Measuring intra-abdominal pressure using an intravaginal pressure tip balloon catheter: a pilot study

Pre-eclampsie ontstaat mogelijks door een verhoogde intra-abdominale druk (IAP) >12 mmHg, die de veneuze bloedstroom verhindert. IAP meting tijdens de zwangerschap zou verhoogde drukken kunnen detecteren. De standaard IAP meettechniek via de blaas is echter niet geschikt voor ambulant gebruik, o.w.v. benodigde katheterisatie en een risico op urineweginfecties. Intra-vaginale drukmeting (IVP) zou de gouden standaard kunnen vervangen. Deze pilootstudie beoordeelde een intra-vaginale ballonkatheter (IVBC) voor IAP meting in zwangeren. De herhaalbaarheid van IVBC metingen werd onderzocht in 45° half-liggende positie op het einde van de ademhaling. IVP bepaling gebeurde telkens bij verschillende inflatievolumes van de katheter ballon. Nadien werd IVP vergeleken met de gouden standaard (Foley Manometer) door met beide technieken te meten in dezelfde positie, op het einde van de ademhaling. Spearman correlatiecoëfficiënten (SPCCs) werden berekend voor gemiddelden van 2, 3 en 4 IVP metingen, alsook voor intravesicale druk (IAPVes) versus IVP bij verschillende ballonvolumes. SPCC voor herhaalde IVP metingen waren '0.95 voor gemiddelden van '3 metingen. SPCC tussen IAPVes en IVP metingen waren '0.46 bij inflatievolumes '40 ml, en <0.25 vanaf een inflatievolume '60 ml. Overeenkomst tussen beide technieken werd ook geïllustreerd in Bland-Altman plots. Hoewel de IVP meettechniek sterk herhaalbaar is vanaf '3 herhaalde metingen, was correlatie met IAPVes te laag om IVP als een geldig alternatief te beschouwen voor de gouden standaard

Measuring intra-abdominal pressure using an intravaginal pressure tip balloon catheter: a pilot study

Pre-eclampsie ontstaat mogelijks door een verhoogde intra-abdominale druk (IAP) >12 mmHg, die de veneuze bloedstroom verhindert. IAP meting tijdens de zwangerschap zou verhoogde drukken kunnen detecteren. De standaard IAP meettechniek via de blaas is echter niet geschikt voor ambulant gebruik, o.w.v. benodigde katheterisatie en een risico op urineweginfecties. Intra-vaginale drukmeting (IVP) zou de gouden standaard kunnen vervangen. Deze pilootstudie beoordeelde een intra-vaginale ballonkatheter (IVBC) voor IAP meting in zwangeren. De herhaalbaarheid van IVBC metingen werd onderzocht in 45° half-liggende positie op het einde van de ademhaling. IVP bepaling gebeurde telkens bij verschillende inflatievolumes van de katheter ballon. Nadien werd IVP vergeleken met de gouden standaard (Foley Manometer) door met beide technieken te meten in dezelfde positie, op het einde van de ademhaling. Spearman correlatiecoëfficiënten (SPCCs) werden berekend voor gemiddelden van 2, 3 en 4 IVP metingen, alsook voor intravesicale druk (IAPVes) versus IVP bij verschillende ballonvolumes. SPCC voor herhaalde IVP metingen waren '0.95 voor gemiddelden van '3 metingen. SPCC tussen IAPVes en IVP metingen waren '0.46 bij inflatievolumes '40 ml, en <0.25 vanaf een inflatievolume '60 ml. Overeenkomst tussen beide technieken werd ook geïllustreerd in Bland-Altman plots. Hoewel de IVP meettechniek sterk herhaalbaar is vanaf '3 herhaalde metingen, was correlatie met IAPVes te laag om IVP als een geldig alternatief te beschouwen voor de gouden standaard

Is it feasible to measure intra-abdominal pressure using a balloon-tipped rectal catheter? – Results of a pilot study

