Quality measurement in cancer care delivery.

During the past decade, increasing emphasis has been placed on defining and measuring the quality of health care delivery. The Outcomes Committee of the Society of Surgical Oncology (SSO) was established in 2008 to explore and promote emerging outcomes-related topics that are most relevant to society membership. In recognition of the importance of health care quality, a mini-symposium was held at the SSO's 63rd Annual Cancer Symposium in St.

Telmisartan inhibits vasoconstriction via PPARγ-dependent expression and activation of endothelial nitric oxide synthase.

Aims: Telmisartan activates peroxisome proliferator-activated receptor-γ (PPARγ) in addition to serving as an angiotensin II type 1 receptor (AT(1)R) blocker. The PPARγ activity of telmisartan on resistance arteries has remained largely unknown. The present study investigated the hypothesis that telmisartan inhibited vascular tension in mouse mesenteric resistance arteries, which was attributed to an increased nitric oxide (NO) production through the PPARγ-dependent augmentation of expression and activity of endothelial nitric oxide synthase (eNOS).

Prostaglandins in action indispensable roles of cyclooxygenase-1 and -2 in endothelium-dependent contractions.

Endothelium regulates local vascular tone by means of releasing relaxing and contracting factors, of which the latter have been found to be elevated in vascular pathogenesis of hypertension, diabetes, hypercholesterolemia, and aging. Endothelium-derived contracting factors (EDCFs) are mainly metabolites of arachidonic acid generated by cyclooxygenase (COX), as vasodilatations in patients with hypertension, metabolic diseases, or advancing age are improved by acute treatment with COX inhibitor indomethacin. COX is presented in two isoforms, COX-1 and COX-2, with the former regarded as constitutive and the latter mainly expressed upon induction.

An unusual cause of blepharospasm.

We describe a rare case of multiple dilated Virchow-Robin spaces in the brainstem in a patient presenting initially with blepharospasm with subsequent spread to involve the face and neck. On magnetic resonance imaging (MRI), these lesions demonstrated an isointense signal to cerebrospinal fluid on all sequences with no mass effect or enhancement. Although rare, this condition should be considered part of the differential diagnosis when evaluating cystic abnormalities in the brainstem.

The demographics of molar pregnancies in England and Wales from 2000-2009.

Objective: To analyze the overall incidence of molar pregnancies and that of complete and partial molar pregnancies across the reproductive age range for England and Wales for the period 2000-2009.

Study Design: The cases of all patients with molar pregnancies registered with the UK Trophoblast disease service from England and Wales were identified. The overall number of molar pregnancies registered from 1998-2007 was compared to the number of maternities (live births and still births) and total viable conceptions for each year.

Loxoscelism and negative pressure wound therapy (vacuum-assisted closure): an experimental study.

Brown recluse spider (Loxosceles) bites cause lesions ranging from chronic necrotic ulcers to acute life-threatening sepsis. Based on our experience in treating acute and chronic wounds with negative pressure, we postulated that vacuum-assisted closure (VAC) would be valuable in this application. Chester pigs were procured and injected with purified brown recluse spider venom, 1 µl of venom in two anterior sites and 0·1 µl of venom in two posterior sites on their dorsum.

Single-dose pharmacokinetics and tolerability of telavancin in elderly men and women.

Study Objective: To assess the safety and tolerability, and the effect of sex on the pharmacokinetic disposition, of a single intravenous dose of telavancin 10 mg/kg in elderly (> or = 65 yrs) subjects.

Design: Phase I, open-label, single-dose, sex-stratified study.

Setting: Clinical research unit.

Atretic cephalocele - an uncommon cause of cystic scalp mass.

A 6 year-old girl presented with a midline parietal scalp swelling that had been gradually enlarging since birth. Magnetic resonance imaging revealed communication of the cyst with the subarachnoid space through a calvarial defect, with concomitant findings of vertically positioned straight venous sinus and subependymal grey matter heterotopia. A diagnosis of atretic cephalocele was thus made based on these classical imaging findings.

American Society of Clinical Oncology provisional clinical opinion: chronic hepatitis B virus infection screening in patients receiving cytotoxic chemotherapy for treatment of malignant diseases.

Unlabelled: PURPOSE An American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) offers timely clinical direction to ASCO's membership following publication or presentation of potentially practice-changing information. This PCO addresses recommendations for chronic hepatitis B virus (HBV) infection screening in patients receiving cytotoxic or immunosuppressive chemotherapy for treatment of malignant diseases.

Clinical Context: The Centers for Disease Control and Prevention (CDC) issued Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection, recommending screening for hepatitis B infection (hepatitis B surface antigen [HBsAg], antihepatitis B core antigen [anti-HBc], and antibodies to HBsAg [anti-HBs]) for "persons receiving cytotoxic or immunosuppressive therapy (eg, chemotherapy for malignant diseases.

Endothelial dysfunction: the common consequence in diabetes and hypertension.

Endothelial dysfunction plays a key role in the initiation of cellular events evolving into the development of vascular complications in diabetes and hypertension. Diminished production and function of endothelium-derived nitric oxide and other vasoprotective factors and/or the exaggerated production of proinflammatory and vasoconstrictors such as angiotensin II, endothelin-1, reactive oxygen species, and cyclooxygenase-derived metabolites of arachidonic acid eventually lead to endothelial dysfunction, resulting in elevated vascular tone which contributes to hypertension, vascular, and cardiac remodeling, culminating in microvascular, macrovascular, and renal damages. Specific therapies targeting reactive oxygen species using antioxidants and inhibitors of the rennin-angiotensin system or increasing endothelial nitric oxide synthase activity might assist to reverse endothelial dysfunction and thus reduce the related cardiovascular morbidity and mortality in diabetes and hypertension.

