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Cutaneous melanoma is a disorganized and uncontrolled growth of melanocytes located in the epidermis. Melanomas can originate from existing pigmented lesions such as nevi or from ¨de novo¨ lesions. There are different predisposing factors for cutaneous melanoma, but the most important is the exposure to ultraviolet radiation. The diagnosis of cutaneous melanoma is always made with a biopsy of the suspicious lesion. The staging of melanoma skin cancer is complex and depends on many factors of the lesion reported by the pathologist after the biopsy. There are different therapeutic options for patients diagnosed with cutaneous melanoma, even for patients in advanced stages, in whom previously only benefited from palliative treatment., El melanoma cutáneo es un crecimiento desorganizado y no controlado de los melanocitos localizados en la epidermis. Los melanomas se pueden originar de lesiones pigmentadas existentes como los nevus o de lesiones de novo. Existen diferentes factores predisponentes para padecer de melanoma cutáneo, pero el más importante es la exposición a la radiación ultravioleta. El diagnóstico del melanoma cutáneo se realiza siempre con una biopsia de la lesión sospechosa. El estadiaje del cáncer de piel de tipo melanoma es complejo y depende de muchos factores de la lesión reportada por el patólogo posterior a la biopsia. Existen diferentes opciones terapéuticas para pacientes con diagnóstico de melanoma cutáneo, incluso para pacientes en estadios avanzados, en los cuales anteriormente únicamente se beneficiaban de tratamiento paliativo.

BACKGROUND: Tumor Treating Fields (TTFields) is a non-invasive modality for cancer treatment that utilizes a specific sinusoidal electric field ranging from 100 kHz to 300 kHz, with an intensity of 1 V/cm to 3 V/cm. Its purpose is to inhibit cancer cell proliferation and induce cell death. Despite promising outcomes from clinical trials, TTFields have received FDA approval for the treatment of glioblastoma multiforme (GBM) and malignant pleural mesothelioma (MPM). Nevertheless, global acceptance of TTFields remains limited. To enhance its clinical application in other types of cancer and gain a better understanding of its mechanisms of action, this review aims to summarize the current research status by examining existing literature on TTFields clinical trials and mechanism studies. CONCLUSIONS: Through this comprehensive review, we seek to stimulate novel ideas and provide physicians, patients, and researchers with a better comprehension of the development of TTFields and its potential applications in cancer treatment.

PURPOSE: Gastrointestinal stromal tumor (GIST) is associated with increased risk of additional cancers. In this study, synchronous GIST, and peritoneal mesothelioma (PM) were characterized to evaluate the relationship between these two cancers. METHODS: A retrospective chart review was conducted for patients diagnosed with both GIST and PM between July 2010 and June 2021. Patient demographics, past tumor history, intraoperative reports, cross-sectional imaging, peritoneal cancer index (PCI) scoring, somatic next-generation sequencing (NGS) analysis, and histology were reviewed. RESULTS: Of 137 patients who underwent primary GIST resection from July 2010 to June 2021, 8 (5.8%) were found to have synchronous PM, and 4 patients (50%) had additional cancers and/or benign tumors. Five (62.5%) were male, and the median age at GIST diagnosis was 57 years (range: 45-76). Seventy-five percent of GISTs originated from the stomach. Of the eight patients, one patient had synchronous malignant mesothelioma (MM), and the remaining had well-differentiated papillary mesothelioma (WDPM), which were primarily located in the region of the primary GIST (89%). The median PCI score was 2 in the WDPM patients. NGS of GIST revealed oncogenic KIT exon 11 (62.5%), PDGFRA D842V (25%), or SDH (12.5%) mutations, while NGS of the MM revealed BAP1 and PBRM1 alterations. CONCLUSIONS: One in 17 GIST patients undergoing resection in this series have PM, which is significantly higher than expected if these two diseases were considered as independent events. Our results indicate that synchronous co-occurrence of GIST and PM is an underrecognized finding, suggesting a possible relationship that deserves further investigation.

