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https://www.readbyqxmd.com/read/28096986/extracorporeal-membrane-oxygenation-rescue-in-adolescent-with-bronchiolitis-obliterans-organizing-pneumonia-like-wegener-s-granulomatosis
#1
Lars Falk, Lars Mikael Broman
We report a 17-year-old woman with bronchiolitis obliterans-organizing pneumonia (BOOP)-like granulomatosis with polyangiitis developing severe airway obliterations. Pending age, phase and grade of autoimmune treatment, and offering ECMO treatment may be crucial for survival but occasionally preface futility. ECMO-treated patient with BOOP-like GPA has never been described before.
January 2017: Clinical Case Reports
https://www.readbyqxmd.com/read/28091982/death-from-pulmonary-embolism-of-cyanoacrylate-glue-following-gastric-varix-endoscopic-injection
#2
Michael Philip Burke, Chris O'Donnell, Yeliena Baber
We present the case of a 25 year old woman with a complex past medical history including Crigler-Najjar syndrome (Type 1) with a liver transplant in 1993 and subsequent development of cirrhosis with portal hypertension in the transplanted liver. The deceased presented to hospital with hematemesis and investigations showed a large gastric varix. The varix was injected with cyanoacrylate glue. Within 30 min of injection the patient became acutely hypoxic. Urgent chest X-ray demonstrated radio opaque glue within the pulmonary arteries...
January 14, 2017: Forensic Science, Medicine, and Pathology
https://www.readbyqxmd.com/read/28089562/sequential-multiple-assignment-randomized-trials-an-opportunity-for-improved-design-of-stroke-reperfusion-trials
#3
William J Meurer, Nicholas J Seewald, Kelley Kidwell
BACKGROUND: Modern clinical trials in stroke reperfusion fall into 2 categories: alternative systemic pharmacological regimens to alteplase and "rescue" endovascular approaches using targeted thrombectomy devices and/or medications delivered directly for persistently occluded vessels. Clinical trials in stroke have not evaluated how initial pharmacological thrombolytic management might influence subsequent rescue strategy. A sequential multiple assignment randomized trial (SMART) is a novel trial design that can test these dynamic treatment regimens and lead to treatment guidelines that more closely mimic practice...
January 12, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28081583/-early-results-of-adjuvant-topical-treatment-of-recurrent-osteomyelitis-with-absorbable-antibiotic-carriers
#4
Y Gramlich, G Walter, J Gils, R Hoffmann
Background Treatment of musculoskeletal infections principally consists of radical surgical debridement and systemic administration of antibiotics. Additional local antibiotic therapy is not yet generally established, and lacks evidence-based proof of efficacy. Nonetheless, there are a variety of practical approaches, as most specialised departments are unwilling to forego this option. The established polymethylmetacrylate (PMMA) carrier system has a number of practical disadvantages. This has led to the increased use of absorbable carrier systems, and those based on calcium sulphate have given particularly encouraging results...
January 12, 2017: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/28070237/to-ventricular-assist-devices-or-not-when-is-implantation-of-a-ventricular-assist-device-appropriate-in-advanced-ambulatory-heart-failure
#5
EDITORIAL
Emily Cerier, Brent C Lampert, Arman Kilic, Asia McDavid, Salil V Deo, Ahmet Kilic
Advanced heart failure has been traditionally treated via either heart transplantation, continuous inotropes, consideration for hospice and more recently via left ventricular assist devices (LVAD). Heart transplantation has been limited by organ availability and the futility of other options has thrust LVAD therapy into the mainstream of therapy for end stage heart failure. Improvements in technology and survival combined with improvements in the quality of life have made LVADs a viable option for many patients suffering from heart failure...
