ICORG 10-14: NEOadjuvant trial in Adenocarcinoma of the oEsophagus and oesophagoGastric junction International Study (Neo-AEGIS).

BACKGROUND: Neoadjuvant therapy is increasingly the standard of care in the management of locally advanced adenocarcinoma of the oesophagus and junction (AEG). In randomised controlled trials (RCTs), the MAGIC regimen of pre- and postoperative chemotherapy, and the CROSS regimen of preoperative chemotherapy combined with radiation, were superior to surgery only in RCTs that included AEG but were not powered on this cohort. No completed RCT has directly compared neoadjuvant or perioperative chemotherapy and neoadjuvant chemoradiation. The Neo-AEGIS trial, uniquely powered on AEG, and including comprehensive modern staging, compares both these regimens. METHODS: This open label, multicentre, phase III RCT randomises patients (cT2-3, N0-3, M0) in a 1:1 fashion to receive CROSS protocol (Carboplatin and Paclitaxel with concurrent radiotherapy, 41.4Gy/23Fr, over 5 weeks). The power calculation is a 10% difference in favour of CROSS, powered at 80%, two-sided alpha level of 0.05, requiring 540 patients to be evaluable, 594 to be recruited if a 10% dropout is included (297 in each group). The primary endpoint is overall survival, with a minimum 3-year follow up. Secondary endpoints include: disease free survival, recurrence rates, clinical and pathological response rates, toxicities of induction regimens, post-operative pathology and tumour regression grade, operative in-hospital complications, and health-related quality of life. The trial also affords opportunities for establishing a bio-resource of pre-treatment and resected tumour, and translational research. DISCUSSION: This RCT directly compares two established treatment regimens, and addresses whether radiation therapy positively impacts on overall survival compared with a standard perioperative chemotherapy regimen Sponsor: Irish Clinical Research Group (ICORG). TRIAL REGISTRATION: NCT01726452 . Protocol 10-14. Date of registration 06/11/2012.

Method for continuous conjunctival oxygen monitoring during carotid artery surgery.

A new device for measuring conjunctival oxygen tension (PcjO2) was used for intraoperative monitoring during carotid endarterectomy. The PcjO2 measures local tissue oxygenation and, thus, reflects the oxygen delivery to the areas supplied by the internal carotid artery. PcjO2 was found to be sensitive to manipulation, clamping, and obstruction of the carotid artery; it provided a useful monitoring system for assessment of the cerebral circulation during carotid surgery.

Medical management of neurocysticercosis with Praziquantel.

This paper summarizes the experience with Praziquantel, a new broad spectrum antihelmintic for the treatment of neurocysticercosis.

Reversal of intracerebral steal by STA-MCA anastomosis.

A major factor determining the severity of neurological deficits caused by cerebral ischemia is the ability of the vasculature to provide collateral circulation to the ischemic areas. By establishing a major conduit by means of extracranial-intracranial anastomosis, the increased perfusion pressure through the collateral arterioles may reduce morbidity in these patients. Twenty-seven patients were selected for superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis based on clinical and angiographic evidence of lesions of the internal carotid arterial system. Cerebral blood flows (CBF's) were determined by the xenon-133 inhalation method using 16 symmetrically placed scintillator probes; two-compartment analysis was used to compute a mean flow for the compartment. An average mean flow was computed for each hemisphere, and for four regions with the lowest mean CBF in each hemisphere. The CBF was measured preoperatively and within 8 weeks postoperatively. The average mean flow was 29 ml/100 mg/min in the symptomatic hemisphere, and 30 ml/100 gm/min in the asymptomatic hemisphere. In 11 patients, the mean flow for the symptomatic hemisphere increased by 24% postoperatively, and for the asymptomatic hemisphere by 23%. Regions with lowest CBF showed an increase of 32% in the symptomatic hemisphere, and of 35% in the asymptomatic hemisphere. The low-flow regions differed from the total hemisphere (symptomatic: p less than 0.02; asymptomatic: p less than 0.05). Areas of lowest blood flow preoperatively had the greatest increase in flow postoperatively. Postoperative elevation of CBF in the contralateral hemisphere is consistent with an "intracerebral steal" before surgery. The postoperative elevation of flow in the asymptomatic hemisphere is related to improved perfusion pressure in the symptomatic hemisphere.

Hemodynamic and clinicopathologic verification of a stroke model in the dog.

Twenty-five mongrel dogs had intracranial internal carotid and proximal middle cerebral artery occlusions. The animals were followed for one week and subsequently sacrificed. This method of clipping produced a mean drop in cortical cerebral blood flow of 48.4% as measured by the 85Kr washout technique. Cerebral blood flow was not affected by the brain retraction necessary for clip placements. Mortality in the first week was 16% and neurological deficits were observed in 73% of the animals. Infarction was present in 80% of the animals, and the mean percent infarction of the affected hemisphere was 17.00 +/0 3.98SE. This is a useful stroke model in an animal which is easily available, inexpensive, and suitable for microvascular intracranial surgery research.

Treatment of intraoperative middle cerebral artery occlusion with pentobarbital and extracranial-intracranial bypass. Case report.

A patient with a meningioma of the medial sphenoid wing underwent inadvertent intraoperative occlusion of the middle cerebral artery. Neurological deficit and infarction were presumably prevented by immediate administration of pentobarbital followed by extracranial-intracranial bypass.