Objective: To analyze the prevention of arterial hypertension risk factors in street vendors of the 11 de abril association in the city of Tulcán. Method: Descriptive observational study. Results: 70% of the population has not received educational information on arterial hypertension, this being one of the main factors of misinformation. Conclusion: Because of their work and the lack of information about this disease, street vendors have adopted habits that are detrimental to their quality of life. In some cases, the lack of information about the disease, the lack of physical activity, smoking and alcoholism, advanced age, sex, obesity and overweight, and inadequate lifestyle, cause serious problems that lead to the acquisition of this disease or, in some cases, its complications., Objetivo: Analizar la prevención sobre factores de riesgo de la hipertensión arterial en los vendedores ambulantes de la asociación 11 de abril de la ciudad de Tulcán. Método: Descriptivo observacional. Resultados: El 70% de la población no ha recibido información de carácter educativo de la hipertensión arterial, siendo este uno de los principales factores de desinformación. Conclusión: Los vendedores ambulantes por su trabajo y por la desinformación de dicha enfermedad han tomado hábitos que perjudican su calidad de vida en algunos casos la falta de información sobre la enfermedad, la falta de actividad física, el tabaquismo y alcoholismo, la edad avanzada, sexo, obesidad y el sobrepeso, y el inadecuado estilo de vida, causan problemas de gravedad lo cual conlleva adquirir esta enfermedad o en algunos casos las complicaciones.

Background Endoscopic full-thickness resection (EFTR) has been shown to be a feasible and safe technique in several studies since the introduction of the full-thickness resection device (FTRD(R)). This study aimed to describe our clinical experience and long-term follow up in in patients who underwent EFTR of benign and malignant colon lesions using FTRD. Methods All patients with difficult adenomas or early adenocarcinomas referred for an EFTR to two centres in Denmark were included in this prospective consecutive study. The primary outcome was technical success with R0 resection and relapse-free follow up. The secondary outcome was procedure-related adverse events. Results Twenty-six patients were enrolled in the study. Technical success was achieved in 81% patients and R0 resection rate was 86%. Full-thickness resection was achieved in 86% patients. In 13 patients with malignant lesions, we obtained follow-up in 10 cases (two patients underwent surgery and one was non-compliant). Findings of the three-month follow up showed no residual tumour in all 10 cases. At the 12-month follow up, one patient had a late relapse. There were no residual or recurrent adenomas in the benign subgroup. Overall, adverse events were observed in 11.5% (3/26) patients with a perforation rate of 7.7%. Conclusion EFTR with FTRD proves to be an additional technique for the treatment of difficult non-lifting colorectal lesions. For malignant lesions, EFTR is technically safe and feasible and can potentially treat small early low-risk tumours; however, some cases may require subsequent surgery according to the histological staging observed in the resected specimen.

A collision tumor is a neoplastic lesion comprised of two or more tumors consisting of distinct cell populations in the concurrent location. Multiple skin neoplasms at one site (MUSK IN A NEST) is a term recently coined to describe two or more cutaneous benign or malignant tumors occurring at the same anatomic site. In retrospective studies, seborrheic keratosis and cutaneous amyloidosis have both individually been documented as a component of a MUSK IN A NEST. This report describes a 42-year-old woman who presented with a pruritic skin condition on her arms and legs of 13 years' duration. Skin biopsy results showed epidermal hyperplasia with hyperkeratosis, hyperpigmentation of the basal layer with mild acanthosis, and evidence of amyloid deposition in the papillary dermis. Based on the clinical presentation and pathology findings, a concurrent diagnosis of macular seborrheic keratosis and lichen amyloidosis was established. A MUSK IN A NEST consisting of a macular seborrheic keratosis and lichen amyloidosis is likely a more common occurrence than implied by the paucity of published cases of this phenomenon.

