In patients with an anticipated difficult airway, videolaryngoscopy significantly improved the laryngeal exposure thus facilitating endotracheal intubation.
Single oral intake of 400 mg moxifloxacin is accompanied by good penetration through healthy meninges within 2-6 h post-dose and reached adequately high levels in human CSF exerting satisfactory bactericidal activity against penicillin-resistant S. pneumoniae. These results render novel perspectives for a role of moxifloxacin in CNS infections.
Background. The combined treatment of peritoneal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is a rigorous surgical treatment, most suitable for young and good performance status patients. We evaluated the outcomes of elderly patients undergoing CRS and HIPEC for peritoneal carcinomatosis with careful perioperative care. Methods. All consecutive patients 70 years of age or older who were treated for peritoneal carcinomatosis over the past five years were included. Primary outcomes were perioperative morbidity and mortality. Secondary outcomes were disease-free survival and overall survival. Results. From a pool of 100 patients, with a diagnosis of PC who underwent CRS and HIPEC in our center, we have included 30 patients at an age of 70 years or older and the results were compared to the patients younger than 70 years. The total morbidity rate was 50% versus 41.5% in the group younger than 70 years (NSS). The mortality rate was 3.3% in the elderly group versus 1.43% in the younger group (NSS). Median overall survival was 30 months in the older group versus 38 months in the younger group. Conclusion. Cytoreductive surgery and HIPEC for peritoneal carcinomatosis may be safely performed with acceptable morbidity in selected elderly patients.
Introduction: Serum lactate elevation has been used as a marker of tissue hypoxia in the setting of perioperative monitoring and critical care. It has also been correlated with perioperative morbidity and mortality. Cytoreductive surgery (CRS) & hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis is a major abdominal operation, requiring meticulous perioperative care. The aim of this study is to assess the clinical use of lactate measurements after CRS & HIPEC and its prognostic value in terms of immediate postoperative morbidity and mortality, as well as long term survival. Material & Methods: Of 140 patients diagnosed with peritoneal carcinomatosis who underwent cytoreductive surgery and HIPEC were prospectively studied. Serum lactate was measured by air blood gases analyser intraoperatively (just before the administration of HIPEC) and then daily till the fifth postoperative day. Postoperative complications were recorded and divided into two groups according to Clavien Dindo classification. Results: Intraoperative lactate measurements have not been associated with postoperative morbidity and mortality. On the other hand, lactate measurements on postoperative days 3 and 4 are of clinical significance. Specifically, an increase of 1 mmol/L of the average lactate value of days 3 and 4 raises the risk of a minor complication (Grades I to IIIa) by 1.9, the risk of a major complication (Grades IIIb to V) by 10.9 and the risk of mortality by 32.1%. Conclusions: The average of day 3 and 4 postoperative day lactate level is an independent predictor of morbidity and mortality in patients undergoing CRS and HIPEC.
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