Articles: postoperative.
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To assess whether CT attenuation values help in differentiating benign from malignant etiology of focal (18) F-FDG avid breast lesions detected on whole-body PET/CT exam in postoperative breast cancer patients. Institutional review board approval and waived informed consent were obtained for this HIPAA-compliant retrospective study. Between January 2009 and July 2011, a total of 85 patients had 97 focal (18) F-FDG avid breast lesions on whole-body PET/CT. ⋯ ICC with regard to interobserver agreement in measuring the mean HU of the benign lesions was 0.84 (95% confidence interval 0.64-0.93) and for the malignant lesions was 0.88 (95% confidence interval 0.77-0.94). A CT attenuation threshold value of less than 17 HU suggests benign etiology of focal (18) FDG avid breast lesions in postoperative breast cancer patients. If confirmed by additional studies, these findings may provide additional information to guide the treating physician regarding decisions for supplementary imaging or the need to biopsy.
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Anesthesia and analgesia · May 2014
Randomized Controlled TrialDexmedetomidine Reduces Propofol and Remifentanil Requirements During Bispectral Index-Guided Closed-Loop Anesthesia: A Double-Blind, Placebo-Controlled Trial.
The α2-adrenergic agonist dexmedetomidine is a sedative and can be used as an adjunct to anesthetics. Our primary goal was thus to determine the extent to which dexmedetomidine reduces the requirement for propofol and remifentanil. ⋯ Dexmedetomidine administration significantly reduced the requirement for both propofol and remifentanil during anesthetic induction and reduced propofol use during maintenance of anesthesia. Dexmedetomidine also delayed postoperative analgesic use. Dexmedetomidine is a useful adjuvant that reduces anesthetic requirement and provides postoperative analgesia.
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Aseptic trauma engages the innate immune response to trigger a neuroinflammatory reaction that results in postoperative cognitive decline. The authors sought to determine whether high-mobility group box 1 protein (HMGB1), an ubiquitous nucleosomal protein, initiates this process through activation and trafficking of circulating bone marrow-derived macrophages to the brain. ⋯ Postoperative neuroinflammation and cognitive decline can be prevented by abrogating the effects of HMGB1. Following the earlier characterization of the resolution of surgery-induced memory decline, the mechanisms of its initiation are now described. Together, these data may be used to preoperatively test the risk to surgical patients for the development of exaggerated and prolonged postoperative memory decline that is reflected in delirium and postoperative cognitive dysfunction, respectively.