Introduction: Malignant pleural effusions (MPEs) are common. MPE causes significant breathlessness and impairs quality of life. Indwelling pleural catheters (IPC) allow ambulatory drainage and reduce hospital days and re-intervention rates when compared to standard talc slurry pleurodesis. Daily drainage accelerates pleurodesis, and talc instillation via the IPC has been proven feasible and safe. Surgical pleurodesis via video-assisted thoracoscopic surgery (VATS) is considered a one-off intervention for MPE and is often recommended to patients who are fit for surgery. The AMPLE-3 trial is the first randomised trial to compare IPC (±talc pleurodesis) and VATS pleurodesis in those who are fit for surgery. Methods and analysis: A multi-centre, open-labelled randomised trial of patients with symptomatic MPE, expected survival of ≥ 6 months and good performance status randomised 1:1 to either IPC or VATS pleurodesis. Participant randomisation will be minimised for (i) cancer type (mesothelioma vs non-mesothelioma); (ii) previous pleurodesis (vs not); and (iii) trapped lung, if known (vs not). Primary outcome is the need for further ipsilateral pleural interventions over 12 months or until death, if sooner. Secondary outcomes include days in hospital, quality of life (QoL) measures, physical activity levels, safety profile, health economics, adverse events, and survival. The trial will recruit 158 participants who will be followed up for 12 months. Ethics and dissemination: Sir Charles Gairdner and Osborne Park Health Care Group (HREC) has approved the study (reference: RGS356). Results will be published in peer-reviewed journals and presented at scientific meetings. Discussion: Both IPC and VATS are commonly used procedures for MPE. The AMPLE-3 trial will provide data to help define the merits and shortcomings of these procedures and inform future clinical care algorithms. Trial registration: Australia New Zealand Clinical Trial Registry ACTRN12618001013257. Registered

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

Background Endoscopic full-thickness resection (EFTR) has been shown to be a feasible and safe technique in several studies since the introduction of the full-thickness resection device (FTRD(R)). This study aimed to describe our clinical experience and long-term follow up in in patients who underwent EFTR of benign and malignant colon lesions using FTRD. Methods All patients with difficult adenomas or early adenocarcinomas referred for an EFTR to two centres in Denmark were included in this prospective consecutive study. The primary outcome was technical success with R0 resection and relapse-free follow up. The secondary outcome was procedure-related adverse events. Results Twenty-six patients were enrolled in the study. Technical success was achieved in 81% patients and R0 resection rate was 86%. Full-thickness resection was achieved in 86% patients. In 13 patients with malignant lesions, we obtained follow-up in 10 cases (two patients underwent surgery and one was non-compliant). Findings of the three-month follow up showed no residual tumour in all 10 cases. At the 12-month follow up, one patient had a late relapse. There were no residual or recurrent adenomas in the benign subgroup. Overall, adverse events were observed in 11.5% (3/26) patients with a perforation rate of 7.7%. Conclusion EFTR with FTRD proves to be an additional technique for the treatment of difficult non-lifting colorectal lesions. For malignant lesions, EFTR is technically safe and feasible and can potentially treat small early low-risk tumours; however, some cases may require subsequent surgery according to the histological staging observed in the resected specimen.

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

Introduction: Malignant pleural effusions (MPEs) are common. MPE causes significant breathlessness and impairs quality of life. Indwelling pleural catheters (IPC) allow ambulatory drainage and reduce hospital days and re-intervention rates when compared to standard talc slurry pleurodesis. Daily drainage accelerates pleurodesis, and talc instillation via the IPC has been proven feasible and safe. Surgical pleurodesis via video-assisted thoracoscopic surgery (VATS) is considered a one-off intervention for MPE and is often recommended to patients who are fit for surgery. The AMPLE-3 trial is the first randomised trial to compare IPC (±talc pleurodesis) and VATS pleurodesis in those who are fit for surgery. Methods and analysis: A multi-centre, open-labelled randomised trial of patients with symptomatic MPE, expected survival of ≥ 6 months and good performance status randomised 1:1 to either IPC or VATS pleurodesis. Participant randomisation will be minimised for (i) cancer type (mesothelioma vs non-mesothelioma); (ii) previous pleurodesis (vs not); and (iii) trapped lung, if known (vs not). Primary outcome is the need for further ipsilateral pleural interventions over 12 months or until death, if sooner. Secondary outcomes include days in hospital, quality of life (QoL) measures, physical activity levels, safety profile, health economics, adverse events, and survival. The trial will recruit 158 participants who will be followed up for 12 months. Ethics and dissemination: Sir Charles Gairdner and Osborne Park Health Care Group (HREC) has approved the study (reference: RGS356). Results will be published in peer-reviewed journals and presented at scientific meetings. Discussion: Both IPC and VATS are commonly used procedures for MPE. The AMPLE-3 trial will provide data to help define the merits and shortcomings of these procedures and inform future clinical care algorithms. Trial registration: Australia New Zealand Clinical Trial Registry ACTRN12618001013257. Registered

