[What are the barriers for doctors to stop medication?].

There are several dilemma's for the doctor in stopping or deminuishing medication and in diagnosing and exploring the origin of a diseaese. There can be doubt about having enough actual information about the patient, possessing knowledge about tapering and its consequences. The doctor can be vulnerable about her capacities in communication and shared decision making, in dealing with resistance or agression from the patient and with her own disappointment and feeling of failure.

American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock.

Objectives: The American College of Critical Care Medicine provided 2002 and 2007 guidelines for hemodynamic support of newborn and pediatric septic shock. Provide the 2014 update of the 2007 American College of Critical Care Medicine "Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock."

Design: Society of Critical Care Medicine members were identified from general solicitation at Society of Critical Care Medicine Educational and Scientific Symposia (2006-2014).

Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children.

Background: Targeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after in-hospital cardiac arrest are limited.

Methods: In a trial conducted at 37 children's hospitals, we compared two temperature interventions in children who had had in-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose children older than 48 hours and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.

Potential value of EUS in pancreatic surveillance of VHL patients.

Background: Patients with von Hippel-Lindau (VHL) disease are prone to develop pancreatic neuroendocrine tumors (pNETs). However, the best imaging technique for early detection of pNETs in VHL is currently unknown. In a head-to-head comparison, we evaluated endoscopic ultrasound (EUS) and (11)C-5-hydroxytryptophan positron emission tomography ((11)C-5-HTP PET) compared with conventional screening techniques for early detection of pancreatic solid lesions in VHL patients.

Feasibility of measuring renal blood flow by phase-contrast magnetic resonance imaging in patients with autosomal dominant polycystic kidney disease.

Objectives: Renal blood flow (RBF) has been shown to predict disease progression in autosomal dominant polycystic kidney disease (ADPKD). We investigated the feasibility and accuracy of phase-contrast RBF by MRI (RBFMRI) in ADPKD patients with a wide range of estimated glomerular filtration rate (eGFR) values.

Methods: First, we validated RBFMRI measurement using phantoms simulating renal artery hemodynamics.

Therapeutic hypothermia after out-of-hospital cardiac arrest in children.

Background: Therapeutic hypothermia is recommended for comatose adults after witnessed out-of-hospital cardiac arrest, but data about this intervention in children are limited.

Methods: We conducted this trial of two targeted temperature interventions at 38 children's hospitals involving children who remained unconscious after out-of-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose patients who were older than 2 days and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.

Quantification of infectious bronchitis coronavirus by titration in vitro and in ovo.

Quantification of the number of infectious viruses in a sample is a basic virological technique. In this chapter we provide a detailed description of three techniques to estimate the number of viable infectious avian coronaviruses in a sample. All three techniques are serial dilution assays, better known as titrations.

Hepatocellular carcinoma in tyrosinemia type 1 without clear increase of AFP.

Patients with hereditary tyrosinemia type 1 have an elevated risk of developing hepatocellular carcinoma, especially if initiation of treatment with 2-(2-nitro-4-trifluoro-methylbenzoyl)-1,3-cyclohexanedione is delayed. Hepatocellular carcinoma can usually be suspected when there are increased α1-fetoprotein levels and characteristic imaging features. The present case shows that a lack of a clear increase in α1-fetoprotein should still lead to consideration of liver transplantation when imaging features change.

Short-term Effects of Tolvaptan in Individuals With Autosomal Dominant Polycystic Kidney Disease at Various Levels of Kidney Function.

Background: A recent study showed that tolvaptan, a vasopressin V2 receptor antagonist, decreased total kidney volume (TKV) growth and estimated glomerular filtration rate (GFR) loss in autosomal dominant polycystic kidney disease (ADPKD) with creatinine clearance≥60mL/min. The aim of our study was to determine whether the renal hemodynamic effects and pharmacodynamic efficacy of tolvaptan in ADPKD are dependent on GFR.

Study Design: Clinical trial with comparisons before and after treatment.

EUS is superior for detection of pancreatic lesions compared with standard imaging in patients with multiple endocrine neoplasia type 1.

Background: In multiple endocrine neoplasia type 1 (MEN1), pancreatic neuroendocrine tumors (pNETs) are the leading MEN1-related cause of death.

Objective: To evaluate EUS and (11)C-5-hydroxytryptophan positron emission tomography ((11)C-5-HTP PET), compared with the recommended screening techniques in MEN1 patients for early detection of pNETs.

Design: Cross-sectional study.

Clinical validation of FDG-PET/CT in the radiation treatment planning for patients with oesophageal cancer.

Background: The aim of this prospective study was to determine the proportion of locoregional recurrences (LRRs) that could have been prevented if radiotherapy treatment planning for oesophageal cancer was based on PET/CT instead of CT.

Materials And Methods: Ninety oesophageal cancer patients, eligible for high dose (neo-adjuvant) (chemo)radiotherapy, were included. All patients underwent a planning FDG-PET/CT-scan.

The cumulative risk of multiple CT exposures using two different methods.

