The effect of anterior quadratus lumborum block on morphine consumption in minimally invasive colorectal surgery: a multicentre, double-blind, prospective randomised placebo-controlled trial.

We investigated the efficacy and safety of a bilateral anterior quadratus lumborum block in patients undergoing minimally invasive colorectal surgery. This was a two-centre, double-blind, prospective, randomised, placebo-controlled trial including 150 patients undergoing laparoscopic colorectal surgery (left- or right hemicolectomy, sigmoidectomy) who were enrolled in the institutional abdominal enhanced recovery programme. Before induction of anaesthesia, patients received a bilateral anterior quadratus lumborum block in the left and right lateral decubitus position under ultrasound guidance and were allocated randomly to receive 30 ml of ropivacaine 0.375% (n = 75) or placebo (saline 0.9%) (n = 75) bilaterally. Postoperatively, all patients received multimodal intravenous analgesia including paracetamol, ketorolac and patient-controlled analgesia with morphine. The primary outcome was morphine consumption during the first 24 h after tracheal extubation. Secondary outcomes included severity of pain; presence and extent of sensory block; incidence of postoperative nausea and vomiting; and hospital duration of stay. We also investigated the need for, and dose of, rescue analgesia. Safety outcomes included the incidence of adverse events. Mean (SD) 24-hour morphine consumption was no different between patients allocated to ropivacaine and placebo (28.6 (22.3) mg vs. 28.4 (22.5) mg, p = 0.966, respectively). While a sensory block could be detected in significantly more patients allocated to the ropivacaine group, no differences were detected in pain scores or other secondary or safety endpoints. Patient satisfaction scores were high in both groups. In laparoscopic colorectal surgery, adding a bilateral anterior quadratus lumborum block to a standard multimodal analgesia regimen did not reduce opioid consumption or improve pain scores.

Ultrasound guided femoral nerve block and lateral femoral cutaneous nerve block for postoperative pain control after primary hip arthroplasty: a retrospective study.

PURPOSE: The purpose of this study was to evaluate the use of an ultrasound guided femoral nerve (FN) block together with an ultrasound guided lateral femoral cutaneous nerve (LFCN) block in addition to a patient controlled intravenous analgesia (PCIA) pump with piritramide as a strategy for postoperative pain-management after primary hip arthroplasty. METHODS: In a retrospective study, data recorded from 32 patients undergoing primary hip arthroplasty in 2008, before peripheral blocks were used, were compared with data from 38 patients undergoing primary hip arthroplasty in 2011, when an ultrasound guided single shot FN and LFCN block was used. As primary endpoint the total piritramide consumption after 48 hours was analyzed. A score on a visual analog pain scale at rest and during movement was included as a secondary outcome. RESULTS: Patients receiving the peripheral nerve blocks used significantly less piritramide in comparison to the patients who received no peripheral nerve blocks (p < 0.01). Moreover, pain scores at rest and during movement were significantly lower in the group with the peripheral nerve block (p-values respectively < 0.01 and < 0.05). CONCLUSIONS: This retrospective study indicates that a FN block in combination with a LFCN block as supplementary postoperative analgesia after primary hip arthroplasty, can reduce the piritramide consumption. Furthermore, patients receiving the peripheral nerve block report lower pain scores at rest and during movement compared with the patients who did not receive a peripheral block. However, as this is a retrospective study, conclusions have to be drawn cautiously.

A phase II randomized study of combined infusional leucovorin sodium and 5- FU versus the leucovorin calcium followed by 5-FU both in combination with irinotecan or oxaliplatin in patients with metastatic colorectal cancer.

BACKGROUND: Leucovorin Sodium (LV/Na) has a high solubility, and is stable when given with continuous infusion of 5-FU. It could maintain significant plasma concentration of 5, 10-meTHF during the whole 5-FU perfusion with the potential of increasing 5-FU cytotoxicity. We conducted a randomized phase II clinical trial on leucovorin calcium (LV/Ca) and LV/Na in metastatic colorectal cancer patients (mCRC). Main objectives were to assess efficacy and safety. PATIENTS AND METHODS: Fifty seven patients with mCRC and no previous chemotherapy for metastatic disease were randomized to receive LV/Na or LV/Ca with irinotecan or oxaliplatine combined with infusional 5-FU. LV/Na was defined as warranting further evaluation in phase III if true overall response rate (ORR) > 35% (α=5%, ß=10% in case of true ORR >55%, 51 evaluable patients planned/arm). RESULTS: Results for LV/Ca and LV/Na arm respectively were: observed ORR, 55% (significantly higher than 35%, p = 0.02) and 61% (p = 0.004). Median overall survival durations were 11.9 months and 22.9 months (p = 0.02) and PFS 8.0 vs. 11.5 months (ns). Grade 3 events were 64% and 46% (p = 0.28). CONCLUSION: Both LV/Na and LV/Ca disclosed an ORR > 35% with comparable safety.

