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Sample records for abdominal oncology clinical

  1. American Society of Clinical Oncology

    ... Media Policy Sponsor Policy Terms of Use American Society of Clinical Oncology Genitourinary Cancers Symposium Call for ... or cosponsored by ASCO View Event 13th Asian Society for Neuro-Oncology (ASNO) Meeting/9th COGNO Annual ...

  2. Topics in clinical oncology. 15

    The monograph comprising primarily papers on topical subjects of oncology and cancer research, contains also a selection of papers presented at the 2. Congress of the Czechoslovak Society of Nuclear Medicine and Radiation Hygiene. Seven papers were selected on behalf of their subject related to clinical oncology. All of them were iputted in INIS; five of them deal with the scintiscanning of the skeleton of cancer patients, one with radioimmunodetection of tumors, and one with radionuclide lymphography. (A.K.)

  3. Raman Spectroscopy for Clinical Oncology

    Michael B. Fenn

    2011-01-01

    Full Text Available Cancer is one of the leading causes of death throughout the world. Advancements in early and improved diagnosis could help prevent a significant number of these deaths. Raman spectroscopy is a vibrational spectroscopic technique which has received considerable attention recently with regards to applications in clinical oncology. Raman spectroscopy has the potential not only to improve diagnosis of cancer but also to advance the treatment of cancer. A number of studies have investigated Raman spectroscopy for its potential to improve diagnosis and treatment of a wide variety of cancers. In this paper the most recent advances in dispersive Raman spectroscopy, which have demonstrated promising leads to real world application for clinical oncology are reviewed. The application of Raman spectroscopy to breast, brain, skin, cervical, gastrointestinal, oral, and lung cancers is reviewed as well as a special focus on the data analysis techniques, which have been employed in the studies.

  4. Radioimmunoimaging in clinical oncology

    In the thesis radiolabeled antibodies were tested for screening of cancer in patients without previous knowledge of tumour histopathology. They were tested as well targeting known cancer, sometimes in unknown clinical stage. Methods for detection enhancement utilizing double-tracer techniques and alternative routes of administration were also investigated. (385 refs., 11 tabs.)

  5. Introduction to veterinary clinical oncology

    Weller, R.E.

    1991-10-01

    Veterinary clinical oncology involves a multidisciplinary approach to the recognition and management of spontaneously occurring neoplasms of domestic animals. This requires some knowledge of the causes, incidence, and natural course of malignant disease as it occurs in domestic species. The purpose of this course is to acquaint you with the more common neoplastic problems you will encounter in practice, so that you can offer your clients an informed opinion regarding prognosis and possible therapeutic modalities. A major thrust will be directed toward discussing and encouraging treatment/management of malignant disease. Multimodality therapy will be stressed. 10 refs., 3 tabs.

  6. A clinical dilemma: abdominal tuberculosis

    Oya Uygur-Bayramicli; G(u)l Dabak; Resat Dabak

    2003-01-01

    AIM: To evaluate the clinical, radiological and microbiological properties of abdominal tuberculosis (TB) and to discuss methods needed to get the diagnosis.METHODS: Thirty-one patients diagnosed as abdominal TB between March 1998 and December 2001 at the Gastroenterology Department of Kartal State Hospital,Istanbul, Turkey were evaluated prospectively. Complete physical examination, medical and family history, blood count erythrocyte sedimentation rate, routine biochemical tests,Mantoux skin test, chest X-ray and abdominal ultrasonography (USG) were performed in all cases, whereas microbiological examination of ascites, upper gastrointestinal endoscopy, colonoscopy or barium enema, abdominal tomography, mediastinoscopy, laparoscopy or laparotomy were done when needed.RESULTS: The median age of patients (14 females, 17males) was 34.2 years (range 15-65 years). The most frequent symptoms were abdominal pain and weight loss.Eleven patients had active pulmonary TB. The most common abdominal USG findings were ascites and hepatomegaly. Ascitic fluid analysis performed in 13 patients was found to be exudative and acid resistant bacilli were present in smear and cultured only in one patient with BacTec (3.2 %). Upper gastrointestinal endoscopy yielded nonspecific findings in 16 patients. Colonoscopy performed in 20 patients showed ulcers in 9 (45 %), nodules in 2 (10 %)and, stricture, polypoid lesions, granulomatous findings in terminal ileum and rectal fistula each in one patient (5 %).Laparoscopy on 4 patients showed dilated bowel loops,thickening in the mesentery, multiple ulcers and tubercles on the peritoneum. Patients with abdominal TB were divided into three groups according to the type of involvement.Fifteen patients (48 %) had intestinal TB, L1 patients (35.2 %) had tuberculous peritonitis and 5 (16.8 %)tuberculous lymphadenitis. The diagnosis of abdominal TB was confirmed microbiologically in 5 (16 %) and histopathologically in 19 patients (60.8 %). The