December 26, 2016: World Journal of Cardiology
https://www.readbyqxmd.com/read/28062650/euthanasia-embedded-in-palliative-care-responses-to-essentialistic-criticisms-of-the-belgian-model-of-integral-end-of-life-care
#6
Jan L Bernheim, Kasper Raus
The Belgian model of 'integral' end-of-life care consists of universal access to palliative care (PC) and legally regulated euthanasia. As a first worldwide, the Flemish PC organisation has embedded euthanasia in its practice. However, some critics have declared the Belgian-model concepts of 'integral PC' and 'palliative futility' to fundamentally contradict the essence of PC. This article analyses the various essentialistic arguments for the incompatibility of euthanasia and PC. The empirical evidence from the euthanasia-permissive Benelux countries shows that since legalisation, carefulness (of decision making) at the end of life has improved and there have been no significant adverse 'slippery slope' effects...
January 6, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28054148/the-cost-of-surviving-nitrogen-excess-energy-and-protein-demand-in-the-lichen-cladonia-portentosa-as-revealed-by-proteomic-analysis
#7
Silvana Munzi, Lucy J Sheppard, Ian D Leith, Cristina Cruz, Cristina Branquinho, Luca Bini, Assunta Gagliardi, Giampiero Cai, Luigi Parrotta
Different nitrogen forms affect different metabolic pathways in lichens. In particular, the most relevant changes in protein expression were observed in the fungal partner, with NO 3(-) mostly affecting the energetic metabolism and NH 4(+) affecting transport and regulation of proteins and the energetic metabolism much more than NO 3(-) did. Excess deposition of reactive nitrogen is a well-known agent of stress for lichens, but which symbiont is most affected and how, remains a mystery. Using proteomics can expand our understanding of stress effects on lichens...
January 4, 2017: Planta
https://www.readbyqxmd.com/read/28052486/impact-of-acute-on-chronic-liver-failure-on-90-day-mortality-following-a-first-liver-transplantation
#8
Eric Levesque, Audrey Winter, Zaid Noorah, Jean-Pierre Daurès, Paul Landais, Cyrille Feray, Daniel Azoulay
BACKGROUND: Acute-On-Chronic Liver Failure (ACLF) is associated with a significant short-term mortality rate (23% to 74%), depending on the number of organ failures. Some patients present with ACLF at the time of liver transplantation (LT). The aim of this study was to assess whether ACLF was also a prognostic factor after LT and, if applicable, to construct a score that could predict 90-day mortality. METHODS: Three hundred and fifty cirrhotic patients, who underwent LT between January 2008 and December 2013, were enrolled...
January 4, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28049139/a-randomized-phase-2-study-of-mk-2206-versus-everolimus-in-refractory-renal-cell-carcinoma
#9
E Jonasch, E Hasanov, P Corn, T Moss, K Shaw, S Stovall, V Marcott, B Gan, S Bird, X Wang, K Do, P Altamirano, A Zurita, L Doyle, P Lara, N M Tannir
BACKGROUND: Activation of the phosphoinisitide-3 kinase (PI3K) pathway through mutation and constitutive upregulation have been described in renal cell carcinoma (RCC), making it an attractive target for therapeutic intervention. We performed a randomized phase II study in vascular endothelial growth factor (VEGF) therapy refractory patients to determine whether MK-2206, an allosteric inhibitor of AKT, was more efficacious than the mammalian target of rapamycin inhibitor everolimus. PATIENTS AND METHODS: A total of 43 patients were randomized in a 2:1 distribution, with 29 patients assigned to the MK-2206 arm and 14 to the everolimus arm...
January 3, 2017: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/28038934/emerging-cardiac-non-coding-landscape-the-importance-of-meta-analysis
#10
REVIEW
K Shanmugha Rajan, Subbiah Ramasamy, J N George-William, Jeyaprakash Rajendhran
The invention of transcriptome-wide deep sequencing technology has fundamentally changed our understanding of the complex networks that mediate cardiac functions. Since its inception, researchers have uncovered various novel pathways and transcripts that could be one day used for therapeutics and diagnostics. The characterization of various non-protein coding RNAs (ncRNAs) has aided the study of cardiac manifestation in more detail. Although numerous studies have unearthed the importance of miRNA and lncRNA, the existence and importance of other ncRNAs have been neglected due to their unusual behaviors and outdated ideologies...
