Successful Treatment of Multiple Angiomyolipomas with Sirolimus in a Child.

Tuberous sclerosis complex frequently results in the formation of renal angiomyolipomas (AMLs). Sirolimus (SIR) or everolimus can be used to treat large AMLs, although this treatment has rarely been described in children, particularly for multiple renal AMLs. A 15-year-old girl presented with bilateral severe chronic flank pain coinciding with increased renal size and hundreds of renal AMLs.

A review of the literature and discussion: establishing a consensus for the definition of post-mastectomy pain syndrome to provide a standardized clinical and research approach.

Chronic pain presents a management challenge for physicians and patients alike, and post-mastectomy pain is no exception. In this issue, Waltho and Rockwell present a review of post-mastectomy pain syndrome (PMPS) and propose a standard definition that should allow future studies to be comparable. The proposed definition of "post-breast surgery pain syndrome" includes pain after any type of breast surgery that is of at least moderate intensity and comprises neuropathic qualities, that is present in the ipsilateral breast/chest/arm, that lasts longer than 6 months and is present at least half the time.

Predicting which patients actually receive radiation following breast conserving therapy in Canadian populations.

Canadian women with breast cancer may choose breast conserving therapy as their course of treatment, requiring both breast conserving surgery and adjuvant radiation therapy. However, more than 15% of Canadian women fail to receive the appropriate radiation therapy, putting them at increased risk for recurrence. Age, distance from their radiation therapy centre and stage of disease affect patients' likelihood of receiving prescribed radiation therapy.

Serum Biomarkers Help Predict Attention Problems in Critically Ill Children With Traumatic Brain Injury.

Objective: To evaluate the association between acute serum biomarkers, and the changes in attention at 1 year following traumatic brain injury.

Design And Setting: A prospective observational and laboratory study conducted in PICUs at five Canadian children's hospitals.

Study Population And Measurements: Fifty-eight patients aged 5 to 17 years with traumatic brain injury were enrolled in the study.

Facial Fractures.

Learning Objectives: After reading this article, the participant should be able to: 1. Demonstrate an understanding of some of the changes in aspects of facial fracture management. 2.

Is it safe to wait? The effect of surgical wait time on survival in patients with non-small cell lung cancer.

Background: The effect of surgical wait times on survival in patients with non-small cell lung cancer (NSCLC) remains largely unknown. Our objective was to determine the effect of surgical wait time on survival and incidence of upstaging in patients with stage I and II NSCLC.

Methods: All patients with clinical stage I and II NSCLC who underwent surgical resection in a single centre between January 2010 and December 2011 were reviewed.

Extramural Pilot Project: Designated On-Call Intensivist in Tertiary Care Centre Improves Access to Critical Care Consultation/Referral and Resources.

Timely consultation with an intensivist will promote early and appropriate management of critically ill patients. We determined whether implementing a call roster of intensivists who did not have on-call responsibilities in an intensive care unit (ICU) and who received referrals from community physicians would improve access to critical care services. This program created efficiencies to critical care services by: timely access to consultation with an intensivist (<10 minutes) and/or subspecialist, timely referral to an appropriate institution (<30 minutes) and optimal resource utilization by determining the availability of ICU beds at non-tertiary care hospitals capable of providing the care needs of the patient, thus relieving pressure on the neighbouring tertiary/quaternary care centre.

Best Practices in Alemtuzumab Administration: Practical Recommendations for Infusion in Patients With Multiple Sclerosis.

With the growing complexity of multiple sclerosis (MS) care, nursing professionals have increasing responsibility in managing clinical disease and treatment. Nursing professionals and other health care providers play important roles in educating patients about disease-modifying therapy options, the course of therapy, and managing potential adverse effects. A panel of nursing and MS experts was convened and used a modified Delphi method to reach consensus on best-practice recommendations for alemtuzumab infusion in MS patients.

Managing access and flow through appropriate discharge: preventing common errors and improving processes.

Increased pressure on acute care hospitals to move patients seamlessly through the healthcare system has resulted in more attention to the process of discharging patients, particularly seniors, from hospitals. When alignment with the Health Care Consent Act is lacking, errors can occur in the process. Examples of mistakes by healthcare professionals include these: taking direction from the wrong substitute decision-maker (SDM); taking direction from a family member when the patient is capable; allowing an SDM to make an advance directive on behalf of a patient; being aware of a known prior expressed wish but ignoring that wish when considering a placement plan; waiting for an SDM who is not available, willing and capable instead of proceeding down the hierarchy of decision-makers; or permitting families to propose discharge plans.

Nocturnal home hemodialysis associates with improvement of electrocardiographic features linked to sudden cardiac death.

Sudden cardiac death (SCD) remains the leading cause of death in hemodialysis patients. We performed a retrospective electrocardiograph (ECG) and chart review to determine whether hemodialysis modality, frequency, or duration could predict change in ECG parameters associated with SCD. Frequent nocturnal hemodialysis was associated with an improvement in Tpeak to Tend within 365 days (83.