  7. Clinical Oncology Assistantship Program for Medical Students.

    Neilan, Barbara A.; And Others

    1985-01-01

    The Clinical Oncology Assistantship Program at the University of Arkansas for Medical Sciences is described, along with student reactions to the program. The summer elective program involves cancer lectures (one week) and clinical exposure (nine weeks) in medical, surgical, and pediatric oncology services, as well as self-directed learning…

  8. American Society of Clinical Oncology Policy Statement on Clinical Pathways in Oncology.

    Zon, Robin T; Frame, James N; Neuss, Michael N; Page, Ray D; Wollins, Dana S; Stranne, Steven; Bosserman, Linda D

    2016-03-01

    The use of clinical pathways in oncology care is increasingly important to patients and oncology providers as a tool for enhancing both quality and value. However, with increasing adoption of pathways into oncology practice, concerns have been raised by ASCO members and other stakeholders. These include the process being used for pathway development, the administrative burdens on oncology practices of reporting on pathway adherence, and understanding the true impact of pathway use on patient health outcomes. To address these concerns, ASCO's Board of Directors established a Task Force on Clinical Pathways, charged with articulating a set of recommendations to improve the development of oncology pathways and processes, allowing the demonstration of pathway concordance in a manner that promotes evidence-based, high-value care respecting input from patients, payers, and providers. These recommendations have been approved and adopted by ASCO's Board of Directors on August 12, 2015, and are presented herein. PMID:26759491

  9. Clinical oncology in resource-limited settings

    Buonaguro, Franco M.; Gueye, Serigne N; Wabinga, Henry R; Ngoma, Twalib A.; Vermorken, Jan B; Mbulaiteye, Sam M

    2013-01-01

    Infectious Agents and Cancer is introducing a new section of Clinical Oncology with the main objective of stimulating debate through articles published in the section. Infectious diseases have been the major causes of morbidity and mortality in human populations, and have dominated the medical approach to clinical and public health. Successful efforts to control mortality from acute infections have paved the way for chronic, mostly indolent, infections to become major causes of morbidity. Can...

  10. Topics in clinical oncology. 14

    The symposium proceedings contain 39 papers. All papers were inputted in INIS. The subjects of the papers were the use of computers in radiotherapy planning, and clinical dosimetry, equipment and quality assurance, biological radiation effects and radiation protection problems in radiotherapy. (J.P.)

  11. Clinical oncology in Malaysia: 1914 to present

    Lim, GCC

    2006-01-01

    A narration of the development of staff, infrastructure and buildings in the various parts of the country is given in this paper. The role of universities and other institutions of learning, public health, palliative care, nuclear medicine and cancer registries is described together with the networking that has been developed between the government, non-governmental organisations and private hospitals. The training of skilled manpower and the commencement of the Master of Clinical Oncology in...

  12. Penile Cancer: Clinical Practice Guidelines in Oncology

    Clark, Peter E.; Philippe E. Spiess; Agarwal, Neeraj; Biagioli, Matthew C.; Eisenberger, Mario A.; Greenberg, Richard E.; Herr, Harry W.; Inman, Brant A.; Kuban, Deborah A.; Kuzel, Timothy M.; Lele, Subodh M.; Michalski, Jeff; Pagliaro, Lance; Pal, Sumanta K.; Patterson, Anthony

    2013-01-01

    Squamous cell carcinoma of the penis represents approximately 0.5% of all cancers among men in the United States and other developed countries. Although rare, it is associated with significant disfigurement, and only half of the patients survive beyond 5 years. Proper evaluation of both the primary lesion and lymph nodes is critical, because nodal involvement is the most important factor of survival. The NCCN Clinical Practice Guidelines in Oncology for Penile Cancer provide recommendations o...

  13. Abdominal tuberculosis: clinical presentation and outcome

    To study the clinical presentation and outcome of cases of Abdominal Tuberculosis. Fifty four patients of Abdominal Tuberculosis were seen during the study period. Four patients were lost to follow-up, which were excluded. Detailed information of all the patients including age, sex, symptoms, signs, investigations and management was recorded, analyzed and compared with local and international data. Out of the 50 patients with Abdominal Tuberculosis, 31 were females and 19 males. Their ages ranged from 17 to 63 years, with a mean age of 25.1 years. Thirty five cases were admitted through Emergency and 15 through Outpatients departments. Abdominal pain was the most common symptom found in 44 (88%) patients followed by vomiting in 33 (66%). Abdominal tenderness was seen in 22 (44%) patients, while 16 (32%) patients had rigidity and other features of peritonitis. Surgery was performed in all these patients, limited right hemicolectomy in 17 (34%), segmental resection and anastomosis in 12 (24%), ileostomy and strictureplasty in six (12%) each, repair of perforation in five (10%) and adhesiolysis in four (8%) patients. Overall mortality was 8% due to septicaemia and multiorgan failure. Abdominal Tuberculosis is a significant clinical entity with lethal complications in neglected cases. It affects a younger age group and is more common in females. Clinical features are rather non-specific but vague ill health, low grade fever, weight loss and anorexia may help to diagnose the case. (author)