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

For humans, control of body temperature is vital. One of its alterations is hyperthermia. Malignant Hyperthermia (MH) is a critical event in the area of anesthesia, which, although infrequent, is potentially fatal. Malignant hyperthermia is a dangerous elevation in body temperature, usually as a result of a hypermetabolic response to the concomitant use of a depolarizing muscle relaxant and a potent, volatile inhalational anesthetic. The objective of this study is to capture what is related to the diagnosis and treatment of Malignant Hyperthermia. Consequently, it has been decided to develop a bibliographic design study, through a review methodology. The results highlight the importance of performing the differential diagnosis. Likewise, the diagnosis must be based on clinical suspicion and early recognition, which are essential to start treatment as soon as possible. The treatment basically includes the suspension of the administration of the triggering agents and ventilating the patient with 100% O2, waiting for a decrease in expired CO2. An attempt should be made to complete the surgical act as soon as possible. The specific drug to treat crises is dantrolene sodium. It is concluded that MH is a critical event in anesthesia, which, although it is not frequent, is potentially fatal, therefore its study is of great importance to minimize its morbidity and mortality. The diagnosis of MH is not easy, it must be based on clinical evaluation, the search for complications and susceptibility for people at high risk. The administration of dantrolene, rapid body cooling of the patient, as well as their transfer to the intensive care unit, proper monitoring of their evolution and attention to any of their complications, are some of the basic steps in the treatment of this dangerous entity., Para los seres humanos el control de la temperatura corporal es vital. Una de sus alteraciones es la hipertermia. La Hipertermia Maligna (HM) es un evento crítico en el área de anestesia, que aunque infrecuente resulta potencialmente mortal. La hipertermia maligna es una elevación peligrosa de la temperatura corporal, por lo general como resultado de una respuesta hipermetabólica al uso concomitante de un relajante muscular despolarizante y un potente anestésico inhalatorio y volátil. El objetivo del presente estudio plasmar lo relacionado con el diagnóstico y tratamiento de la Hipertermia Maligna. En consecuencia, se ha decidido desarrollar un estudio de diseño bibliográfico, mediante una metodología de revisión. En los resultados se destaca la importancia de realizar el diagnóstico diferencial. Asimismo, el diagnóstico debe fundarse en la sospecha clínica y el reconocimiento precoz, los cuales resultan fundamentales para iniciar el tratamiento a la mayor brevedad posible. El tratamiento básicamente incluye la suspensión de la administración de los agentes desencadenantes y ventilar al paciente con O2 al 100%, esperando una disminución del CO2 espirado. Se debe intentar finalizar el acto quirúrgico lo antes posible. El fármaco específico para tratar las crisis es el Dantroleno sódico. Se concluye que la HM es un evento crítico en anestesia, que si bien no es frecuente es potencialmente mortal, por tanto su estudio es de gran importancia para minimizar su morbimortalidad. El diagnóstico de la HM no es sencillo, debe estar fundamentado en la evaluación clínica, la búsqueda de complicaciones y la susceptibilidad para personas de alto riesgo. La administración de dantroleno, el enfriamiento corporal rápido del paciente, así como su traslado a la unidad de cuidados intensivos, un debido seguimiento de su evolución y la atención de cualquiera de sus complicaciones, son algunos de los pasos básicos del tratamiento de esta peligrosa entidad.

Breast cancer is a major health issue that affects women all over the world recording about 23% of all malignancies. The disease was the leading cause of female mortality in developed countries, second in the world, and third in developing countries, amounting to 14% of cancer fatality. Data mining is an excellent tool in data science that allows practical scenarios to be analysed using various techniques. In the field of medicine, analysing records with large data become a herculean task and time pressing issue. Thus, the most challenging aspect in this area is not just to identify that a breast tumor is benign or malignant but also knowing the stage of the disease as early as possible, this will help in treatment and prognosis of the disease. In this field, several research studies are now underway. As a result, a careful examination of completed and unfinished research is required in order to open up a new study horizon. Hence, the goal of the study is to provide an in-depth review of data mining application in health care, with focus on breast cancer.

