Research Day Book 2013 - College of Medicine - Florida Atlantic ...

METHODS: A retrospective chart review was performed at a single center to identify all patients who
received ketorolac for postoperative analgesia within 72 hours after cardiac surgery to limit postoperative
narcotic use. Perioperative data was collected, focusing on preoperative comorbidities, types of surgery,
and postoperative ketorolac dosing. Postoperative adverse events were recorded, including bleeding,
cardiovascular, and renal complications.
RESULTS: Between September 2006 and July 2012, 488 patients received at least one dose of ketorolac for
pain management after cardiac surgery (78.9% coronary bypass, 16.6% valve). Patients treated with
ketorolac were often young men (mean age 67.2 years, 70.3% male) with near normal preoperative renal
function (mean preoperative creatinine: 1.05 mg/dL). Ketorolac was administered on average 8.7 hours
after surgery (mean doses: 3.1; mean cumulative dose 81.7 mg). Eight patients (1.6%) required reopening
for bleeding after ketorolac administration, and 6 patients (1.2%) developed gastrointestinal bleeding.
While the mean postoperative increase in creatinine was 0.20 mg/dL, 2 patients (0.4%) developed acute
renal failure requiring dialysis. Two patients (0.4%) had a perioperative myocardial infarction, 4 patients
(0.8%) had a perioperative stroke or transient ischemic attack, and there were 2 perioperative deaths (0.4%).
CONCLUSION: Ketorolac appears safe for use as a postoperative analgesic when administered selectively
following cardiac operations. With a low risk of complications associated with its administration, our data
call into question the need for a black box warning recommending against the use of ketorolac in the
postoperative setting after cardiac surgery.
ASBTRACT TITLE: Reliability of the diagnosis of perineural invasion as a prognostic indicator in
colorectal cancer
AUTHORS: S. Millette, D. Allende, E. Silva, A. Maya, N. Sengul, F. Potenti, S. Wexner and M. Berho
DEPARTMENT: Integrated Medical Science and Cleveland Clinic Florida
BACKGROUND: Perineural invasion (PNI) has emerged as an adverse prognostic marker in colorectal
cancer, however its applicability may be limited due to variable inter‐observer variability.
AIM: To assess the impact of nerve stains (S100) in the recognition of PNI, to evaluate inter‐observer
variability (IOV) and to correlate PNI with other markers of prognosis.
METHODS: After IRB approval, patients with colorectal cancer who underwent surgical treatment from
1/2002 to 12/2009, were identified from a prospective database. Only cases in which clinical/surgical
information and slides/blocks were available were included. Clinical and histological parameters were
obtained by chart review. IOV in the detection of PNI by both H&E and S100 stained slides was assessed by
two gastrointestinal pathologists. Time required to read the H&E and S100 slides and the number of
positive slides for PNI were recorded.
RESULTS: 139 colorectal patients (mean 64 years, 67% female) were included in the study (colon: 46,
rectum: 93), with a mean follow‐up of 50.8 months. PNI was noted in 44% (pathologist A) and 52%
(pathologist B) of the cases on H&E; and 63% and 58% on S100, respectively. The time to diagnosis went