The role of tlie laryngeal mask airway in children is supported by numerous papers (12 = 20), abstracts ( n = 33), and other reports ( i i = 88). but there are only a few large scale studies ( > I000 patients) assessing its safety and efficacy and none in which anaesthetic management was standardised. In addition, coiieeriis have been raised that placement may be more dillicult in children [4] and it has been suggested thxt the standard insertion technique recommended by Bruin may be suboptimal in infants and children [5, 61.Recently we conducted a trial assessing tlie rate of skill acquisition of trainee anaestlietists in 600 children [7]. We have continued to gather data about LMA usage by trainee anaestlietists pacdiatric anaesthetic practice and would like to present data from ii further 1400 LMA uses. The primary aim o f this further study was to provide information about insertion and complication rates using the standard recommended insertion technique. A secondary aim was to assess factors leading to an increased risk of problems with LMA usage in infants and children using a limited range of stundaidiscd anaesthetic techniques. ,\~i,lll O d \A prospective survey of 1400 consecutive pacdiati-ic anaesthetics given by trainee anxsthetists in which the LMA W;IS the planned form of airway management was iindcrtitkcn at tlie Maranon University Hospital. Data from ;I previous prospective study determining skill acquisition were excluded from the analysis [7]. Ethics committee approval W;IS not obtained sincc all aspects of management wcrc part o f routine practice.Iletailcd records were kept of all LMA uses by trainee anacsthetists tising ii predesigned data sheet. All observations were made by tlie supervising consultant involved in the case wlio was trained in the sttidy protocol and problem definitions. The supervising consultants only intervened if the oxygen saturation decreased below W%,. All trainees were individually instructed in LMA tisagc and the study protocol by one of tlie authors. wlio also ensured that the study protocol was adhered to by const;int education and supervision. The decision to LISC the LMA in each patient was made by [he supervising consultant. ;is W;IS the mode of its use. These decisions were based on tlie requirements of individual patients and the prcfcrred choice of the supervising consultant within thc confines o f tlie study protocol. The LMA was not used In patients ;it I-isk of a s pi ration o r for in t 1-21 -;I bdom i n a I. thoracic. in Li-io r head and neck 01-vascular surgery. or patients who were ASA grade 4 o r 5.Data obtained included age, sex, ASA griide. anaesthetic technique, type and duration of surgery. LMA size ;ind tlie number of attempts required for succcssftil placement. The cumulative experience of the trainee with tlic LMA in paediatric practice and predelincd problems occurring d iir i ng i lid uc ti on. main tena nee and recovery were ;I 1 so documented. Induction was delined H S the start 01' iqjcction of propofol until the beginning of surgery. M...
Drug delivery systems can provide enhanced efficacy and/or reduced toxicity for anticancer agents. Liposome drug delivery systems are able to modify the pharmacokinetics and biodistribution of cytostatic agents, increasing the concentration of the drug released to neoplastic tissue and reducing the exposure of normal tissue. Anthracyclines are a key drug in the treatment of both metastatic and early breast cancer, but one of their major limitations is cardiotoxicity. One of the strategies designed to minimize this side effect is liposome encapsulation. Liposomal anthracyclines have achieved highly efficient drug encapsulation and they have proven to be effective and with reduced cardiotoxicity, as a single agent or in combination with other drugs for the treatment of either anthracyclines-treated or naïve metastatic breast cancer patients. Of particular interest is the use of the combination of liposomal anthracyclines and trastuzumab in patients with HER2-overexpressing breast cancer. In this paper, we discuss the different studies on liposomal doxorubicin in metastatic and early breast cancer therapy.
This study examined steroidal regulation of tissue factor expression by cultured endometrial stromal cells. Confluent stromal cell cultures derived from cycling human endometria were exposed to vehicle control, 10(-8) mol/L estradiol (E2), 10(-8)-10(-6) mol/L medroxyprogesterone acetate (MPA), or both E2 and MPA for 2-24 days in serum-containing medium. The progestin enhanced immunoreactive and functionally active stromal cell tissue factor content, achieving peak effects by 8-12 days of culture. Although E2 alone was ineffective, it augmented MPA-enhanced tissue factor content by 8 days of culture, with continued increases beyond 20 days. Dose-dependent effects on tissue factor protein content were observed between 10(-8)-10(-6) mol/L MPA added alone or together with E2. The content of tissue factor mRNA was also increased by MPA and synergistically increased by E2 plus MPA. Similar steroidal effects on stromal cell tissue factor protein and mRNA content were observed using a defined medium. After optimal induction of tissue factor expression by E2 plus MPA, removal of these steroids reduced levels of stromal cell tissue factor mRNA and protein, with virtually complete reversal by day 7 of withdrawal. These time-course and dose-response relationships establish in vitro conditions with which to dissect factors controlling endometrial hemostasis, whereas the observed effects of steroid withdrawal establish a novel model for the study of mechanisms regulating normal and abnormal uterine bleeding.
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