Objective: To evaluate a strategy for the prevention of cerebrovascular disease (CVD) in patients with arterial hypertension belonging to the city of Riobamba. Methodology: A descriptive, cross-sectional study was carried out with a universe of 48 people diagnosed with arterial hypertension. Results: They determined that there are differences between blood pressure values and cholesterol and triglyceride levels, obtaining a value of p ˂ 0.001. In conclusion: Patients who were administered statins decreased lipid levels (cholesterol and triglycerides), for this reason it is suggested to carry out more studies on the use of statins that are currently underused, since their use helps primary and secondary prevention of ECV., Objetivo: Evaluar una estrategia para la prevención de la enfermedad cerebro vascular (ECV) en pacientes con hipertensión arterial pertenecientes a la ciudad de Riobamba. Metodología: Se realizó un estudio descriptivo, transversal con un universo de 48 personas diagnosticadas con hipertensión arterial. Resultados: Determinaron que existen diferencias entre los valores de tensión arterial y los niveles de colesterol y triglicéridos, obteniéndose un valor de p ˂ 0,001. En conclusión: Los pacientes que se les administró estatinas disminuyeron los niveles de lípidos (colesterol y triglicéridos), por esta razón se sugiere realizar más estudios sobre el uso de estatinas que actualmente están subutilizadas, puesto que su uso ayuda a la prevención primaria y secundaria de ECV.

Liver cancer represents the third leading cause of cancer-related death worldwide. Cholangiocarcinoma (CCA) is the second most common type of liver cancer after hepatocellular carcinoma, accounting for 10-15% of all primary liver malignancies. Both the incidence and mortality of CCA have been steadily increasing during the last decade. Moreover, most CCAs are diagnosed at an advanced stage, when therapeutic options are very limited. CCA may arise from any tract of the biliary system and it is classified into intrahepatic, perihilar, and distal CCA, according to the anatomical site of origin. This topographical classification also reflects distinct genetic and histological features, risk factors, and clinical outcomes. This review focuses on histopathology of CCA, its differential diagnoses, and its diagnostic pitfalls.

Granular cell tumors (GCTs), sometimes called Abrikossoff tumors, are rare and typically benign soft tissue tumors. Malignant GCTs, which are even rarer than benign GCTs, can occur and must be detected early given their high mortality rate. Distinguishing between benign and malignant GCTs is difficult clinically; however, histologic evaluation plays an essential role in this endeavor.

We hypothesized that small molecule transcriptional perturbation could be harnessed to target a cellular dependency involving protein arginine methyltransferase 5 (PRMT5) in the context of methylthioadenosine phosphorylase (MTAP) deletion, seen frequently in malignant pleural mesothelioma (MPM). Here we show, that MTAP deletion is negatively prognostic in MPM. In vitro, the off-patent antibiotic Quinacrine efficiently suppressed PRMT5 transcription, causing chromatin remodelling with reduced global histone H4 symmetrical demethylation. Quinacrine phenocopied PRMT5 RNA interference and small molecule PRMT5 inhibition, reducing clonogenicity in an MTAP-dependent manner. This activity required a functional PRMT5 methyltransferase as MTAP negative cells were rescued by exogenous wild type PRMT5, but not a PRMT5E444Q methyltransferase-dead mutant. We identified c-jun as an essential PRMT5 transcription factor and a probable target for Quinacrine. Our results therefore suggest that small molecule-based transcriptional perturbation of PRMT5 can leverage a mutation-selective vulnerability, that is therapeutically tractable, and has relevance to 9p21 deleted cancers including MPM.

Malignant pleural effusions (MPEs) are associated with reduced survival and contribute to significant morbidity and burden on the health-care system. Although there are numerous MPE management strategies, such as pleurodesis and intermittent drainage via thoracentesis, indwelling pleural catheters (IPCs) have become an effective tool in both managing symptoms and reducing the need for hospitalization in the end-stages of life. The American Association for Bronchology and Interventional Pulmonology (AABIP) recently had society-endorsed guidelines “AABIP Evidence-Informed Guidelines and Expert Panel Report for the Management of Indwelling Pleural Catheters”1 published in the Journal of Bronchology and Interventional Pulmonology to address issues relevant to the postinsertion management of IPCs in MPEs.1 This commentary summarizes many of the key recommendations from the guidelines in a frequently-asked-questions format.

