A pressure-resistant peripherally inserted central catheter is as useful as a central venous catheter for rapid fluid infusion: an in vitro study.

BACKGROUND: Although peripherally inserted central catheters (PICCs) have been widely used, they have not been frequently used in anesthesia practice. The central venous pressure measured via PICCs are reportedly as accurate as that measured via central venous catheters (CVCs), but the findings concerning rapid infusion are unclear. This study examined whether or not pressure-resistant PICCs could be used for rapid fluid infusion.  METHODS: The in-line pressure was measured in similar-sized double-lumen catheters-4-Fr PICC (55, 45 and 35 cm) and 17-G CVC (20 and 13 cm)-at flow rates of saline decided using a roller pump system. We also examined the flow rate at an in-line pressure of 300 mmHg, which is the critical pressure at which hemolysis is considered to occur during blood transfusion. RESULTS: The pressure-resistant PICCs obtained a high flow rate similar to that of CVCs, but the in-line pressures increased in proportion to the flow rate and catheter length. Flow rates at an intra-circuit pressure of 300 mmHg were not significantly different between the 45-cm PICC and 20-cm CVC. CONCLUSION: Pressure-resistant PICCs can be used for rapid fluid infusion.

[COMPLETE RESPONSE OF BULKY LYMPH NODE METASTASES TREATED WITH ENZALUTAMIDE AFTER CHEMOTHERAPY WITH DOCETAXEL IN CASTRATION-RESISTANT PROSTATE CANCER: A CASE REPORT].

A 74-year-old man was initially diagnosed as having cT4N0M0 and Gleason score 5+4 prostate adenocarcinoma in 2012. Systemic therapy was initiated with luteinizing hormone-releasing hormone (LH-RH) agonist and bicalutamide, and serum prostate-specific antigen (PSA) levels fell to a nadir of 0.02 ng/ml from 25.55 ng/ml.After 3 years of initial treatment, the patient presented with metastatic castrate-resistant prostate cancer (mCRPC) with extensive bulky lymphadenopathy and a serum PSA of 4.81 ng/ml. Open biopsy of the left supraclavicular lymph node revealed metastasis by poorly-differentiated adenocarcinoma of prostatic origin. He continued to receive LH-RH agonist and bicalutamide and underwent seven courses of docetaxel (DOC) chemotherapy plus prednisolone. Computed tomography showed partial response in all but one metastatic pelvic lymph node, which gradually increased in size. The mCRPC response to DOC was heterogeneous, and DOC chemotherapy was stopped because of toxicity and progressive disease.Second-line hormonal therapy with enzalutamide and LH-RH agonist was started and after 6 months, computed tomography revealed complete response in the metastatic lymph nodes based on response evaluation criteria in solid tumors (RECIST); PSA levels decreased to 0.01 ng/ml. The patient has been in complete remission for 28 months.

Clinical Investigation of Adrenal Incidentalomas in Japanese Patients of the Fukuoka Region with Updated Diagnostic Criteria for Sub-clinical Cushing's Syndrome.

Objectives We retrospectively investigated the clinical and endocrinological characteristics of adrenal incidentalomas. Methods We studied 61 patients who had been diagnosed with adrenal incidentalomas and had undergone detailed clinical and endocrinological evaluations while hospitalized. We used common criteria to diagnose the functional tumors, but for sub-clinical Cushing's syndrome, we used an updated set of diagnosis criteria: serum cortisol ≥1.8 µg/dL after a positive response to a 1-mg dexamethasone suppression test if the patient has a low morning adrenocorticotropic hormone (ACTH) level (<10 pg/mL) and a loss of the diurnal serum cortisol rhythm. Results Of the 61 patients, none (0%) had malignant tumors, 8 (13.1%) had pheochromocytoma, and 15 (24.6%) had primary aldosteronism; when diagnosed by our revised criteria, 13 (21.3%) had cortisol-secreting adenomas (Cushing's syndrome and sub-clinical Cushing's syndrome), and 25 (41.0%) had non-functional tumors. Compared with the non-functional tumor group, the primary aldosteronism group and the cortisol-secreting adenoma group were significantly younger and had significantly higher rates of hypokalemia, whereas the pheochromocytoma group had significantly larger tumors and a significantly lower body mass index. Conclusion Our study found a larger percentage of functional tumors among adrenal incidentalomas than past reports, partly because we used a lower serum cortisol level after a dexamethasone suppression test to diagnose sub-clinical Cushing's syndrome and because all of the patients were hospitalized and could therefore receive more detailed examinations. Young patients with hypokalemia or lean patients with large adrenal tumors warrant particularly careful investigation.