The aim of this study was to compare the summing method (A) with the complement method (B) for calculating the cumulative lifetime-attributable-risk (LAR(tot)) of tumor incidence and mortality of multiple CT exposures. Method A defines LAR(tot) as the summation of the risk of each separate exposure. Method B was defined as the complement of the probability of inducing no cancer in N separate exposures.

Evaluation of progression prior to surgery after neoadjuvant chemoradiotherapy with computed tomography in esophageal cancer patients.

Background: The risk of tumor progression during neoadjuvant chemoradiotherapy (CRT) in esophageal cancer (EC) is around 8% to 17%. We assessed the efficacy of computed tomography (CT) to identify these patients before esophagectomy.

Methods: Ninety-seven patients with locally advanced EC treated with Carboplatin/Paclitaxel and 41.

Duct-to-duct reconstruction in liver transplantation for primary sclerosing cholangitis is associated with fewer biliary complications in comparison with hepaticojejunostomy.

There is no consensus on the preferred type of biliary reconstruction for patients undergoing orthotopic liver transplantation (OLT) for primary sclerosing cholangitis (PSC). The aim of this study was to compare long-term outcomes after OLT for PSC using either duct-to-duct anastomosis or Roux-en-Y hepaticojejunostomy for biliary reconstruction. In a consecutive series of 98 adult patients undergoing OLT for PSC, 45 underwent duct-to-duct reconstruction, and 53 underwent Roux-en-Y biliary reconstruction.

Using patient characteristics to predict usefulness of abdominal computed tomography in children.

Objective: The study goal was to determine whether clinical symptoms, physical findings, or laboratory values predict the usefulness of abdominal computed tomography (CT) scans in children.

Methods: We conducted a retrospective review of pediatric patients who received an abdominal CT scan between June 2009 and November 2011 at an urban medical center. A panel of pediatric hospitalists independently categorized each CT read as: (1) necessary for diagnosis; (2) unnecessary but helpful for diagnosis; or (3) neither necessary nor helpful for diagnosis.

Influence of preoperative chemotherapy on CT volumetric liver regeneration following right hemihepatectomy.

Background: An increasing number of patients undergo major liver resection following preoperative chemotherapy. Liver regeneration may be impaired in these patients, predisposing them to postoperative liver dysfunction. The aim of the present study was to evaluate the effects of preoperative chemotherapy on liver regeneration after partial liver resection.

Computer-assisted solid lung nodule 3D volumetry on CT: influence of scan mode and iterative reconstruction: a CT phantom study.

Objective: To evaluate the effect of high-resolution scan mode and iterative reconstruction on lung nodule 3D volumetry.

Methods: Solid nodules with various sizes (5, 8, 10 and 12 mm) were placed inside a chest phantom. CT images were obtained with various tube currents, scan modes (conventional mode, high-resolution mode) and iterative reconstructions [0, 50 and 100 % blending of adaptive statistical iterative reconstruction (ASiR) and filtered back projection].

Lack of Anatomical Concordance between Preablation and Postablation CT Images: A Risk Factor Related to Ablation Site Recurrence.

Objective. Variation in the position of the liver between preablation and postablation CT images hampers assessment of treatment of colorectal liver metastasis (CRLM). The aim of this study was to test the hypothesis that discordant preablation and postablation imaging is associated with more ablation site recurrences (ASRs).

The impact of hepatic steatosis on liver regeneration after partial hepatectomy.

Background & Aim: Experimental studies in animals have suggested that liver regeneration is impaired in steatotic livers. However, few studies have focused on the impact of steatosis in patients undergoing partial hepatectomy (PH). This study aims to determine the role of steatosis on liver regeneration in humans following PH.

Improving Pediatric Survival from Resuscitation Events: The Role and Organization of Hospital-based Rapid Response Systems and Code Teams.

During the past 10-15 years it has become evident that in spite of the sophistication of medicine, hospitalized patients frequently experience cardiac arrests from which the majority do not survive. A substantial number of these arrests occur on general inpatient units where patients begin to deteriorate but there is a failure of timely recognition so that appropriate intervention can be instituted before the arrest takes place. Much work has been done to determine how survival from adult in-hospital cardiac arrests can be improved by (1) teaching health care providers about resuscitation management using a team approach and (2) more recently, by developing rapid response systems to recognize deteriorating patients early and intervening to prevent the cardiac arrest.

Fibrin sealant for prevention of resection surface-related complications after liver resection: a randomized controlled trial.

Objective: To evaluate the efficacy of fibrin sealant in reducing resection surface-related complications in liver surgery.

Background: Bile leakage, bleeding, and abscess formation are major resection surface-related complications after liver resection. It is unclear whether application of fibrin sealant to the resection surface is effective in reducing these complications.

Early hepatic regeneration index and completeness of regeneration at 6 months after partial hepatectomy.

Background: The liver is known to regenerate following partial hepatectomy (PH), but little is known about the timing and completeness of regeneration relative to the resected volume. This study examined whether liver volume regeneration following PH and its completeness 6 months after surgery is related to the resected volume.

Methods: A consecutive series of patients undergoing PH were included.