The Computer based / assisted system is proposed in this paper for feature extraction of lung nodule from the simple chest X-ray image. In recent years, the image processing mechanisms are widely used in several medical areas for early detection and in deciding treatment stages, where the time and cost factor is very important to discover the disease in the patient. According to WHO -among the cancer, lung cancer is one of the most common causes of death worldwide. Therefore, early detection using diagnostic tests promises to reduce mortality from lung cancer. At present, increased work load on interpretation of digital images (X-Ray and CT) by radiologist can be a potential source of error due to fatigue in detecting subtle lesion. In this work, the problem of developing a computer based system for the extraction of maximum statistical / mathematical features from the lung X-ray image is considered. Further, these properties can be used to classify lung nodule as benign or malignant from the chest X-ray image directly.

Malignant pleural effusions (MPEs) are associated with reduced survival and contribute to significant morbidity and burden on the health-care system. Although there are numerous MPE management strategies, such as pleurodesis and intermittent drainage via thoracentesis, indwelling pleural catheters (IPCs) have become an effective tool in both managing symptoms and reducing the need for hospitalization in the end-stages of life. The American Association for Bronchology and Interventional Pulmonology (AABIP) recently had society-endorsed guidelines “AABIP Evidence-Informed Guidelines and Expert Panel Report for the Management of Indwelling Pleural Catheters”1 published in the Journal of Bronchology and Interventional Pulmonology to address issues relevant to the postinsertion management of IPCs in MPEs.1 This commentary summarizes many of the key recommendations from the guidelines in a frequently-asked-questions format.

BACKGROUND/AIMS: Many unanswered questions remain about the treatment of malignant hilar obstruction. We investigated endoscopic stenting for malignant biliary strictures, as reported in a nationwide registry. METHODS: All endoscopic retrograde cholangiopancreatography (ERCP) procedures entered in the Swedish Registry of Gallstone Surgery and ERCP from January 2010 to December 2017 in which stenting was performed for malignant biliary stricture management were included in this study. Patency was estimated by determining the time to reintervention. RESULTS: Endoscopic stenting was performed for malignant stricture management in 4623 ERCP procedures, of which 1364 (29.5%) were performed for hilar strictures. Of the hilar strictures, 320 (23.5%) were intrahepatic strictures (Bismuth-Corlette III-IV). Adverse events were more common after hilar stenting than after distal stenting (17.2% vs. 12.0%, p<0.0001). The 6-month reintervention rate was 73.4% after hilar stenting compared with 55.9% after distal stenting (p<0.0001). The 6-month reintervention rates for Bismuth-Corlette types I, II, IIIa, IIIb, and IV were 70.4%, 75.6%, 90.0%, 87.5%, and 85.7%, respectively. In multivariate analysis, the risk for reintervention was three times higher after hilar stenting than after distal stenting (hazard ratio 3.47, 95% confidence interval 2.01-6.00, p<0.001). CONCLUSION: This study with a relatively large patient cohort undergoing endoscopic stenting confirms that stenting for malignant hilar obstruction has more adverse events and lower patency than stenting for distal malignant obstruction.

BACKGROUND/AIMS: Many unanswered questions remain about the treatment of malignant hilar obstruction. We investigated endoscopic stenting for malignant biliary strictures, as reported in a nationwide registry. METHODS: All endoscopic retrograde cholangiopancreatography (ERCP) procedures entered in the Swedish Registry of Gallstone Surgery and ERCP from January 2010 to December 2017 in which stenting was performed for malignant biliary stricture management were included in this study. Patency was estimated by determining the time to reintervention. RESULTS: Endoscopic stenting was performed for malignant stricture management in 4623 ERCP procedures, of which 1364 (29.5%) were performed for hilar strictures. Of the hilar strictures, 320 (23.5%) were intrahepatic strictures (Bismuth-Corlette III-IV). Adverse events were more common after hilar stenting than after distal stenting (17.2% vs. 12.0%, p<0.0001). The 6-month reintervention rate was 73.4% after hilar stenting compared with 55.9% after distal stenting (p<0.0001). The 6-month reintervention rates for Bismuth-Corlette types I, II, IIIa, IIIb, and IV were 70.4%, 75.6%, 90.0%, 87.5%, and 85.7%, respectively. In multivariate analysis, the risk for reintervention was three times higher after hilar stenting than after distal stenting (hazard ratio 3.47, 95% confidence interval 2.01-6.00, p<0.001). CONCLUSION: This study with a relatively large patient cohort undergoing endoscopic stenting confirms that stenting for malignant hilar obstruction has more adverse events and lower patency than stenting for distal malignant obstruction.

