A phase I open-label study of the safety, tolerability, and pharmacokinetics of pazopanib in combination with irinotecan and cetuximab for relapsed or refractory metastatic colorectal cancer.

Background: Pazopanib is a multi-targeted tyrosine kinase inhibitor shown to be clinically active in the treatment of various cancer types. This study aimed to evaluate the maximum tolerated regimen (MTR), safety, and pharmacokinetics of pazopanib in combination with irinotecan and cetuximab in adult patients with relapsed or refractory metastatic colorectal cancer (mCRC).

Patients And Methods: This was a Phase I, 3 + 3 design, open-label, dose-escalation study (NCT0050943; VEG108925) conducted in sequential cohorts to determine the MTR of pazopanib and irinotecan administered with cetuximab.

Single-specialty versus multispecialty vascular surgery group model.

The shift in employment options for vascular surgeons in the current era of major health care reform is being widely debated. After the decision to seek hospital employment or independent practice, the choice of then practicing in a single-specialty or a multispecialty practice remains a difficult decision. Although the trend is toward medium-sized to large-sized groups, only 1.

Changing practice paradigms: negotiating your future.

There are many recent and ongoing changes in the practice of medicine from a business standpoint as well as in overall practice management. Economic and lifestyle desires have pushed many physicians to a decision point of whether or not to join a large multispecialty group or to sell their practice and become an employee of a hospital system. There are advantages and disadvantages to both options; however, deciding on the most appropriate path for each individual can be a daunting task.

Salmeterol/Fluticasone combination inhaler: a new, effective and well tolerated treatment for asthma.

Objective: The efficacy and tolerability of a new combination inhaler containing both salmeterol 50mg and fluticasone 100mg in a single device was compared with the delivery of the two drugs via two separate inhalers in a multicentre, double-blind, double-dummy study.

Patients: 244 symptomatic asthma patients (age range 12 to 78 years) were randomised to a 12-week treatment period with either salmeterol/fluticasone (50/100mg twice daily) via a single inhaler (combination) and placebo twice daily via another, or salmeterol 50mg twice daily via one inhaler and fluticasone 100mg twice daily via another (concurrent).

Results: Morning peak expiratory flow rate (PEFR), symptoms and tolerability were collected throughout the treatment period.

Comparison of the effects of salmeterol/fluticasone propionate with fluticasone propionate on airway physiology in adults with mild persistent asthma.

Background: This study compared the effect of inhaled fluticasone propionate (FP) with the combination of salmeterol/fluticasone propionate (SFC) on lung function parameters in patients with mild asthma.

Methods: Adult patients with mild persistent asthma (> or = 80% predicted FEV1) receiving 200-500 mug of BDP or equivalent were randomised to receive either FP 100 mug or SFC 50/100 mug twice daily from a Diskus inhaler for four weeks. The primary outcome was the change from baseline in airway resistance (sRaw) at 12 hrs post dose measured by whole body plethysmography.

The efficacy and safety of fluticasone propionate in very young children with persistent asthma symptoms.

We aimed to evaluate the efficacy and safety of fluticasone propionate (FP) in children aged 12-47 months with recurrent/persistent asthma symptoms. One hundred and sixty children (12-47 months) were randomised into this multicentre, double-blind, placebo-controlled, parallel-group study, and treated with either FP (100 microg bd) or placebo (2 puffs bd), both administered by metered-dose-inhaler and Babyhaler for 12 weeks. The primary endpoint was percentage of symptom-free 24h periods.

Surveillance after endovascular aneurysm repair: diagnostics, complications, and associated costs.

The purpose of this study is to describe the diagnostic tests used, the complications that occurred the reinterventions performed, and the costs incurred after endovascular aneurysm repair. Retrospective review was performed of 77 consecutive individuals in whom endovascular aortic grafts had been successfully deployed. The series represents a single institution's experience with prospective application of a surveillance program using high-resolution CT scanning.

Noninvasive evaluation of the effectiveness of endovascular AAA exclusion.

Purpose: To evaluate the relationship between aneurysm sac pressure and endograft wall motion in vitro and in vivo and to compare this to sac volume changes after endovascular aneurysm repair.

Methods: In a flow model of an aneurysm with a stent-graft in situ, sac pressure was incrementally increased by adding volume to an otherwise excluded sac; sac pressure waves were registered. Clinically, 43 patients who had unsupported endografts were monitored for stent-graft wall motion using electrocardiographically-guided M-mode ultrasonography.

