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المؤلفون: Elizabeth Olek, Kiana Keyvanjah, Jane Liang, Igor Rubets, Blaire Cooke, Alvin Wong, Daniel Di Primeo, Laura Sterling, David Martin
المصدر: Cancer Chemotherapy and Pharmacology. 84:1125-1132
مصطلحات موضوعية: Adult, Male, 0301 basic medicine, Cancer Research, Loperamide, Cmax, Administration, Oral, Pharmacology, Toxicology, Drug Administration Schedule, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pharmacokinetics, Humans, Medicine, Drug Interactions, Tissue Distribution, Pharmacology (medical), Antidiarrheals, Adverse effect, Protein Kinase Inhibitors, Volume of distribution, business.industry, Middle Aged, Drug interaction, Diarrhea, 030104 developmental biology, Oncology, Area Under Curve, 030220 oncology & carcinogenesis, Neratinib, Quinolines, Female, medicine.symptom, business, Half-Life, medicine.drug
الوصف: To evaluate the effects of multiple doses of loperamide on the pharmacokinetics and safety of a single oral dose of neratinib. This was an open-label, two-period, fixed-sequence study. Twenty healthy adult subjects received an oral dose of neratinib 240 mg daily on Days 1–4 of Period 1 followed by a 7-day washout. In Period 2, oral neratinib 240 mg was administered with loperamide 4 mg followed by two further doses of loperamide 2 mg 8 and 16 h later on Days 1–4. Pharmacokinetic sampling was performed for 72 h following each neratinib dose. Safety was monitored throughout the study. A median tmax of ~ 6 h was observed for neratinib during both periods. Apparent clearance and volume of distribution were similar for Periods 1 and 2: mean CLss/F 308.2 and 322.1 L/h; mean Vzτ/F 7995 and 10,318 L, respectively. The half-life of neratinib increased in the presence of loperamide from 18.0 to 22.2 h. Mean exposure was within the same range without and with loperamide administration: Cmax 61.2 ng/mL and 49.5 ng/mL; AUClast 1086 ng h/mL and 1153 ng h/mL, and AUCtau 779 ng h/mL and 745 ng h/mL, respectively. Treatment-emergent adverse events were mainly mild in intensity, with the most frequent events being diarrhea (45%) and constipation (35%). Neratinib administered alone and concomitantly with multiple oral doses of loperamide is generally safe and well tolerated. Loperamide has minimal effects on neratinib pharmacokinetic parameters.
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المؤلفون: David Martin, Gregory L. Falk, Philip A. Le Page, Simon C Gibson, Jennifer Wang, Craig J. Taylor, Himanshu Wadhawan
المصدر: Surgical Endoscopy. 32:2373-2380
مصطلحات موضوعية: Adult, Male, Sleeve gastrectomy, medicine.medical_specialty, Weakness, medicine.medical_treatment, 030209 endocrinology & metabolism, Cohort Studies, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Gastrectomy, Internal medicine, Weight Loss, medicine, Humans, Aged, business.industry, Age Factors, Reflux, Middle Aged, Hepatology, medicine.disease, Dysphagia, humanities, digestive system diseases, Surgery, Hernia, Hiatal, Gastroesophageal Reflux, Quality of Life, GERD, Female, Laparoscopy, 030211 gastroenterology & hepatology, medicine.symptom, business, Follow-Up Studies, Abdominal surgery, Cohort study
الوصف: Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a treatment of choice for morbid obesity and associated comorbidities. There has been a concern about new onset or worsening of gastroesophageal reflux (GERD) following LSG. The objective of the study was to evaluate the effect of surgically treating hiatal weakness on GERD symptoms in patients undergoing LSG. Single tertiary referral institution, Sydney, Australia. A prospective observational cohort study was conducted with consecutive patients undergoing LSG. Hiatal findings, patient demographics, medications and reflux score were recorded prospectively. Patients were followed up post-operatively for a minimum of 12 months and assessed using GERD-HRQL score to quantify reflux symptoms. Data from 100 patients with a minimum of 1-year follow-up were analysed. Mean follow-up was 18.9 months. Overall, GERD-HRQL improved from mean 4.5 ± 5.8 pre-operatively to 0.76 ± 1.5 after 18.9 months (p = 0.0001). For those with pre-operative reflux, GERD-HRQL improved from mean (SD) 8.43 ± 6.26 pre-operatively to 0.94 ± 1.55 (p = 0.0001). All the nine patients with troublesome daily reflux significantly improved. For those without pre-operative reflux, GERD-HRQL improved from 0.88 ± 1.37 to 0.47 ± 1.25 (p-ns) post-operatively. On multivariate analysis, higher pre-operative reflux and dysphagia/bloat scores, younger age and lower percentage excess weight loss after 18.9 months were associated with GERD-HRQL improvement. In the medium term, GERD-HRQL improves following sleeve gastrectomy with meticulous hiatal assessment and repair of hiatal laxity and herniation.