BACKGROUND/AIMS: Many unanswered questions remain about the treatment of malignant hilar obstruction. We investigated endoscopic stenting for malignant biliary strictures, as reported in a nationwide registry. METHODS: All endoscopic retrograde cholangiopancreatography (ERCP) procedures entered in the Swedish Registry of Gallstone Surgery and ERCP from January 2010 to December 2017 in which stenting was performed for malignant biliary stricture management were included in this study. Patency was estimated by determining the time to reintervention. RESULTS: Endoscopic stenting was performed for malignant stricture management in 4623 ERCP procedures, of which 1364 (29.5%) were performed for hilar strictures. Of the hilar strictures, 320 (23.5%) were intrahepatic strictures (Bismuth-Corlette III-IV). Adverse events were more common after hilar stenting than after distal stenting (17.2% vs. 12.0%, p<0.0001). The 6-month reintervention rate was 73.4% after hilar stenting compared with 55.9% after distal stenting (p<0.0001). The 6-month reintervention rates for Bismuth-Corlette types I, II, IIIa, IIIb, and IV were 70.4%, 75.6%, 90.0%, 87.5%, and 85.7%, respectively. In multivariate analysis, the risk for reintervention was three times higher after hilar stenting than after distal stenting (hazard ratio 3.47, 95% confidence interval 2.01-6.00, p<0.001). CONCLUSION: This study with a relatively large patient cohort undergoing endoscopic stenting confirms that stenting for malignant hilar obstruction has more adverse events and lower patency than stenting for distal malignant obstruction.

The Computer based / assisted system is proposed in this paper for feature extraction of lung nodule from the simple chest X-ray image. In recent years, the image processing mechanisms are widely used in several medical areas for early detection and in deciding treatment stages, where the time and cost factor is very important to discover the disease in the patient. According to WHO -among the cancer, lung cancer is one of the most common causes of death worldwide. Therefore, early detection using diagnostic tests promises to reduce mortality from lung cancer. At present, increased work load on interpretation of digital images (X-Ray and CT) by radiologist can be a potential source of error due to fatigue in detecting subtle lesion. In this work, the problem of developing a computer based system for the extraction of maximum statistical / mathematical features from the lung X-ray image is considered. Further, these properties can be used to classify lung nodule as benign or malignant from the chest X-ray image directly.

The Computer based / assisted system is proposed in this paper for feature extraction of lung nodule from the simple chest X-ray image. In recent years, the image processing mechanisms are widely used in several medical areas for early detection and in deciding treatment stages, where the time and cost factor is very important to discover the disease in the patient. According to WHO -among the cancer, lung cancer is one of the most common causes of death worldwide. Therefore, early detection using diagnostic tests promises to reduce mortality from lung cancer. At present, increased work load on interpretation of digital images (X-Ray and CT) by radiologist can be a potential source of error due to fatigue in detecting subtle lesion. In this work, the problem of developing a computer based system for the extraction of maximum statistical / mathematical features from the lung X-ray image is considered. Further, these properties can be used to classify lung nodule as benign or malignant from the chest X-ray image directly.

The Computer based / assisted system is proposed in this paper for feature extraction of lung nodule from the simple chest X-ray image. In recent years, the image processing mechanisms are widely used in several medical areas for early detection and in deciding treatment stages, where the time and cost factor is very important to discover the disease in the patient. According to WHO -among the cancer, lung cancer is one of the most common causes of death worldwide. Therefore, early detection using diagnostic tests promises to reduce mortality from lung cancer. At present, increased work load on interpretation of digital images (X-Ray and CT) by radiologist can be a potential source of error due to fatigue in detecting subtle lesion. In this work, the problem of developing a computer based system for the extraction of maximum statistical / mathematical features from the lung X-ray image is considered. Further, these properties can be used to classify lung nodule as benign or malignant from the chest X-ray image directly.

