Indications for laparoscopic colorectal resections--also for cancers?

In the last decade, laparoscopy has dramatically changed colonic surgery. Laparoscopic procedures are applied to the treatment of almost all colonic diseases, including both benign and malignant lesions. Significant benefits can be expected with a laparoscopic approach relative to decreased pain, ileus, length of hospital stay, disability, and possibly, adhesion formation and subsequent bowel obstruction, and improved cosmesis. However, all those benefits are secondary in the treatment of cancer; tumor-free survival must be the primary goal. Early comparative studies have shown that laparoscopic colectomy for cancer is safe, feasible, and an oncologic adequate resection can be performed with acceptable operative times and conversion rates. The most recent results of prospective randomized trials are now showing similar survival and cure rates after laparoscopic colectomy. There is evidence that laparoscopic colectomy for curable cancer results in equivalent cancer related survival compared to open colectomy when performed by experienced surgeons. The surgical techniques are demanding and require a level of standardization to achieve success. Laparoscopic colorectal surgery for cancer will have a definite role in the future.     

Tea for Tooth

Agoodreasontochooseteaovercoffee :Drinkingteaonaregularbasismayhelpreduceyourteeth’ssensitivitytohotandcoldtemperatures .Thebenefitcomesfromtannicacid1,acompoundinblackteathatclogs2 microscopicholesinyourteeth .Fillingtheseholeshelpskeephotandcoldliquidsfromirritating3therootsofyourteeth ,saysNormanBitter,adentistinFresno ,California .Forpeoplewithsensitiveteeth ,acoupleofcupsofteaeachdaymaybeenoughtoeliminatetoothpain .　Vocabulary　　 1.tannicacid　n .[化 ]　鞣酸　　　　 2 .clog　 [kl g]v…     

Writing for publication: a new skill for nurses?

In this article, we outline a voluntary staff development course – Writing for Publication – and its operation in the context of changing policy, practice and professional demands. One year from course completion we are in a position to discuss its success. We argue that, in a small but significant way, a paradigm shift in nursing is reflected in requests for the course, and for places on it. Clearly, there are new professional needs to be met.     

Endovascular training for obstetrician‐gynecologists: Suggestions for credentialing

This article suggests guidelines for training and credentialing of obstetrician‐gynecologists to perform endovascular procedures. It concentrates on the performance of uterine artery embolization for symptomatic myomata. Comparison is made between other recommended case numbers for credentialing of surgeons, radiologists, and cardiologists. Educational courses are discussed, as are the credits obtained for a typical uterine artery embolization. Two paradigms of endovascular credentialing are appropriate for comparison: Cardiology standards for coronary artery interventions and vascular surgery standards for endovascular stent placement. Both require a course including laboratory and participation in 100 cases, 50 of which as primary operator. In addition, many countries require a certificate of fluoroscopy safety. A credentialing board will be created to verify both the standards and completion of course requirement and proctored cases. Credentialing will benefit both patients and obstetrician gynecologists who will be able to provide continuity of care not currently available. The gynecologist will be able to manage all complications, including myomata, which cannot be done under current circumstances.     

Bariatric surgery for morbid obesity--a cure for metabolic syndrome?

At present there is no single medication that targets the metabolic syndrome directly. Bariatric surgery, a treatment option for morbidly obese individuals who fail medical therapy, has been shown to be very effective in treating multiple aspects of the metabolic syndrome. The decrease in insulin resistance is because of significant weight loss and by enhancing secretion of gut hormones such as glucagon-like peptide-1 (GLP-1).     

No time for education? Creative teaching tools for educators

The creative teaching methods discussed in this paper have been successfully integrated into orientation, mandatory education, and continuing education programs. The response to all of the creative teaching methods discussed has been very positive. Nursing staff appreciates the effort educator's take to communicate information effectively and increase learner satisfaction.     

Amantadine for adynamic speech: possible benefit for aphasia?

OBJECTIVE: Dopaminergic agents may stimulate behavior and verbal expression after frontal lobe dysfunction. Although amantadine is used in neurorehabilitation of motivational disorders and head injury, it is not commonly prescribed to improve aphasia. This pilot study examined verbal fluency on and off amantadine for nonfluent speech. DESIGN: Four participants undergoing inpatient rehabilitation, meeting criteria for transcortical motor aphasia had stroke (2), stroke postaneurysm surgery (1), or brain tumor resection (1). We administered 100 mg of amantadine twice a day in an open-label, on-off protocol, with multiple assessments per on-off period. RESULTS: Off medication, subjects generated a mean 12.62 of words (abnormally few) on the Controlled Oral Word Association test. On medication, word generation significantly improved to 17.71 words (P = 0.04), although scores remained psychometrically in the abnormal range. CONCLUSIONS: Further research on amantadine, specifically for nonfluent speech and nonfluent aphasia, including effects on functional communication and control conditions, may be warranted.     

Is it time for medical therapy for aortic valve disease?

Calcific aortic stenosis is the most common indication for surgical valve replacement. Currently there are no medical therapies approved for the treatment of this disease. This review will summarize the clinical and experimental studies published over the past 5 years that indicate that medical therapy may be an option for this patient population.     

Challenges for Academic Investigator–Initiated Pediatric Trials for Rare Diseases

Background

Clinical trials require great effort, time, expertise, and money. For clinicians at university hospitals with their full work load of teaching and medical care, the planning of an investigator-initiated clinical trial seems almost unthinkable. Despite their expertise in distinct diseases, university clinicians lack the time necessary to organize the funding and to initiate and conduct Phase III clinical trials in adults or in children.

Objective

We sought to determine whether the difficulties faced by a clinician conducting a pediatric clinical trial can be overcome by passionate motivation and external support.

Methods

Critical aspects of the application process of the world?s first clinical trial in children with the rare hereditary kidney disease Alport syndrome treated with an angiotensin-converting enzyme inhibitor (Early Prospective Therapy Trial to Delay Renal Failure in Children With Alport Syndrome [EARLY PRO-TECT Alport]; http://www.clinicaltrials.gov NCT01485978; EudraCT 2010-024300-10) are described.

Results

The following crucial factors enabled the investigator to complete this trial: (1) support through clinical trial, biometrician, and regulatory experts (Institute for Applied Research and Clinical Studies [IFS], Göttingen, Germany); (2) advice from the university?s ethics committee (University Medicine Göttingen, Göttingen, Germany); (3) public funding (€1 million from the German Federal Ministry of Education and Research); (4) support from the respective medical society, aiming at the resolution of an important clinical problem (German Society of Pediatric Nephrology); and (5) support from the investigator?s university as the official sponsor of the trial, providing long-term commitment and covering financial risks (University Medical Center Göttingen, Göttingen, Germany).

Conclusions

The study could pave the way for approval of ramipril as a drug to treat children with Alport syndrome. Even though the study might not result in label changes, the EARLY PRO-TECT Alport trial provides the basis of an educational campaign to sensitize physicians, especially pediatricians, general practitioners, and nephrologists, to pay special attention to the early detection of kidney diseases in children, which could improve medical care for all children with kidney diseases.