  14. Clinical Oncology-A New Era

    Biyun Qian; Dan Su; Herbert Yu

    2007-01-01

    Rapid growth in biomedical research coupled with dramatic advancement in biotechnology has significantly improved our understanding of the molecular basis involving cancer development and progression.This improvement has led to the discovery of new molecular markers for cancer diagnosis and prognosis as well as new molecular targets for cancer treatment and intervention.Continuous emergence of some new developing area in molecular profiling,new therapeutic agents,tissue microenvironment and systems biology have made significant progress in clinical oncology.Clinical research and investigation that focus on these new developments have begun to show exciting results that indicate future promises in improving patient management and survival.

  15. Aggressive malignant abdominal mesothelioma: Clinical report

    A 32-year-old Filipino female, working as an x-ray technician, presented to the Emergency Room (ER) with acute abdominal pain for one day. The pain was mainly on the left side and left hypochondrium. She had recurring abdominal pain before but not significant to worry her. She also complained of abdominal distension, which she noticed one week ago. Abdominal examination revealed fullness in the left hypochondrium with marked tenderness but negative rebound. Abdominal ultrasound (US) showed a huge mass mainly in the left hypochondrium. The origin of the mass cannot be identified by US. A computerized tomography scan showed a mass in the left side of the abdomen crossing the midline with a necrotic centre. The hospital course of the patient runs smoothly, and she was discharged after 7-days and referred to an Oncology Center. Abdominal mesothelioma is a neoplasm arising from the mesothelial surface lining the abdominal cavity. It is less frequent than that of the pleura. It is a rapidly growing and fatal malignancy with a median survival of less than 1-year. The relation between pleural malignant mesothelioma and asbestos is well recognized since it was described in 19602 but implication of asbestos exposure in the etiology of the peritoneal type is less obvious. This patient history is giving no obvious exposure to asbestos but as she is working in the Radiology Department as an x-ray technician she is well exposed to x-ray, but the effect of radioactivity on induction of mesothelioma is still disputed.4 There are several reports linking malignant mesothelioma to radioactivity due to radiation therapy.The fibrous mesothelioma (sarcomatous), as in this case, which is difficult to diagnose microscopically, looks like a fibroma, unless helped by tissue culture. The treatment options of malignant mesothelioma include surgery, intraperitoneal chemotherapy and whole abdominal radiation or multimodality therapy, which were suggested that might prolong the survival in

  16. Clinical applications of PET in oncology.

    Rohren, Eric M; Turkington, Timothy G; Coleman, R Edward

    2004-05-01

    Positron emission tomography (PET) provides metabolic information that has been documented to be useful in patient care. The properties of positron decay permit accurate imaging of the distribution of positron-emitting radiopharmaceuticals. The wide array of positron-emitting radiopharmaceuticals has been used to characterize multiple physiologic and pathologic states. PET is used for characterizing brain disorders such as Alzheimer disease and epilepsy and cardiac disorders such as coronary artery disease and myocardial viability. The neurologic and cardiac applications of PET are not covered in this review. The major utilization of PET clinically is in oncology and consists of imaging the distribution of fluorine 18 fluorodeoxyglucose (FDG). FDG, an analogue of glucose, accumulates in most tumors in a greater amount than it does in normal tissue. FDG PET is being used in diagnosis and follow-up of several malignancies, and the list of articles supporting its use continues to grow. In this review, the physics and instrumentation aspects of PET are described. Many of the clinical applications in oncology are mature and readily covered by third-party payers. Other applications are being used clinically but have not been as carefully evaluated in the literature, and these applications may not be covered by third-party payers. The developing applications of PET are included in this review. PMID:15044750

  17. Abdominal tuberculosis, clinical-radiological revision

    We retrospectively evaluated the clinical charts and diagnostic images of hospitalised patients with histological or bacteriologic demonstration of abdominal tuberculosis (TB) including those with probable abdominal TB, who had pulmonary TB and radiologic findings highly suggestive of abdominal TB with favourable response to treatment. Cases with genitourinary TB were excluded. We found 24 patients with an average age of 25 yrs. In some cases this entity was not suspected on the imaging studies, and diagnosis was made on surgery. The most frequent symptoms were: abdominal pain, diarrhoea, fever, vomiting, weight loss and abdominal mass. Active pulmonary TB was demonstrated on 8 cases (33%) Peritoneal presentation was the most frequent (54%) with septated or simple ascites, cystic ascites or pseudocysts within bowel loops. Mesenteric involvement (21 %) showed adenopathy or masses identified with CT. Intestinal forms (17%) showed pseudo-polyps on terminal ileum and ulcers on ileum, cecum and colon. We found one case with diffuse ulcerative involvement of the colon. Two cases showed hepatic involvement, one with an abscess and a tuberculosis Cole cystitis, with pyloric syndrome due to fibrosis

