Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Surgical treatment of “high-type” fistula in ano is often complicated by fecal incontinence and fistula recurrence. Panjak Kumar, MS, and coauthors reported the results of a randomized controlled trial conducted in a single institution; each comparison group included 42 patients with “high-type” fistula in ano randomized to treatment with endorectal advancement flap (ERAF) or ligation of intersphincteric fistulous tract (LIFT). The main outcome of interest was fistula healing at 6 months following initial treatment.
All patients were followed for a total of 2 years and other outcomes, such as rates of complications, postoperative pain, rates of incontinence and quality of life, were recorded. Healing at 6 months was observed in 76.2% of the LIFT patients and 54.7% of the ERAF group. Flatus incontinence was noted in a small number of each group at 6 months, but this had resolved in all patients at 2 years of follow up. Pain scores and quality of life scores were significantly better in the LIFT patients. The data suggested that LIFT is the preferred treatment for high-type fistula in ano; the authors recommended that additional trials with larger sample sizes should be conducted.
Practical Considerations for the Use of Circulating Tumor DNA in the Treatment of Patients with Cancer
Tissue biopsy remains the preferred method for diagnosing cancer, but tissue samples may not provide adequate tissue for molecular diagnosis, tumor monitoring during therapy, and detection of recurrences. Use of blood or other fluid samples (liquid biopsy) as an adjunct to management of patients with lung and breast cancer is well established, and this technique is increasingly employed in the management of other tumor types.
One liquid biopsy technique, next-generation sequencing, can provide a personalized molecular profile in a timely manner to facilitate cancer treatment and research. The most widely studied factor is circulating tumor DNA. This type of testing is most useful in patients with large tumor burden, and this technique is particularly valuable for monitoring response to treatment. Cancer screening, in contrast, will require a testing technique with high sensitivity that can detect small amounts of tumor genetic material. Such tests are under development and likely will be available for clinical use in the relatively near future.
The authors provide useful descriptions of several of these testing methods, such as the CancerSEEK test, that can detect multiple types of tumors and have potential value for screening. They also provided clear illustrations of the potential uses of liquid biopsy for determining response to surgical therapy, detecting recurrence, and selecting other treatments. Genetic testing may also be useful for predicting response to neoadjuvant and adjuvant chemotherapy and radiation therapy. Readers are encouraged to review the entire contents of the article.
Examining Early Active Mobilization during Mechanical Ventilation in the ICU
Early mobilization using daily physical therapy may mitigate muscle weakness and improve survival in critically ill patients who require mechanical ventilation. This article reported outcomes in a randomized clinical trial in which 750 adult patients were assigned to early mobilization using daily interruption of sedation with high-intensity physical therapy or to conventional care where patients received physical therapy selected by the treating critical care specialists.
The duration of daily physical therapy sessions was 21 minutes for the early mobilization group and 9 minutes for the usual care group. The primary outcome of interest was the number of days patients were alive at 180 days following randomization; the primary outcome was 143 days in the early mobilization group and 145 days in the usual care group. Mortality at 180 days was similar in the two comparison groups but adverse events (arrhythmia, oxygen desaturation, altered blood pressure) occurred significantly more often in the early mobilization group. The authors concluded that early mobilization did not provide significant benefit compared with conventional care for critically ill adults requiring mechanical ventilation.
In the discussion section of the report, the authors hypothesized that the lack of benefit and increased frequency of adverse events may have occurred because of the use of immediate, high-intensity physical therapy as opposed to a gradually increasing intensity protocol. Additional research will be necessary to determine best physical therapy approaches for improving outcomes in critically ill patients.
