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Opioid-free anesthesia (OFA) provides analgesia minimizing opioids. OFA has not been evaluated in cytoreductive surgery (CRS) with or without heated intraperitoneal chemotherapy. We aim to evaluate OFA feasibility and effectiveness in CRS.Retrospective cohort study of adult patients (84) undergoing CRS in a tertiary center from May 2020 until June 2021. Predefined protocols for either opioid-based anesthesia (OBA) or OFA were followed.OFA protocol patients (41) had better mean pain scores (1 ± 0.8 vs. 2 ± 1; p = 0.00) despite the avoidance of intravenous and epidural fentanyl intraoperatively (220 ± 104 and 194 ± 73 µg, respectively, in OBA vs. 0; p = 0.00). Postoperative epidural levobupivacaine was also lower in the OFA group (575 ± 192 vs. 706 ± 346 mg; p = 0.034) despite the lack of epidural fentanyl without difference in duration (4.3 ± 1.2 vs. 4 ± 1.2 days; p = 0.22). Morphine consumption was very low (4.1 ± 10 vs. 1.7 ± 5 mg; p = 0.16). Intraoperative hypertensive events and postoperative nausea and vomiting (PONV) were higher for OBA (43) (30.2% vs. 7.3%; p = 0.01% and 69.8% vs. 34.1%; p = 0.001, respectively). Postoperative epidural fentanyl was independently associated with PONV (p = 0.004). There was no difference in total complications or length of stay.OFA is feasible, safe, and offers optimal pain control while minimizing the use of opioids in CRS. more...

The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of desmoplastic small round cell tumor, breast, and gastrointestinal stromal tumor specifically related to peritoneal surface malignancy. These guidelines are developed with input from leading experts including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence. more...

The Chicago Consensus Working Group provides multidisciplinary recommendations for palliative care specifically related to peritoneal surface malignancies. These guidelines are developed with input from leading experts including surgical oncologists, medical oncologists, gynecologic oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence. more...

The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of neuroendocrine tumors specifically related to the management of peritoneal surface malignancy. These guidelines are developed with input from leading experts, including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence. more...

The abstract is available here: https://uscholar.univie.ac.at/o:1093895

cid_339 166..175 ABSTRACT Background and Purpose: Titanium (Ti) surface roughness and surface hydrophilicity are key factors to regulate osteogenic cell responses during dental implant healing. In detail, specific integrin-mediated interactions with the extracellular environment trigger relevant osteogenic cell responses like differentiation and matrix synthesis via transcriptions factors. Aim of this study was to monitor surface-dependent osteogenic cell adhesion dynamics, proliferation, and specific osteo- genic cell differentiation over a period of 7 days. Materials and Methods: Ti disks were manufactured to present smooth pretreatment (PT) surfaces and rough sandblasted/ acid-etched (SLA) surfaces. Further processing to isolate the uncontaminated TiO2 surface from contact with atmosphere provided a highly hydrophilic surface without alteration of the surface topography (modSLA). Tissue culture polystyrene (TCPS) served as control. Human osteogenic cells were cultivated on the respective substrates. After 24 hours, 48 hours, 72 hours, and 7 days, cell morphology on the Ti substrates was visualized by scanning transmission electron microscopy. As a marker of cellular proliferation, cell count was assessed. For the analysis of cell adhesion and differentiation, specific gene ex- pression levels of the integrin subunits b1 and av, runx-2, collagen type Ia (COL), alkaline phosphatase (AP), and osteocalcin (OC) were obtained by real-time RT-PCR for the respective time points. Data were normalized to internal controls. Results: TCPS and PT surfaces preserved a rather immature, dividing osteogenic phenotype (high proliferation rates, low integrin levels, and low specific osteogenic cell differentiation). SLA and especially modSLA surfaces promoted both cell adhesion as well as the maturation of osteogenic precursors into post-mitotic osteoblasts. In detail, during the first 48 hours, modSLA resulted in lowest cell proliferation rates but exhibited highest levels of the investigated integrins, runx-2, COL, AP, and OC. Conclusion: Our results revealed a strong synergistic effect between submicron-scale roughness and surface hydrophilicity on early osteogenic cell adhesion and maturation. more...

