Lionel A. Mandell, Richard G. Wunderink, Antonio Anzueto, John G. Bartlett, G. Douglas Campbell, Nathan C. Dean, Scott F. Dowell, Thomas M. File, Jr. Daniel M. Musher, Michael S. Niederman, Antonio Torres, and Cynthia G. Whitney McMaster University Medical School, Hamilton, Ontario, Canada; Northwestern University Feinberg School of Medicine, Chicago, Illinois; University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, and Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas; Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi School of Medicine, Jackson; Division of Pulmonary and Critical Care Medicine, LDS Hospital, and University of Utah, Salt Lake City, Utah; Centers for Disease Control and Prevention, Atlanta, Georgia; Northeastern Ohio Universities College of Medicine, Rootstown, and Summa Health System, Akron, Ohio; State University of New York at Stony Brook, Stony Brook, and Department of Medicine, Winthrop University Hospital, Mineola, New York; and Cap de Servei de Pneumologia i Allergia Respiratoria, Institut Clinic del Torax, Hospital Clinic de Barcelona, Facultat de Medicina, Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer, CIBER CB06/06/0028, Barcelona, Spain.

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Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults

Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.Methods: A multidisciplinary panel conducted pra...

/pdf/diagnosis-and-treatment-of-adults-with-community-acquired-4u8h6pikis.pdf

Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

BACKGROUND

Peritoneal carcinomatosis (PC) is a common evolution of digestive cancer, associated with a poor prognosis Yet it is poorly documented in the literature



METHODS

Three hundred seventy patients with PC from non-gynecologic malignancies were followed prospectively: the PC was of gastric origin in 125 cases, of colorectal origin in 118 cases, of pancreatic origin in 58 cases, of unknown origin in 43 cases, and of miscellaneous origins in 26 cases A previously reported PC staging system was used to classify these 370 patients



RESULTS

Mean and median overall survival periods were 60 and 31 months, respectively Survival rates were mainly affected by the initial PC stage (98 months for Stage I with malignant peritoneal granulations less than 5 mm in greatest dimension, versus 37 months for Stage IV with large, malignant peritoneal masses more than 2 cm in greatest dimension) The presence of ascites was associated with poor survival of patients with gastric or pancreatic carcinoma Differentiation of the primary tumor did not influence the prognoses of patients with PC



CONCLUSIONS

A better knowledge of the natural history of PC is needed, in view of the many Phase I, II, and III trials currently being conducted to evaluate aggressive multimodal therapeutic approaches to treating patients with PC from non-gynecologic malignancies Cancer 2000;88:358–63 © 2000 American Cancer Society

Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study.

Guidelines for the management of adult lower respiratory tract infections (LRTIs) were first published by a Task Force of the European Respiratory Society (ERS) in 1998 [1]. In 2005, a completely revised version was produced, this time by a joint Task Force of the ERS and the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) [2]. They used up-to-date methodology for guideline development, including a transparent and objective systematic literature search strategy, and evidence and recommendation grading [2]. Now, 6 yrs later, a joint Task Force of the two Societies, using the same methodology as in 2005, has produced a further update of these guidelines incorporating publications through to May 2010. The Task Force included an epidemiologist with expertise in guideline methodology and experts in the specialty areas relevant to LRTI management, including general practice, microbiology, infectious diseases, respiratory medicine, intensive care and public health.

A short version of the guidelines containing only the recommendations has now been published in Clinical Microbiology and Infection [3], with more detailed versions available on each Society’s website. The guidelines cover the breadth of adult community-acquired respiratory infection, including prevention (both vaccine- and nonvaccine-related), infections in the community and infections in those admitted to hospital, including pneumonia, exacerbations of chronic obstructive pulmonary disease (COPD) and exacerbations of bronchiectasis. The …

https://erj.ersjournals.com/content/erj/26/6/1138.full.pdf

Guidelines for the management of adult lower respiratory tract infections

Rationale: In patients with community-acquired pneumonia, guidelines recommend antibiotic treatment for 7 to 21 d. Procalcitonin is elevated in bacterial infections, and its dynamics have prognostic implications.Objective: To assess procalcitonin guidance for the initiation and duration of antibiotic therapy in community-acquired pneumonia.Methods: In a randomized intervention trial, 302 consecutive patients with suspected community-acquired pneumonia were included. Data were assessed at baseline, after 4, 6, and 8 d, and after 6 wk.The control group (n = 151) received antibiotics according to usual practice. In the procalcitonin group (n = 151), antibiotic treatment was based on serum procalcitonin concentrations as follows: strongly discouraged, less than 0.1 μg/L; discouraged, less than 0.25 μg/L; encouraged, greater than 0.25 μg/L; strongly encouraged, greater than 0.5 μg/L. The primary endpoint was antibiotic use; secondary endpoints were measures of clinical, laboratory, and radiographic outcome.Res...

https://www.atsjournals.org/doi/pdf/10.1164/rccm.200512-1922OC

Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial.