Conceptual binding: integrated visual cues reduce processing costs in bimanual movements.

In discrete reaction time (RT) tasks, it has been shown that nonsymmetric bimanual movements are initiated slower than symmetric movements in response to symbolic cues. By contrast, no such RT differences are found in response to direct cues ("direct cue effect"). Here, we report three experiments showing that the direct cue effect generalizes to rhythmical bimanual movements and that RT cost depends on different cue features: 1) symbolic versus direct or 2) integrated (i.e., action of both hands is indicated as one entity) versus dissociated (i.e., action of each hand is indicated separately). Our main finding was that dissociated symbolic cues were most likely processed serially, resulting in the longest RTs, which were substantially reduced with integrated symbolic cues. However, extra RT costs for switching to nonsymmetrical bimanual movements were overcome only when the integrated cues were direct. We conclude that computational resources might have been exceeded when the response needs to be determined for each hand separately, but not when a common response for both hands is selected. This supports the idea that bimanual control benefits from conceptual binding.

Efficacy of the combination of long-acting release octreotide and tamoxifen in patients with advanced hepatocellular carcinoma: a randomised multicentre phase III study.

To assess the efficacy of the combination of long-acting release (LAR) octreotide and tamoxifen (TMX) for the treatment of advanced hepatocellular carcinoma (HCC). A total of 109 patients with advanced HCC were randomised to receive octreotide LAR combined with TMX (n=56) (experimental treatment group) or TMX alone (n=53; control group). The clinical, biological and tumoural parameters were recorded every 3 months until death. Primary end point was patient survival; secondary end points were the impact of therapy on tumour response, quality of life and variceal bleeding episodes. Univariate and multivariate analyses were performed for assessment of specific prognostic factors. The median survival was 3 months (95% CI 1.4-4.6) for the experimental treatment group and 6 months (CI 95% 2-10) for the control group (P=0.609). There was no difference in terms of alpha-foetoprotein (alpha-FP) decrease, tumour regression, improvement of quality of life and prevention of variceal bleeding between the two groups. Variables associated with a better survival in the multivariate analysis were: presence of cirrhosis, alpha-FP level <400 ng ml(-1) and Okuda stage I. The combination of octreotide LAR and TMX does not influence survival, tumour progression or quality of life in patients with advanced HCC.

Skeletal muscle metastasis from a conventional renal cell carcinoma, two years after nephrectomy: a case report.

In this paper, we describe a case of skeletal muscle metastasis from a conventional (clear cell) renal cell carcinoma, two years after nephrectomy. Our first clinical tentative diagnosis was soft tissue tumour, showing the mimicking capacity of renal cell carcinoma. A review of literature shows that skeletal muscle metastases from renal cell carcinoma are extremely rare: only 16 cases have been described. In 5/16, the muscle mass was the initial manifestation of the renal tumour. In the other 11/16, the muscle masses were metachronous (10 months-16 years). We conclude that, when confronted with a patient with a muscle mass and a history of renal cell carcinoma, one should always keep in mind the possibility of a (late) renal cell carcinoma metastasis.

Benign ulcer in a hiatus hernia complicated with a pericardial fistula.

Penetration of the pericardium by upper gastrointestinal lesions is uncommon. It usually results from trauma, perforation of foreign objects, perforation from gastric or thoracic neoplasm or spontaneous perforation. Unfrequently it is a complication of a benign peptic ulcer of the esophagus or the stomach. Survival from peptic ulcers penetrating to the heart is very rare. From a review of the English literature only 11 survivors have been described. We report the successful outcome of a 76 year old lady with a benign ulcus in a hiatus hernia perforating into the pericardium. Diagnosis of the fistula was established after methylene blue swallow. Treatment consisted of early pericardiotomy and drainage followed by surgical correction of the ulcer and fundoplication of the hiatus hernia.