Abstract Background The gold standard to measure intra-abdominal pressure (IAP) is via intra-vesical measurement via the urinary bladder. However, this technique is restricted in ambulatory settings because of the risk of iatrogenic urinary tract infections. Rectal IAP measurements (IAPrect) may overcome these limitations, but requires validation. This pilot study aims to validate the IAPrect technique against standard intra-vesical IAP measurements (IAPves).Methods IAPrect using an air-filled balloon catheter and IAPves using Foley Manometer Low Volume were measured simultaneously in sedated and ventilated patients. Measurements were performed twice in different positions (supine and 45° elevated head of bed) and with an external abdominal velcro belt. ResultsSixteen patients were included. Seven were not eligible for analysis due to unreliable IAPrect values. IAPrect was significantly higher than IAPves for all positions (p&lt;0.001) and the correlation between IAPves and IAPrect was not significant in any position (p≥0.25, bias 7.2mmHg, LOA -3.5 to 18mmHg). Repeatability of IAPrect was not reliable (r=0.539, p=0.315). For both techniques, measurements with the external abdominal velcro belt were significantly higher compared to those without (p&lt;0.030).ConclusionsIAPrect has important shortcomings making IAP estimation using a rectal catheter unfeasible because the numbers cannot be trusted nor validated.</jats:p

Circulating CCL5 Levels in Patients with Breast Cancer: Is There a Correlation with Lymph Node Metastasis?

CC-chemokine ligand 5 (CCL5) was measured in plasma of 238 patients with breast cancer and in serum of 149 of these patients. Mean circulating CCL5 levels tended to be higher in patients with lymph-node-positive breast cancer, larger tumour sizes, the presence of lymphovascular invasion, and multifocal tumours. Additionally, circulating CCL5 levels were higher in the order of stages III, II, and I.The addition of circulatingCCL5 concentration to known clinicopathological predictors for lymph node involvement did not allow more precise prediction of the lymph node status.These results suggest that CCL5 is a biomarker for tumour load rather than for lymph node involvement.As such, it might be helpful to identify patientswith escape fromimmunosurveillance who will benefit from therapies to restore immune function.status: accepte

Is it feasible to measure intra-abdominal pressure using a balloon-tipped rectal catheter? Results of a validation study

The gold standard to measure intra-abdominal pressure (IAP) is intra-vesical measurement via the urinary bladder. However, this technique is restricted in ambulatory settings because of the risk of iatrogenic urinary tract infections. Rectal IAP measurements (IAP(rect)) may overcome these limitations, but requires validation. This validation study compares the IAP(rect) technique against gold standard intra-vesical IAP measurements (IAP(ves)). IAP(rect) using an air-filled balloon catheter and IAP(ves) using Foley Manometer Low Volume were measured simultaneously in sedated and ventilated patients. Measurements were performed twice in different positions (supine and HOB 45 degrees elevated head of bed) and with an external abdominal pressure belt. Sixteen patients were included. Seven were not eligible for analysis due to unreliable IAP(rect) values. IAP(rect) was significantly higher than IAP(ves) for all body positions (p = 0.25, R-2 < 0.6, Lin's CCC < 0.8, bias - 8.1 mmHg and precision of 5.6 mmHg with large limits of agreement between - 19 to 2.9 mmHg, high percentage error 67.3%, and low concordance 86.2%). Repeatability of IAP(rect) was not reliable (R = 0.539, p = 0.315). For both techniques, measurements with the external abdominal pressure belt were significantly higher compared to those without (p < 0.03). IAP(rect) has important shortcomings making IAP estimation using a rectal catheter unfeasible because the numbers cannot be trusted nor validated.This work is part of a PhD-thesis, which is supported by the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. The authors want to thank Robert Wise, Sharona Vonck, Inneke de Laet, Karen Schoonheydt, Hilde Dits, Salar Tayebi, and Wojciech Dabrowski for their help and advice performing the study and editing and revising this manuscript. Manu Malbrain is professor at the Medical University of Lublin and member of the Executive Committee of the Abdominal Compartment Society, formerly known as the World Society of Abdominal Compartment Syndrome (https:// www.wsacs.org/). He is co-founder, past-president and current treasurer of WSACS. He is co-founder of the International Fluid Academy (IFA). The mission statement of the IFA is to foster education, promote research on fuid management and hemodynamic monitoring, and thereby improve survival of critically ill by bringing together physicians, nurses, and others from throughout the world and from a variety of clinical disciplines. The IFA is integrated within the not-forproft charitable organization iMERiT, International Medical Education and Research Initiative, under Belgian law. The content of the IFA website (http://www.fuidacademy.org) is based on the philosophy of FOAM (Free Open Access Medical education—#FOAMed)