Fluticasone propionate 100 microg bid using a non-CFC propellant, HFA 134a, in asthmatic children.

Background: Secondary to phasing out chlorofluorocarbons (CFCs), the fluticasone propionate (FP) pressurized metered-dose inhaler has been formulated in a nonozone-depleting propellant, hydrofluoralkane (HFA) 134a.

Objectives: To demonstrate equivalent efficacy and safety of FP 200 microg daily propelled by HFA 134a to FP 200 microg daily propelled by CFCs 11 and 12 over a four-week treatment period in pediatric asthmatic patients.

Methods: The study was multinational, randomized, double blind and of parallel group design.

Horner's syndrome after carotid endarterectomy--a case report.

Horner's syndrome is described in a patient with anisocoria and unilateral lid ptosis 48 hours after an ipsilateral carotid endarterectomy. This case illustrates a rare iatrogenic complication of sympathetic nerve dysfunction following elective surgery.

Vein adaptation to arterialization in an experimental model.

Purpose: The events preceding myointimal thickening in vein grafts after vascular reconstructions are not well characterized. Indeed, the injury response associated with vein graft arterialization may be different than that observed in the balloon angioplasty model. Therefore, we used a rat model to study the early cellular response after arterialization of vein grafts.

Preimplant vein intimal thickness is not a predictor of bypass graft stenosis.

Purpose: Preimplant vein morphology has been implicated as a risk factor for subsequent vein graft failure. It is controversial whether microscopic intimal thickening in random saphenous vein biopsy specimens is associated with an increased risk of graft failure. The purpose of this study was to determine the incidence of preexisting intimal thickening in a macroscopically normal preimplant vein, and to evaluate whether preimplant vein intimal thickness was predictive of future vein graft stenosis.

The natural history of intermediate and critical vein graft stenosis: recommendations for continued surveillance or repair.

Objective: Duplex ultrasound surveillance (DUS) after autogenous lower extremity bypass grafting is controversial. Specific criteria mandating graft revision are not uniform. It has been suggested that grafts harboring critical stenoses undergo revision, whereas those with intermediate stenoses undergo arteriography with selective repair.

Understanding strategies for the treatment of ischemic steal syndrome after hemodialysis access.

The recently published guidelines of the National Kidney Foundation-Dialysis Outcome Quality Initiative have focused on improving patient outcomes and survival by providing recommendations for optimal clinical practice. These guidelines firmly endorse the establishment of autogenous hemodialysis access and recommend a 40% to 50% prevalence of autogenous fistulas among all hemodialysis patients. As surgeons strive to meet these guidelines it will be necessary to extend autogenous reconstruction to older individuals, diabetics, and patients with suitable vein only in the upper arm.

Considerations in the management of aneurysms of the superior mesenteric artery.

Aneurysms of the superior mesenteric artery (SMA) are rare, accounting for 5.5% of all splanchnic aneurysms and <0.5% of all intraabdominal aneurysms.

An economic appraisal of lower extremity bypass graft maintenance.

Objective: Infrainguinal graft surveillance leads to intervention on the basis of duplex-identified stenoses. We have become increasingly concerned about the high frequency with which such revisions are required to maximize graft patency and limb salvage rates. The economic implications of these procedures have not been carefully analyzed or justified.

Distal revascularization-interval ligation for maintenance of dialysis access and restoration of distal perfusion in ischemic steal syndrome.

Ischemic steal syndrome after hemodialysis access challenges the clinician to reconcile the dichotomy of maintenance of access patency and restoration of distal limb perfusion. Results from traditional procedures directed toward increasing the resistance in the fistula (eg, banding, lengthening) have yielded unreliable results and frequently eventuate in fistula thrombosis. The recently described technique of distal revascularization, interval ligation (DRIL) provides a more physiological approach.

Minimally invasive cardiac operation: adapting cardioprotective strategies.

Background: Minimally invasive heart operation differs from traditional cardiac operations through the omission of a sternotomy, cardiopulmonary bypass, or both. Current concerns with minimally invasive operation include: operative safety, learning curve, operative times, arrest times, and adequacy of myocardial protection. While many of the protective strategies used for traditional procedures may be applied to minimally invasive cardiac operations, the safe applications of minimally invasive operations require unique techniques of myocardial protection.