% (95% CI; 73.7–91.1%) and Stage III 69.1% (95%; 57.9–82.6%). There was a consistent decrease of OS with increasing stage. On multivariate Cox regression analysis, when compared to Stage I, OS was significantly lower for stage II (p=0.007, HR=2.84, 95% CI; 1.33–6.05) and stage III (p<0.001, HR=3.78, 95% CI; 1.81–7.92), respectively.ConclusionThe ICON-S staging provides better OS stratification for HPV+OPC following RT compared with the 7th Ed TNM staging.



http://ift.tt/2jYr8yw

Lichen myxedematosus: suggestions on the newly proposed diagnostic criteria

http://ift.tt/2jKhxOB

ASCIA News

ASCIA News

• Thunderstorm asthma epidemic

  Dec 9, 2016:  The recent thunderstorm asthma epidemic in Melbourne and its tragic consequences highlight the need for more research, education and awareness in this area. Thunderstorm asthma is thought to be triggered by thunderstorms that have rapid changes in wind, temperature and humidity, which cause pollen grains to absorb moist...

• ASCIA highlights from 2016 and plans for 2017

  Nov 28, 2016:  As the end of 2016 approaches it is timely to reflect on the significant development, achievements and collaborations of ASCIA over the past year, and plans for 2017. Thank you to ASCIA members and supporters for your greatly appreciated contributions throughout 2016.  We look forward to continuing to work wi...

• Allergy and Immunology Foundation of Australasia (AIFA) Research Grants

  Nov 16, 2016:  AIFA has provided $100,000 in research grants to support 6 projects over the past 3 years. This funding includes two $10,000 grants announced this month, one supporting research into Jack Jumper Ant immunotherapy and the second that will improve development of a drug for allergy. For information about these grants go ...

• AusPollen Apps for people with allergic rhinitis (hay fever) and allergic asthma

  Nov 8, 2016:  Local AusPollen Apps provide information on daily levels of pollen in the air and are currently available for Brisbane, Canberra, Melbourne and Sydney at http://ift.tt/2iVezlV downloading the free App for iTunes or Google Play, and through Twitter or Facebook. Completion of a short (~5 minute) online questio...

• National Allergy Strategy - KABAM survey

  Nov 3, 2016:  THANK YOU to all who participated in the National Allergy Strategy survey for teens and young adults (KABAM survey). The response has been overwhelming and we look forward to reviewing the information to ensure we develop suitable resources for 12-24 year olds with severe allergy. Stay tuned for updates on resource devel...

• ASCIA 2016 Conference Report

  Sep 21, 2016:  The ASCIA 2016 conference provided more than 600 delegates with a unique opportunity to hear from 6 international experts and more than 30 local experts on a wide range of areas in allergy and clinical immunology. The conference also included 79 posters, 48 poster presentations and 16 clinical grand rounds presentations...

• AIFA seed funding leads to NHMRC grant

  Aug 23, 2016:  We are proud to announce that the AusPollen project has been awarded $626,442 in the latest round of NHMRC Partnership Project grants with a further $653,129 in partner organisation in kind and cash support. AusPollen, the Australian Pollen Allergen Partnership, will build, implement and evaluate the first standardised ...

• Updated ASCIA Action Plans for Anaphylaxis and Allergic Reactions

  Aug 10, 2016:  ASCIA has released updated Action Plans for Anaphylaxis and Allergic Reactions on its website: http://ift.tt/1yS3Z48 The main changes are an increased emphasis of key messages, inclusion of images to show how to position a person with anaphylaxi...

• ASCIA releases guidelines for infant feeding and allergy prevention

  May 18, 2016: ASCIA Guidelines for infant feeding and allergy prevention and information on how to introduce solid foods to infants have been released on the ASCIA website: http://ift.tt/2jILsWY These guidelines provide parents and health professionals with advice and recommendations relevant to...

• Federal Government announces funding of $500k for National Allergy Strategy implementation

  May 16, 2016:  It is with great pleasure that we confirm that the federal government's funding of $500k for National Allergy Strategy implementation was announced at the launch of Food Allergy Week in Sydney on 16 May 2016, by the Minister for Health, the Hon Sussan Ley MP. The National Allergy Strategy was launched in...

• Changes to adrenaline autoinjector labels

  Apr 19 2016:  In Australia, adrenaline is the approved name of the ingredient in autoinjector devices used for the emergency treatment of anaphylaxis. Currently, the only available autoinjector to treat anaphylaxis in Australia and New Zealand is supplied under the brand name EpiPen®. In some countries, including the USA, adrenaline i...

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