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المؤلفون: Benjamin R. Kivlan, Hal David Martin, RobRoy L. Martin
المصدر: Knee Surgery, Sports Traumatology, Arthroscopy. 25:72-76
مصطلحات موضوعية: Male, medicine.medical_specialty, Ischiofemoral impingement, Femoracetabular Impingement, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Ischium, Cadaver, medicine, Humans, Orthopedics and Sports Medicine, Femur, skin and connective tissue diseases, Aged, Aged, 80 and over, business.industry, 030229 sport sciences, Anatomy, Middle Aged, musculoskeletal system, body regions, Hip rotation, Lesser Trochanter, Orthopedic surgery, Female, Hip Joint, Surgery, sense organs, business, human activities
الوصف: The purpose of this study was to define changes in the ischial-lesser trochanteric space associated with medial and lateral hip rotation in neutral and 10° of extension and adduction.Twenty-five hip joints from 14 embalmed cadavers (7 males and 7 females) were used for this study. The pelvic region of each cadaver was skeletonized, and the hip capsule released distally. With the hip joint in 0° flexion-extension/abduction-adduction, the distance between the lesser trochanter and ischium was measured in: neutral rotation, 40° medial rotation, and 60° lateral rotation. A one-way ANOVA with post hoc analysis determined the difference in the ischiofemoral space in these three positions. An additional position was then tested by laterally rotating the femur with the hip joint positioned in 10° extension and adduction.The average distance between the lesser trochanter and ischium was different (p .0005) in neutral rotation, 40° medial rotation, and 60° lateral rotation at 2.8 cm (SD 1.1), 4.3 cm (SD 1.2), and 1.4 cm (SD 0.7), respectively. With the hip joint laterally rotated from a starting position of 10° extension and adduction, 21 of 25 (84 %) hips made contact between the lesser trochanter and ischium at an average position of 29° (SD 20) of lateral rotation.The lesser trochanter is closest to the ischium in lateral rotation and is furthest away in medial rotation when the hip is in neutral flexion-extension/abduction-adduction. The lesser trochanter approximates the ischium when the hip is laterally rotated in 10° extension and adduction. The information gained through this investigation helps to define the pathomechanics associated with ischiofemoral impingement and validate clinical tests to diagnose ischiofemoral impingement.
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المؤلفون: Sheila Chang Barbarino, David Martin Morrow, Allan Y. Wu
المصدر: Aesthetic Plastic Surgery. 37:205-209
مصطلحات موضوعية: Male, medicine.medical_specialty, Esthetics, medicine.medical_treatment, Cohort Studies, Cicatrix, Blunt dissection, Platysma muscle, medicine, Humans, Local anesthesia, Surgery, Plastic, Aged, Retrospective Studies, Wound Healing, business.industry, Suture Techniques, Anatomy, Middle Aged, Skin Aging, Surgery, Plastic surgery, Platysmaplasty, Otorhinolaryngology, Patient Satisfaction, Liposuction, Female, business, Neck, Rhytidectomy
الوصف: Many patients desire cosmetic improvement of neck laxity when consulting with a plastic surgeon about their face. Neck laxity and loss of the cervicomental angle can be due to multiple components of aging such as skin quality/elasticity, loss of platysma muscle tone, and submental fat accumulation. Traditionally, the procedure of choice for patients with an aging lower face and neck is a cervicofacial rhytidectomy. However, occasionally, a patient wishes to have no other facial surgery than an improvement of their excessive skin of the anterior, lateral, and/or posterior neck. In other instances, a patient may present with having had a face/neck-lifting procedure that left objectionable vertical/diagonal lines at the lateral neck. In both these instances, a surgeon should consider an isolated stork lift (ISL) procedure. An ISL procedure avoids and/or corrects problematic vertical/diagonal lateral neck folds by “walking” the excess skin flaps around the posterior inferior occipital hairline bilaterally, bringing the flaps together at the lateral and posterior neck, which sometimes involves a midline posterior dart excision of the dog ear. A patient presenting with excessive skin of the neck (anterior, lateral, and/or posterior) and/or residual vertical/diagonal skin folds is an excellent candidate for the ISL. The ISL procedure was performed on 273 patients over a 2-year period at The Morrow Institute. Patients were included if they had excessive skin of the anterior, lateral, and/or posterior neck and/or diagonal/vertical lateral bands and did not desire a full face-lifting procedure. Patients were excluded from this study if they would not accept having longer hair in order to cover the scar along the posterior inferior occipital hairline or a midline T-flap skin closure scar at the base of the posterior midline neck. Under a combination of local anesthesia and IV sedation, a postauricular face-lift incision was made that was extended in a circumoccipital fashion along the mastoid and posterior hairline to the midline nape of the neck. Long skin flaps were developed by dissecting the anterior neck from the mentum to the anterior clavicles, the lateral neck from the mastoid to the lateral clavicles, and the posterior neck from the hairline to the base of the nape of the neck, all with a combination of sharp and blunt dissection. Suspension sutures of the SMAS were placed at various strategic locations along the lateral neck in a superior posterior vector. The dog ears were walked posteriorly around the hairline, with final trimming at the midline nape using an A-to-T flap closure. The skin closure was affected by a combination of deep and superficial sutures as well as staples. No drains were used on any of the cases. Of the 273 