BACKGROUND: The Pneumonia Severity Index (PSI) has been advocated as an objective measure of risk stratification to help determine the initial site of treatment for patients with community-acquired pneumonia. OBJECTIVE: To determine whether outpatient care of PSI-defined low-risk patients with community-acquired pneumonia is as safe and effective as hospitalization. DESIGN: Unblinded, randomized, controlled trial. SETTING: 2 tertiary care hospitals. PATIENTS: 224 immunocompetent adults in risk class II or III (PSI scores <or=90 points) who received a diagnosis of community-acquired pneumonia in the emergency department and had no extenuating circumstances. INTERVENTION: Outpatient care with oral levofloxacin therapy or hospitalization with sequential intravenous and oral levofloxacin therapy. MEASUREMENTS: The primary end point was the percentage of patients with an overall successful outcome at the end of treatment, according to 7 predefined criteria. Secondary end points included patients' quality of life and satisfaction. RESULTS: Overall successful outcome was achieved in 83.6% of outpatients and 80.7% of hospitalized patients (absolute difference, 2.9 percentage points [95% CI, -7.1 to 12.9 percentage points]). More outpatients were satisfied with their overall care (91.2% vs. 79.1%; absolute difference, 12.1 percentage points [CI, 1.8 to 22.5 percentage points]). Quality of life and the percentages of patients with adverse drug reactions (9.1% vs. 9.6%), medical complications (0.9% vs. 2.6%), subsequent hospital admissions (6.3% vs. 7.0%), and overall mortality (0.9% vs. 0%) were similar in the outpatient and hospitalization groups. LIMITATIONS: The power to detect a serious complication, such as death, was limited given the relatively small sample size. CONCLUSIONS: In selected patients who had community-acquired pneumonia, PSI risk class II and III, and were treated with levofloxacin, outpatient care in the absence of respiratory failure, unstable comorbid conditions, complicated pleural effusions, and social problems was as safe and effective as hospitalization and provided greater patient satisfaction.

Outpatient care compared with hospitalization for community-acquired pneumonia: a randomized trial in low-risk patients.

Randomised trial of endoscopic sphincterotomy with gallbladder left in situ versus open surgery for common bileduct calculi in high-risk patients

After the explosive success of laparoscopic cholecystectomy, great interest has been shown in the laparoscopic treatment of digestive malignancies. Laparoscopy has been proposed for diagnosis and staging, and as a technical option aiming to cure or palliate. But this optimism has been tempered by the doubt about the potential disseminatory role of laparoscopy after the observation of a large number of port site seeding tumors. Since the first laparoscopic cholecystectomy, more than 100 port site metastases have been reported, without a clear explanation for these findings. Port site recurrences have been observed after gynaecologic procedures, laparoscopic cholecystectomy in which an unsuspected gallbladder cancer was found and after laparoscopic operations indicated for oncological treatment of digestive tumors, mainly colorectal cancer. Other cases have been reported after thoracoscopic resection of oesophageal cancer or urologic cancer, even after staging laparoscopy associated with sampling. Possible mechanisms for port site cell implantation are direct implantation in the wound during unprotected and forced tissue retrieval or by contaminated instruments during tumor dissection, the effect of gas turbulence in long laparoscopic procedures and embolization of exfoliated cells during tumor dissection or hematogenous dissemination. Probably, a multifactorial mechanism may be responsible, in which the key factors could be a long operative procedure, the high pressure pneumoperitoneum, tumoral manipulation during dissection and forced extraction of unprotected specimens. Prophylactic measures proposed to avoid this disastrous complication are the use of protective bags for tissue retrieval, peritoneal lavage with heparin in order to avoid adhesion of free cells, or lavage with cytocidal solutions.

Port site metastasis. An unresolved problem in laparoscopic surgery : A review

The aim of this paper is to present the practical control structure (PCS) and energy management strategy of a testbed hybrid electric vehicle (HEV). This vehicle is equipped with batteries, a supercapacitor system, and a fuel cell system (FCS). The PCS, based on the energetic macroscopic representation methodology, is used to evaluate and compare the different energy management strategies to be implemented in the vehicle. This paper introduces a dynamic strategy to manage the energy in the hybrid electric vehicle; this strategy uses a fuzzy logic controller and considers the slow dynamics in the FCS, the vehicle speed, and the state of charge in the supercapacitors.

Practical Control Structure and Energy Management of a Testbed Hybrid Electric Vehicle

n = 11) or laparotomy (group 2, n = 12). A Medline review of all experimental studies about the risk of cancer dissemination during laparoscopic surgery was undertaken. Both models were associated with implants in parietal wounds [1/11 in group 1 (9%) vs. 1/12 in group 2 (8%), p
 = NS]. Analysis of the current literature confirms that laparoscopy is associated with abdominal cell mobilization, and cells can be recovered in trocars, filtered exhaust gas, and instruments. Postoperative immunosuppression, the biologic aggressiveness of the tumor, and the gas used for laparoscopy also influence tumoral growth. Port-site metastases are secondary to multiple factors, including the technical skill of the surgeon, the biologic properties of the tumors, and local environmental aspects. Undoubtedly, laparoscopy can help disseminate aggressive tumors and should be reserved for diagnostic and staging procedures or for treatment of low-grade malignant tumors. Therapeutic resection, especially of colon cancer, should be restricted to prospective and randomized trials until there are enough hard data to rule out the clinical importance of this potentially severe complication.

Joaquín Martínez

Papers

Outpatient care compared with hospitalization for community-acquired pneumonia: a randomized trial in low-risk patients.

Randomised trial of endoscopic sphincterotomy with gallbladder left in situ versus open surgery for common bileduct calculi in high-risk patients

Port site metastasis. An unresolved problem in laparoscopic surgery : A review

Practical Control Structure and Energy Management of a Testbed Hybrid Electric Vehicle

Cancer dissemination during laparoscopic surgery: tubes, gas, and cells.