The Computer based / assisted system is proposed in this paper for feature extraction of lung nodule from the simple chest X-ray image. In recent years, the image processing mechanisms are widely used in several medical areas for early detection and in deciding treatment stages, where the time and cost factor is very important to discover the disease in the patient. According to WHO -among the cancer, lung cancer is one of the most common causes of death worldwide. Therefore, early detection using diagnostic tests promises to reduce mortality from lung cancer. At present, increased work load on interpretation of digital images (X-Ray and CT) by radiologist can be a potential source of error due to fatigue in detecting subtle lesion. In this work, the problem of developing a computer based system for the extraction of maximum statistical / mathematical features from the lung X-ray image is considered. Further, these properties can be used to classify lung nodule as benign or malignant from the chest X-ray image directly.

The Computer based / assisted system is proposed in this paper for feature extraction of lung nodule from the simple chest X-ray image. In recent years, the image processing mechanisms are widely used in several medical areas for early detection and in deciding treatment stages, where the time and cost factor is very important to discover the disease in the patient. According to WHO -among the cancer, lung cancer is one of the most common causes of death worldwide. Therefore, early detection using diagnostic tests promises to reduce mortality from lung cancer. At present, increased work load on interpretation of digital images (X-Ray and CT) by radiologist can be a potential source of error due to fatigue in detecting subtle lesion. In this work, the problem of developing a computer based system for the extraction of maximum statistical / mathematical features from the lung X-ray image is considered. Further, these properties can be used to classify lung nodule as benign or malignant from the chest X-ray image directly.

The Computer based / assisted system is proposed in this paper for feature extraction of lung nodule from the simple chest X-ray image. In recent years, the image processing mechanisms are widely used in several medical areas for early detection and in deciding treatment stages, where the time and cost factor is very important to discover the disease in the patient. According to WHO -among the cancer, lung cancer is one of the most common causes of death worldwide. Therefore, early detection using diagnostic tests promises to reduce mortality from lung cancer. At present, increased work load on interpretation of digital images (X-Ray and CT) by radiologist can be a potential source of error due to fatigue in detecting subtle lesion. In this work, the problem of developing a computer based system for the extraction of maximum statistical / mathematical features from the lung X-ray image is considered. Further, these properties can be used to classify lung nodule as benign or malignant from the chest X-ray image directly.

BACKGROUND/AIMS: Many unanswered questions remain about the treatment of malignant hilar obstruction. We investigated endoscopic stenting for malignant biliary strictures, as reported in a nationwide registry. METHODS: All endoscopic retrograde cholangiopancreatography (ERCP) procedures entered in the Swedish Registry of Gallstone Surgery and ERCP from January 2010 to December 2017 in which stenting was performed for malignant biliary stricture management were included in this study. Patency was estimated by determining the time to reintervention. RESULTS: Endoscopic stenting was performed for malignant stricture management in 4623 ERCP procedures, of which 1364 (29.5%) were performed for hilar strictures. Of the hilar strictures, 320 (23.5%) were intrahepatic strictures (Bismuth-Corlette III-IV). Adverse events were more common after hilar stenting than after distal stenting (17.2% vs. 12.0%, p<0.0001). The 6-month reintervention rate was 73.4% after hilar stenting compared with 55.9% after distal stenting (p<0.0001). The 6-month reintervention rates for Bismuth-Corlette types I, II, IIIa, IIIb, and IV were 70.4%, 75.6%, 90.0%, 87.5%, and 85.7%, respectively. In multivariate analysis, the risk for reintervention was three times higher after hilar stenting than after distal stenting (hazard ratio 3.47, 95% confidence interval 2.01-6.00, p<0.001). CONCLUSION: This study with a relatively large patient cohort undergoing endoscopic stenting confirms that stenting for malignant hilar obstruction has more adverse events and lower patency than stenting for distal malignant obstruction.