December 27, 2016: Biochimie
https://www.readbyqxmd.com/read/28029317/laparoscopy-to-predict-the-result-of-primary-cytoreductive-surgery-in-patients-with-advanced-ovarian-cancer-a-randomized-controlled-trial
#11
Marianne J Rutten, Hannah S van Meurs, Roelien van de Vrie, Katja N Gaarenstroom, Christiana A Naaktgeboren, Toon van Gorp, Henk G Ter Brugge, Ward Hofhuis, Henk W R Schreuder, Henriette J G Arts, Petra L M Zusterzeel, Johanna M A Pijnenborg, Maarten van Haaften, Guus Fons, Mirjam J A Engelen, Erik A Boss, M Caroline Vos, Kees G Gerestein, Eltjo M J Schutter, Brent C Opmeer, Anje M Spijkerboer, Patrick M M Bossuyt, Ben Willem Mol, Gemma G Kenter, Marrije R Buist
Purpose To investigate whether initial diagnostic laparoscopy can prevent futile primary cytoreductive surgery (PCS) by identifying patients with advanced-stage ovarian cancer in whom > 1 cm of residual disease will be left after PCS. Patients and Methods This multicenter, randomized controlled trial was undertaken within eight gynecologic cancer centers in the Netherlands. Patients with suspected advanced-stage ovarian cancer who qualified for PCS were eligible. Participating patients were randomly assigned to either laparoscopy or PCS...
December 28, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28025915/field-station-as-stage-re-enacting-scientific-work-and-life-in-amani-tanzania
#12
P Wenzel Geissler, Ann H Kelly
Located high in Tanzania's Usambara Mountains, Amani Hill Station has been a site of progressive scientific endeavours for over a century, pushing the boundaries of botanical, zoological and medical knowledge, and providing expertise for imperial expansion, colonial welfare, national progress and international development efforts. The station's heyday was from the 1950s to the 1970s, a period of global disease eradication campaigns and the 'Africanization' of science. Today, Amani lies in a state of suspended motion...
December 2016: Social Studies of Science
https://www.readbyqxmd.com/read/28012838/clinical-outcome-of-mechanical-thrombectomy-for-stroke-in-the-elderly
#13
Itxaso Azkune Calle, Jone Bocos Portillo, Ane Anton-Ladislao, Alberto Gil Garcia, Eva Gonzalez Diaz, Marian Gomez-Beldarrain, Covadonga Fernandez Maiztegi, Ana Pinedo Brochado, Juan Carlos Garcia-Monco
BACKGROUND: Endovascular revascularization with mechanical devices has proven an effective treatment for proximal occlusions of the major intracranial arteries in stroke patients, but there is only limited information as to whether there should be an age limit for its use. We aimed to evaluate the safety and effectiveness of endovascular revascularization in stroke patients aged 80 years and older, and compare the results with younger patients. METHODS: We prospectively collected 81 consecutive patients subjected to mechanical thrombectomy for proximal occlusion of the anterior circulation during a period of 27 months...
December 21, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28011612/oral-vancomycin-followed-by-fecal-transplantation-versus-tapering-oral-vancomycin-treatment-for-recurrent-clostridium-difficile-infection-an-open-label-randomized-controlled-trial
#14
Susy S Hota, Valerie Sales, George Tomlinson, Mary Jane Salpeter, Allison McGeer, Bryan Coburn, David S Guttman, Donald E Low, Susan M Poutanen
BACKGROUND: Fecal transplantation (FT) is a promising treatment for recurrent Clostridium difficile infection (CDI), but its true effectiveness remains unknown. We compared 14 days of oral vancomycin followed by a single FT by enema with oral vancomycin taper (standard of care) in adult patients experiencing acute recurrence of CDI. METHODS: In a phase 2/3, single-center, open-label trial, participants from Ontario, Canada, experiencing recurrence of CDI were randomly assigned in a 1:1 ratio to 14 days of oral vancomycin treatment followed by a single 500-mL FT by enema, or a 6-week taper of oral vancomycin...