Abstract P4-04-19: Recruitment of tumor associated macrophages in patients with breast cancer is not host dependent but tumor grade dependent

Abstract Background: It has been shown that tumor related inflammation plays a crucial role in breast cancer progression. However, it remains unclear whether the density of immune cells in the tumor micro-environment is determined by tumour or by host characteristics. To answer this question, we measured tumor associated macrophage (TAM) density in 52 patients with a synchronous bilateral breast cancer with different lymph node status on both sites. Materials and methods: TAMs were identified by CD68 and CD163 antibodies. Tumour stromal macrophages were counted using a semi-quantitative method. GradeDescription0no TSMIscanty TSMIIsmall foci of TSMIIIlarge foci of TSMIVdiffuse dense infilatration of TSMTSM = tumor stromal macrophages Macrophage count was scored by two independent pathologists who were blinded from the clinicopathological data during the assessment. To evaluate the relative impact on TAM density exerted by the tumor itself and by the host, we used the likelihood ratio tests for the variance components related to host and tumor in determination of CD68 and CD163 levels. Results: In 60% of the tumors, the scores for CD68 and CD163 of both pathologists were identical resulting in a moderate concordance according to the weighted kappa coefficient te st (0.534; CI 0.418-0.649, p&amp;lt;0.0001). The TAM density strongly correlated with the number of mitosis and secondly with tumor grade. The results for CD68 and CD163 were similar. The association of clinicopathological variables with CD163 are shown. Association of clinicopathological variables with CD163VariableNScore (No(%))p-value0IIIIIIIVHistological subtype0.0883IDC1483 (2%)64 (43%)58 (39%)20 (14%)3 (2%)ILC310 (0%)21 (68%)7 (23%)3 (10%)0 (0%)Mixed80 (0%)0 (0%)7 (88%°1 (13%)0 (0%)Mitosis0.00050-101432 (1%)76 (53%)50 (35%)15 (10%)0 (0%)10-20191 (5%)9 (47%)7 (37%)1 (5%)1 (5%)&amp;gt;20250 (0%)0 (0%)15 (60%)8 (32%)2 (8%)Grade0.0226I450 (0%)22 (49%)19 (42%)4 (9%)0 (0%)II982 (2%)53 (54%)31 (32%)12 (12%)0 (0%)III441 (2%)10 (23%)22 (50%)8 (18%)3 (7%)pT0.23121931 (1%)49 (53%)32 (34%)10 (11%)1 (1%)2711 (1%)27 (38%)30 (42%)11 (15%)2 (3%)3211 (5%)9 (43%)10 (48%)1 (5%)0 (0%)420 (0%)0 (0%)0 (0%)2 (100%)0 (0%)pN0.13760922 (2%)44 (48%)39 (42%)6 (7%)1 (1%)+951 (1%)41 (43%)33 (35%)18 (19%)2 (2%)LVI0.8007No1623 (2%)73 (45%)64 (40%)19 (12%)3 (2%)Yes250 (0%)12 (48%)8 (32%)5 (20%)0 (0%)ER/Negative40 (0%)0 (0%)1 (25%)3 (75%)0 (0%)Positive1793 (2%)83 (46%)70 (39%)20 (11%)3 (2%)PR0.4849Negative250 (0%)10 (40%)10 (40%)5 (20%)0 (0%)Positive1563 (2%)73 (47%)60 (38%)17 (11%)3 (2%)Her-20.0903Negative1663 (2%)79 (47%)62 (37%)20 (12%)3 (2%)Positive80 (0%)0 (0%)6 (75%)2 (25%)0 (0%)Focality0.8170Unifocal11411 (1%)66 (47%)55 (39%)16 (11%)3 (2%)Multifocal462 (4%)19 (41%)17 (37%)8 (17%)0 (0%)Age at diagnosis0.8936&amp;lt;55601 (2%)18 (31%)35 (57%)6 (10%)0 (0%)55-65562 (4%)32 (57%)17 (30%)4 (7%)1 (2%)&amp;gt;65770 (0%)34 (44%)29 (38%)14 (18%)0 (0%) For both CD 68 and CD163, the tumor introduces important clustering or correlation, whereas the host does not introduce any additionale correlation. TAM recruitment is therefore primarily determined by tumor-related characteristics. Citation Format: Ann Smeets, Giuseppe Floris, Kathleen Lambein, Sigrid Hatse, Annouschka Laenen, Ines Nevelsteen, Hans Wildiers, Marie-Rose Christiaens. Recruitment of tumor associated macrophages in patients with breast cancer is not host dependent but tumor grade dependent [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-04-19.</jats:p