The effect of liver transplantation for primary sclerosing cholangitis on disease activity in patients with inflammatory bowel disease.

Immunosuppressive therapies are indicated following liver transplantation (LT) to prevent graft loss through rejection, and these same agents also may have a role in the management of inflammatory bowel disease (IBD). The aims of this study were to examine the effects of immunosuppression following LT on IBD activity and to identify markers of IBD control post-LT in patients with IBD who underwent LT for primary sclerosing cholangitis (PSC). A retrospective analysis of all adult patients with a pre-LT diagnosis of IBD who underwent LT for PSC over a 15-year period was performed.

The effects of neuropsychiatric drugs on glycogen synthase kinase-3 signaling.

Glycogen synthase kinase-3 (GSK-3) has been implicated in the action of antipsychotics, mood stabilizers, and antidepressants. Given that only antipsychotics are able to alleviate the positive symptoms of schizophrenia, the regulation of GSK-3 by antipsychotics would be expected to differ from other neuropsychiatric drugs if GSK-3 is involved in the alleviation of psychosis. Consequently, the current study examined the effects of antipsychotics (haloperidol and clozapine), mood stabilizers (lithium and valproic acid), and antidepressants (imipramine and fluoxetine) on GSK-3, as well as Akt and Wnt in the prefrontal cortex and striatum.

Regulation of Akt and Wnt signaling by the group II metabotropic glutamate receptor antagonist LY341495 and agonist LY379268.

Metabotropic glutamate receptors 2/3 (mGlu(2/3)) have been implicated in schizophrenia and as a novel treatment target for schizophrenia. The current study examined whether mGlu(2/3) regulates Akt (protein kinase B) and Wnt (Wingless/Int-1) signaling, two cascades associated with schizophrenia and modified by antipsychotics. Western blotting revealed increases in phosphorylated Akt (pAkt) and phosphorylated glycogen synthase kinase-3 (pGSK-3) following acute and repeated treatment of LY379268 (mGlu(2/3) agonist), whereas increases in dishevelled-2 (Dvl-2), dishevelled-3 (Dvl-3), GSK-3 and β-catenin were only observed following repeated treatment.

Stressors and coping in individuals with chronic kidney disease.

The purpose of this study was to develop a valid and reliable instrument to measure stressors of patients with chronic kidney disease (CKD), identify those stressors, and determine which coping strategies were used and effective. The participants reported fatigue, sleep problems, and peripheral neuropathy as the most frequently experienced stressors. Optimism as a coping style was most commonly used and was also the most effective.

Inhibiting nitric oxide overproduction during hypotensive sepsis increases local oxygen consumption in rat skeletal muscle.

Objective: Although nitric oxide (NO) is a known regulator of cardiovascular function, the effect of NO overproduction during sepsis on capillary oxygen transport and local tissue oxygen consumption is not well understood. The objectives of this study were to determine whether sepsis-induced NO overproduction increased capillary stopped-flow and modulated tissue oxygen consumption in skeletal muscle.

Design: Prospective, controlled laboratory study.

Neurosurgery for the treatment of epilepsy.

Purpose Of Review: Epilepsy is a common condition that is estimated to afflict 0.5-1.0% of the world's population.

Development and application of functional databases for planning deep-brain neurosurgical procedures.

This work presents the development and application of a visualization and navigation system for planning deep-brain neurosurgeries. This system, which incorporates a digitized and segmented brain atlas, an electrophysiological database, and collections of final surgical targets of previous patients, provides assistance for non-rigid registration, navigation, and reconstruction of clinical image data. The fusion of standardized anatomical and functional data, once registered to individual patient images, facilitates the delineation of surgical targets.

The effects of antipsychotics on beta-catenin, glycogen synthase kinase-3 and dishevelled in the ventral midbrain of rats.

Protein kinase B and glycogen synthase kinase-3 have been identified as susceptibility genes for schizophrenia and altered protein and mRNA levels have been detected in the brains of schizophrenics post-mortem. Recently, we reported that haloperidol, clozapine and risperidone alter glycogen synthase kinase-3 and beta-catenin protein expression and glycogen synthase kinase-3 phosphorylation levels in the rat prefrontal cortex and striatum. In the current study, beta-catenin, adenomatous polyposis coli, Wnt1, dishevelled and glycogen synthase kinase-3 were examined in the ventral midbrain and hippocampus using western blotting.

Percutaneous retrogasserian glycerol rhizotomy in the treatment of tic douloureux associated with multiple sclerosis.

Objective: Patients with multiple sclerosis (MS) have a relatively high incidence of tic douloureux (TD) and often do not tolerate medical therapy well. The minimally invasive nature of percutaneous retrogasserian glycerol rhizotomy (PRGR) renders it ideal for first-line surgical treatment of TD. We sought to ascertain the benefits of PRGR in patients with MS and to determine whether hypalgesia after PRGR correlates with efficacy.