February 1, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28005821/strategy-for-successful-management-of-facial-keloid-using-triamcinolone-injection-as-adjunct-to-surgery
#15
Bayo Aluko-Olokun, Ademola Abayomi Olaitan
The literature on keloids is replete with authors expressing frustration with treatment results. Triamcinolone is effective in shrinking keloids and preventing their recurrence following excision, if delivered successfully. Strategies for effective delivery of drug are presented: recommended needle size, use of metal syringe, slow injection to avoid skin rupture, and delayed withdrawal of needle after injection. The futility of expecting pedunculated keloids to be completely flattened by steroid injection alone is mentioned...
November 2016: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28004700/resistance-is-futile
#16
David Pogue
No abstract text is available yet for this article.
November 15, 2016: Scientific American
https://www.readbyqxmd.com/read/28004198/leukoaraiosis-is-a-predictor-of-futile-recanalization-in-acute-ischemic-stroke
#17
Nicola Gilberti, Massimo Gamba, Enrico Premi, Angelo Costa, Veronica Vergani, Ilenia Delrio, Raffaella Spezi, Mardighian Dikran, Michele Frigerio, Roberto Gasparotti, Alessandro Pezzini, Alessandro Padovani, Mauro Magoni
Futile recanalization occurs when successful recanalization fails to improve clinical outcome in acute ischemic stroke patients. Predictors of futile recanalization are still debated and may help in selecting patients for reperfusion strategies. We aim to determine whether leukoaraiosis may be useful in predicting futile recanalization in acute ischemic stroke patients treated by endovascular mechanical thrombectomy. We included in the analysis patients with acute ischemic stroke due to anterior circulation large vessel occlusion undergoing endovascular mechanical thrombectomy obtaining complete vessel recanalization...
December 21, 2016: Journal of Neurology
https://www.readbyqxmd.com/read/28001142/perspective-medical-futility-a-contemporary-review
#18
Ellen Coonan
As medical technology has advanced, the question of medical futility has become a topic of intense debate both within the medical community and within society as a whole. However, a unanimous definition thereof is yet to be decided-some commentators are sceptical as to whether an agreement will ever be reached-and this continues to lead to difficulties, tension, and even legal action when a treating physician disagrees with a patient and/or a patient's family regarding care and treatment options. Although living in a pluralistic society presents one of the major reasons as to why, despite 30 years of intense discussion, no consensus has been made; the issue of medical futility will always be complex as it is, by nature, multifaceted, and numerous elements-including possible risks, evidence of the probability of benefit, the wishes of the patient (and family), professional standards, and cost-interact...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28001135/a-survey-of-physicians-attitudes-toward-decision-making-authority-for-initiating-and-withdrawing-va-ecmo-results-and-ethical-implications-for-shared-decision-making
#19
Ellen C Meltzer, Natalia S Ivascu, Meredith Stark, Alexander V Orfanos, Cathleen A Acres, Paul J Christos, Thomas Mangione, Joseph J Fins
OBJECTIVE: Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians' attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28000489/medical-futility-treatment-in-intensive-care-units
#20
Marko Jukić, Lenko Šarić, Ivana Prkić, Livia Puljak
OBJECTIVE: To investigate cases of potential medical futility treatment in intensive care unit (ICU). MATERIALS AND METHODS: Retrospective review of 1567 charts of patients treated during the three-year period (2012 - 2014) in the ICU of the University Hospital Centre Split, Croatia, was conducted. More detailed analysis of the deceased patients' (n=429) charts was performed to identify cases of potential medical futility treatment. There were 99 patients for which ICU treatment was questionable due to their low Glasgow coma scale (GCS) score...
November 2016: Acta Medica Academica
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