Additional Value of PET-CT in Staging of Clinical Stage IIB and III Breast Cancer

To evaluate retrospectively the accuracy of integrated PET/CT, against PET, CT, or conventional staging in breast cancer. Seventy consecutive biopsy proven clinical stage IIB and III breast cancer patients were included. Descriptive statistics of integrated PET/CT for the primary tumor, nodal status and metastasis detection were compared to PET, CT with contrast, and conventional staging (biochemistry, chest X-ray, liver ultrasound, and bone scintigraphy). Sensitivity of PET/CT for primary tumor and nodal status was 97.1% and 62.5%, respectively. Specificity and negative predictive value for nodal status were 100% and 66.6%, respectively. The values for conventional staging for nodal involvement were 100% and 85.7% with a sensitivity of 87.5%. PET/CT showed metastatic disease in seven women despite normal conventional staging. PET/CT is able to visualize most clinical stage IIB and III primary breast cancers. PET/CT is superior to conventional staging for detecting internal mammary chain nodes and metastatic disease, but not for axillary staging. Future studies will have to test whether therapy adjustment based on PET/CT has the potential to improve survival.? 201

Reproducibility of lymphoscintigraphic evaluation of the upper limb

Although reproducibility studies are missing, a lymphoscintigraphic evaluation of the upper limb is often used in routine practice to diagnose lymphedema and in clinical research, for example, to investigate the effect of a physical treatment. Therefore, the aim of the present study was to investigate the reproducibility of the lymphoscintigraphic evaluation of the upper limb.status: publishe

Reproducibility of lymphoscintigraphic evaluation of the upper limb

Background: Although reproducibility studies are missing, a lymphoscintigraphic evaluation of the upper limb is often used in routine practice to diagnose lymphedema and in clinical research, for example, to investigate the effect of a physical treatment. Therefore, the aim of the present study was to investigate the reproducibility of the lymphoscintigraphic evaluation of the upper limb. Methods and Results: In breast cancer patients, 20 lymphoscintigraphic evaluations of the upper limb were performed on two test occasions with an interval of 1 week. 99mTc nanocol was injected subcutaneously in the hand. A standardized protocol was applied. In the early phase, two static images of the injection places were taken and in between dynamic images of both axilla during 40min (15min rest, 15min squeezing a ball, and 15min rest). After a break of 70min, a static image of the injection places and of the axilla was made. At the end, a partial whole body image was acquired. A strong reproducibility was found for the following quantitative variables (ICC 0.75 to 0.85): change of uptake in axilla during the break; change of extraction from hands during the break; and extraction and uptake in the late phase. The other quantitative variables (i.e. extraction form the hands in the early phase, time of arrival, accumulation rate, and uptake in axilla in the early phase) had weak to moderatie reproducibility (ICC 0.07 to 0.70). All qualitative variables (i.e. number of lymph nodes in the axilla, upper arm and elbow/lower arm, gradation of lymph collectors in upper or lower arm and of dermal backflow, and presence of lymph collaterals) had strong to very strong reproducibility (ICC 0.76 to 1.00). Conclusion: A lymphoscintigraphy of the upper limb is a reproducible imaging tool to assess lymph transport quantitatively and qualitatively.SCOPUS: ar.jinfo:eu-repo/semantics/publishe