Complete atrioventricular block complicating acute anterior myocardial infarction can be reversed with acute coronary angioplasty.

Introduction: A retrospective case series of acute anterior myocardial infarction (MI) patients complicated by complete atrioventricular block (AVB) treated with acute percutaneous transluminal coronary angioplasty (PTCA).

Clinical Picture: Eight patients with anterior MI and complete AVB underwent acute PTCA between 2000 and 2005. Mean onset of complete AVB was 16.

Observation of ureteric diameter in negative intravenous urogram in hospital universiti kebangsaan malaysia.

Background: This study observed the widest ureteric diameter in negative intravenous urogram (IVU) examinations using low osmolar contrast media.

Methods: We reviewed a total of one hundred and eighty four ureters from 92 negative IVUs.

Results: The results show a mean diameter for the abdominal ureter of 4.

Dermatofibrosarcoma protuberans: how wide should we resect?

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare dermal tumor with local recurrence rates ranging from 0 to 50%. Controversy exists regarding margin width and excision techniques, with some advocating Mohs surgery and others wide excision (WE). We reviewed the experience in two tertiary centers using WE with total peripheral margin pathologic evaluation.

Osteonecrosis of the jaw after oral bisphosphonate for osteoporosis.

Bisphosphonates are a common treatment for osteoporosis. Osteonecrosis of the jaw has been associated with the use of bisphosphonates, usually when they have been used parenterally to treat malignancies. Cases associated with oral bisphosphonate as a treatment for osteoporosis are less frequent.

Evidence-based surgical practice in academic medical centers: consistently anecdotal?

Introduction: Randomized trials, meta-analyses, and guidelines form the basis of clinical decision making. We queried a small sample of surgeons at three academic medical centers to determine whether key elements of surgical practice were concordant with available evidence.

Materials And Methods: A French Society of Digestive Surgery (FSDS) questionnaire was submitted to general surgery trainees and faculty at the University of South Florida and University of Chicago and to surgical oncology fellows at the Memorial Sloan-Kettering Cancer Center.

Experimental measurements and large eddy simulation of expiratory droplet dispersion in a mechanically ventilated enclosure with thermal effects.

Understanding of droplet transport in indoor environments with thermal effects is very important to comprehend the airborne pathogen infection through expiratory droplets. In this work, a well-resolved Large Eddy Simulation (LES) was performed to compute the concentration profiles of monodisperse aerosols in non-isothermal low-Reynolds turbulent flow taking place in an enclosed environment. Good care was taken to ensure that the main dynamical features of the continuous phase were captured by the present LES.

Effect of Telavancin on the pharmacokinetics of the cytochrome P450 3A probe substrate midazolam: a randomized, double-blind, crossover study in healthy subjects.

Study Objective: To examine the effect of telavancin, a lipoglycopeptide antibiotic with potent gram-positive activity, on the pharmacokinetics of midazolam, a cytochrome P450 (CYP) 3A probe substrate. Design. Phase I, randomized, double-blind, placebo-controlled, crossover study.

An unexpected cause of hoarseness of voice in a healthy teenager.

Laryngeal amyloidosis is a rare cause of stridor in a healthy young adult. We report a case of localised laryngeal amyloidosis, including our MRI findings, which included a necrotic centre that has not previously been described. This case also highlights the need for a high index of clinical suspicion to achieve the correct histopathological interpretation.

Perspective: Physician advocacy: what is it and how do we do it?

Many medical authors and organizations have called for physician advocacy as a core component of medical professionalism. Despite widespread acceptance of advocacy as a professional obligation, the concept remains problematic within the profession of medicine because it remains undefined in concept, scope, and practice. If advocacy is to be a professional imperative, then medical schools and graduate education programs must deliberately train physicians as advocates.

Lack of effect of moderate hepatic impairment on the pharmacokinetics of telavancin.

Study Objective: To evaluate the pharmacokinetics of the lipoglycopeptide antibiotic, telavancin, in patients with moderate hepatic impairment compared with healthy controls.

Design: Phase I, open-label, single-dose, matched-control, pilot study.

Setting: Clinical research unit.

Loxoscelism and negative pressure wound therapy (vacuum-assisted closure): a clinical case series.

Brown recluse spider (Loxosceles sp) bites continue to be a significant challenge to manage clinically. Sequelae from these lesions range from chronic necrotic ulcers that persist for months to an acute life-threatening course of sepsis. Negative pressure wound therapy using vacuum-assisted closure (VAC) has been described for use in both acute and chronic wounds.

American Society of Clinical Oncology 2009 clinical evidence review on radiofrequency ablation of hepatic metastases from colorectal cancer.

Purpose: To review the evidence about the efficacy and utility of radiofrequency ablation (RFA) for hepatic metastases from colorectal cancer (CRHM).

Methods: The American Society of Clinical Oncology (ASCO) convened a panel to conduct and analyze a comprehensive systematic review of the RFA literature from Medline and the Cochrane Collaboration Library.

Results: Because data were considered insufficient to form the basis of a practice guideline, ASCO has instead published a clinical evidence review.