Background A treatment option for patients with peritoneal mucinous carcinomatosis (PMCA) from an appendiceal neoplasm is cytoreductive surgery and perioperative intraperitoneal chemotherapy. Also, these patients are recommended for systemic chemotherapy using an oxaliplatin and 5-fluorouracil (FOLFOX) regimen. A major question concerns the proper timing (neoadjuvant vs. adjuvant) of the systemic chemotherapy. Methods In January of 2005 a prospective study was initiated to routinely treat patients with peritoneal dissemination of a mucinous adenocarcinoma of the appendix with neoadjuvant chemotherapy using FOLFOX. All patients had a clinical, CT, intraoperative, and histopathological assessment of chemotherapy effects. The study was closed in July of 2009. Results Thirty-four consecutive patients were available for evaluation. In the clinical evaluation and CT evaluation, 24 (71%) and 22 (65%), respectively, had stable disease on chemotherapy. By intraoperative examination 17 (50%) patients were observed to have progressed. By histopathology seven had a partial response and three patients a complete response (29%). Conclusions In these carcinomatosis patients clinical and CT assessment of response to neoadjuvant chemotherapy seldom provided useful data over this short time period. Intraoperative findings indicated progression in 50% of patients. By histopathology, 29% of patients had a response. J. Surg. Oncol. 2010;102:576–581. © 2010 Wiley-Liss, Inc. more...

Objective: Modifications of surface topography and surface chemistry are key factors for guiding target cells during dental implant healing. Recent in vitro studies confirmed promotion of early osteogenic cell differentiation on submicron scaled surfaces in particular when hydrophilized. However, no long-term observations on both osteogenic cell proliferation as well as on cell maturation have been reported for respectively modified surfaces. Aim of this study was to monitor osteogenic cell proliferation and expression of specific osteogenic cell differentiation markers on a protein level over an extended period of 3 weeks with respect to surface modifications. Material and methods: Modified titanium (Ti) disks were obtained from Institute Straumann, representing the following surfaces: smooth pretreatment (PT), sandblasted/acid etched (SLA), and hydrophilized (modSLA). Surface topography was analyzed by scanning electron microscopy, surface elemental composition was assessed by X-Ray Photoelectronic Spectroscopy (XPS). Tissue culture polystyrene (TCPS) served as a control substrate. Human osteogenic cells (HOB-c) were cultivated on the respective substrates. After 24 hrs, 48 hrs, 72 hrs, 7 d, 14 d and 21 d, cell count was assessed as well as osteogenic cell differentiation utilizing cellular Quantitative Immuno-Cytochemistry (QIC) assay for collagen type I (COL), alkaline phosphatase (AP), osteopontin (OPN) and osteocalcin (OC). Data were normalized with respect to internal controls. Results: In contrast to the other modified Ti disks, modSLA stands out due to low surface carbon contamination. TCPS and PT surfaces preserved a rather immature, mitotic active osteogenic phenotype (high proliferation rates, no increase of OC production), SLA and especially modSLA surfaces promoted the maturation of osteogenic precursors into post-mitotic osteoblasts. In detail, modSLA resulted in lowest cell proliferation rates, but exhibited highest expression rates of OC. Discussion: Our results, which confirm previous studies, reveal long-term promotion of osteogenic cell maturation by topography (micron and submicron scale roughness) and surface hydrophilicity. To cite this article: Klein MO, Bijelic A, Toyoshima T, Gotz H, von Koppenfels RL, Al-Nawas B, Duschner H. Long-term response of osteogenic cells on micron and submicron-scale-structured hydrophilic titanium surfaces: sequence of cell proliferation and cell differentiation. Clin. Oral Impl. Res. 21, 2010; 642–649. doi: 10.1111/j.1600-0501.2009.01883.x more...