patients (59 males and 214 females) who had the ISL, 240 rated their satisfaction with the results as very high, 21 rated it as high, and 12 rated it as some what satisfied. The average age of the patients was 58.7 years (range = 45–79 years). There were two patients who needed a minimal amount of submental liposuction after the procedure. No patients had vertical/diagonal skin folds after this procedure. Five patients reported being slightly bothered by the appearance of the midline posterior scar for the first 6 months. Three of these cases involved hypertrophic scarring and were treated with intralesional triamcinolone suspension 40 mg per cc dilution; doses ranged from 20 to 40 mg per session and no more than two sessions were required. All five cases rated their scar appearance after 6 months to be acceptable. All of the remaining 268 patients reported that the final posterior scar was virtually undetectable. Ten patients needed scar revision for secondary widening of the scar at various locations of the lateral, posterior, and or nape of the neck. There were no other significant complications. Most patients were satisfied with their cosmetic result 2 years after their operation. An ISL procedure provides excellent lifting of the anterior, lateral, and posterior neck without the resulting postoperative sequelae of vertical/diagonal lines, and it is especially indicated for the patient who has markedly excessive skin in those areas and does not want to undergo a lower face-lift procedure at the same time. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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المؤلفون: Charbel Sandroussi, Phyllis Butow, Michael J. Solomon, James D. Harrison, Jane M. Young, David Martin, Joanne Shaw
المصدر: Supportive Care in Cancer. 21:749-756
مصطلحات موضوعية: Male, Health Knowledge, Attitudes, Practice, medicine.medical_specialty, Coping (psychology), Time Factors, Pain medicine, MEDLINE, Upper gastrointestinal cancer, Health Services Accessibility, Social support, Adaptation, Psychological, Humans, Medicine, Longitudinal Studies, Psychiatry, Gastrointestinal Neoplasms, Health Services Needs and Demand, Family caregivers, business.industry, Data Collection, Nursing research, Social Support, Middle Aged, Prognosis, Caregivers, Oncology, Family medicine, Female, business, human activities, Stress, Psychological, Qualitative research
الوصف: Family caregivers of patients with poor prognosis upper gastrointestinal (GI) cancers are at high risk of experiencing psychological distress and carer burden. The early postoperative period is a time of high patient care needs and transition of care, with carers new to the caring role. This study aimed to explore the experiences of family caregivers of people diagnosed with upper GI cancer after surgical intervention to (1) identify their unmet supportive care needs and (2) investigate how family caregivers perceive their role during this time.Family caregivers of newly diagnosed postsurgical upper GI cancer patients were recruited. Semi-structured telephone interviews were conducted at 3 weeks and 3 months post-surgery. Analysis involved a constant comparative approach. Sampling was discontinued when information redundancy was achieved. Fifteen family caregivers participated in the first interview and eight agreed to a second interview.Family caregivers reported significant information and support needs. Family caregiver distress was exacerbated by a lack of patient care knowledge. Access to support was limited by caregivers' lack of understanding of the health system. Family caregivers view their role as part of their family responsibility.This study provides new insight into the supportive care needs of family caregivers of upper GI cancer patients and the impact of unmet need on the emotional well-being of family caregivers. These results will inform future supportive care service development and intervention research aimed at reducing unmet supportive care needs and psychological distress of family caregivers of patients with poor prognosis upper GI cancer.
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المؤلفون: Andrew Jin, J. David Martin
المصدر: Canadian Journal of Public Health. 94:176-179
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Adolescent, Population, Sewage, Water supply, Article, Risk Factors, Environmental health, Epidemiology, medicine, Humans, Child, education, Aged, Aged, 80 and over, education.field_of_study, British Columbia, Poverty, business.industry, Incidence, Incidence (epidemiology), Public health, Infant, Newborn, Public Health, Environmental and Occupational Health, Infant, Hepatitis A, General Medicine, Middle Aged, medicine.disease, Geography, Inuit, Child, Preschool, Female, business
الوصف: Background: Hepatitis A spreads by the fecal-oral route. We hypothesize that it is more common in Aboriginal communities because of poverty, crowded housing and inadequate or substandard water and sewage systems. Methods: We tabulated on-reserve cases reported to First Nations and Inuit Health Branch, Health Canada. We obtained information on community water supply, sewage disposal and mean population per housing unit, from site inspections in a 1994 survey. Results: Crude incidence on-reserve was 31 per 100,000 persons per year (95% CI: 25 to 37), twice as high as in the general population of BC (15.1 per 100,000). Higher incidence of hepatitis A was associated with more persons per housing unit and with presence of community water supply problems. Conclusions: An ecologic, multi-factorial approach to disease prevention is needed, including upgrading housing and sanitary infrastructure, specific measures (i.e., hepatitis A vaccination) and general measures (e.g., education, poverty reduction, population planning).
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