Background Peritonectomy combined with perioperative intraperitoneal chemotherapy is a successful treatment option for patients with peritoneal dissemination of appendiceal and colorectal malignancy. Despite its efficacy, recurrences remain a common problem. Methods Patients with peritoneal dissemination from appendiceal or colorectal malignancy who underwent complete cytoreduction and perioperative intraperitoneal chemotherapy were included in this study. Data regarding recurrent disease found on abdominal exploration and/or diagnostic studies was extracted from a prospective database and analyzed. Results Seventy patients with colorectal cancer carcinomatosis and 402 with appendiceal neoplasm were analyzed. Forty-nine of 70 and 111 of 402 patients developed documented recurrences. The median survival of 49 patients with colorectal cancer was 33 months while the median survival for patients with appendiceal neoplasms was not reached. The most common type of recurrent disease was a localized intra-abdominal recurrence for both appendiceal and colon cancer patients. Patients who underwent second surgery for recurrent disease had an improved survival. Conclusion Additional treatments should be strongly considered in patients who fail an initial cytoreduction combined with perioperative intraperitoneal chemotherapy. This resulted in 5-year survival in 17% of colorectal patients and 70% of the appendiceal mucinous neoplasm patients. J. Surg. Oncol. 2008;98:295–299. © 2008 Wiley-Liss, Inc. more...

We designed a 24-field array and an on-line control box that selects which and how many of 24 fields will conduct electrical charge during functional electrical stimulation. The array was made using a conductive microfiber textile, silver two-component adhesive, and the conductive ink imprint on the polycarbonate. The control box comprised 24 switches that corresponded one-to-one to the fields on the array. Each field could be made con- ductive or nonconductive by simple pressing of the corre- sponding push-button type switch on the control box. We present here representative results of the selectivity of the new electrode measured in three tetraplegic patients dur- ing functional electrical stimulation of the forearm. The task was to generate finger flexion and extension with min- imal interference of the wrist movement during lateral and palmar grasps. Therapists determined the appropriate pat- tern that lead to effective grasping, lasting on average 5 min per stimulation channel in the first session. This opti- mal conductive pattern (size and shape) provided effective finger flexion and extension with minimal wrist flexion/ extension and ulnar/radial deviations ( < 10 degrees). The optimal size and shape of the electrode in all cases had a branched pattern. The selection of the optimal stimulation site was achieved without moving the electrode. The size and shape were reproducible in the same subject from session to session, yet were different from subject to sub- ject. The optimal electrode size and shape changed when subjects pronated and supinated their forearm. The control box includes a program that can dynamically change the number and sites of the conductive fields; hence, it is fea- sible to use this during functional movements. Subjects learned how to determine the optimal electrode pattern; hence, these electrodes could be effective for home usage. Key Words: Electrical stimulation—Electrode— Selective—Surface—Conductive fields. more...

A model mechanism that accounts for the experimentally observed pH-dependent enhancement of enzymatic activity of horseradish peroxidase through the catalase-like pathway is proposed. Predictions of the model are tested against a number of experimental results to confirm that kinetic constants used in the numerical simulation are correctly chosen and that the model can be used to emulate the reaction between horseradish peroxidase and hydrogen peroxide in a wide range of conditions. more...

Purpose The objective of this data analysis was to study treatment failure after complete cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) for peritoneal dissemination from appendiceal mucinous neoplasms. Methodology Prior to June 2006, 402 patients with peritoneal dissemination from appendiceal mucinous neoplasms underwent complete cytoreduction and PIC at the Washington Cancer Institute. Patient characteristics, pathologic features and treatment-related data were obtained from a prospective database. Survival analyses were performed using Kaplan-Meier method and Cox Regression model. Results After a median follow-up of 66 months, the 5- and 10-year overall survival rates for the entire 402 patients were 90% and 85%, respectively. The 5- and 10-year progression-free survival rates were 70% and 67%, respectively. Disease progression was the only independent risk factor for a reduced overall survival. One hundred and eleven patients (28%) developed progressive disease. Of these, 98 patients underwent second-time and 26 patients third-time CRS and PIC. Complete cytoreduction after repeat surgery was the only independent prognostic factor for an improved survival. The most common sites of treatment failure were on the small bowel and in the pelvis. Conclusions The present study reported the patterns of treatment failure after complete cytoreduction and demonstrated that a disease-free state is important for long-term survival in peritoneal dissemination from appendiceal mucinous neoplasms. Repeat complete cytoreduction should be pursued when possible and is associated with an improved overall survival in patients with recurrent disease. more...