  18. Clinical profile of abdominal tuberculosis in children

    Ira Shah

    2010-01-01

    Full Text Available Aim: A retrospective study was conducted in children, suffering from abdominal TB, attending Pediatric TB clinic from 2007 to 2009. Materials And Methods: Age-wise distribution and type of abdominal TB were analyzed with clinical features. Results : Out of 285 children with TB, 32 (11.2% had abdominal tuberculosis. Male: Female ratio was 2.1:1. 7 (21.9% children were 10 years of age. The most common clinical features were fever in 24 (75%, pain in abdomen in 17 (53.1%, loss of weight in 15 (46.9%, raised ESR in 14 (43.8%, and loss of appetite in 13 (40.6% children. TB contact was present in 10 (31.2%, and 7 (21.9% children had tuberculosis in the past. 28 (87.5% children had received BCG vaccine, and 17 (53.1% had a positive Mantoux test. Extra-abdominal tuberculosis was found in 17 patients (53.1%. Duration of fever was more in children less than 5 years of age (127 ± 66 days than that in children between 5 -10 years (37 ± 30 days and in > 10 years of age (73 ± 66 days, which is statistically significant (P = 0.0228. Lymph node TB (17 patients, 53.1% was found to be the commonest, followed by intestinal (10 patients, 31.2% and peritoneal TB (4 patients, 12.5%. 18 (56.2% of the total patients had recovered, 7 (21.9% of all patients failed first line therapy and had to be started on second line drugs, of which 4 (12.5% were proven to have drug-resistant TB. Conclusion : Abdominal TB is seen in 11.2% of children affected with TB, of which over 53% will have extra-abdominal manifestations. Common clinical and laboratory features include fever, pain in abdomen, loss of weight, loss of appetite, and raised ESR. The duration of fever is more in children of younger age group. Lymph node TB is the most common type of abdominal TB. Drug-resistant TB is seen in at least 12.5% of the patients.

  19. A clinical intranet model for radiation oncology

    Purpose: A new paradigm in computing is being formulated from advances in client-server technology. This new way of accessing data in a network is referred to variously as Web-based computing, Internet computing, or Intranet computing. The difference between an internet and intranet being that the former is for global access and the later is only for intra-departmental access. Our purpose with this work is to develop a clinically useful radiation oncology intranet for accessing physically disparate data sources. Materials and Methods: We have developed an intranet client-server system using Windows-NT Server 4.0 running Internet Information Server (IIS) on the back-end and client PCs using a typical World Wide Web (WWW) browser. The clients also take advantage of the Microsoft Open Database Connectivity (ODBC) standard for accessing commercial database systems. The various data sources used include: a traditional Radiation Oncology Information (ROIS) System (VARiS 1.3tm); a 3-D treatment planning system (CAD Plantm); a beam scanning system (Wellhoffertm); as well as an electronic portal imaging device (PortalVisiontm) and a CT-Simulator providing digitally reconstructed radiographs (DRRs) (Picker AcQsimtm). We were able to leverage previously developed Microsoft Visual C++ applications without major re-writing of source code for this. Results: With the data sources and development materials used, we were able to develop a series of WWW-based clinical tool kits. The tool kits were designed to provide profession-specific clinical information. The physician's tool kit provides a treatment schedule for daily patients along with a dose summary from VARiS and the ability to review portal images and prescription images from the EPID and Picker. The physicists tool kit compares dose summaries from VARiS with an independent check against RTP beam data and serves as a quick 'chart-checker'. Finally, an administrator tool kit provides a summary of periodic charging

  20. Selenium in Oncology: From Chemistry to Clinics

    Oliver Micke

    2009-10-01

    Full Text Available The essential trace element selenium, which is a crucial cofactor in the most important endogenous antioxidative systems of the human body, is attracting more and more the attention of both laypersons and expert groups. The interest of oncologists mainly focuses in the following clinical aspects: radioprotection of normal tissues, radiosensitizing in malignant tumors, antiedematous effect, prognostic impact of selenium, and effects in primary and secondary cancer prevention. Selenium is a constituent of the small group of selenocysteine-containing selenoproteins and elicits important structural and enzymatic functions. Selenium deficiency has been linked to increased infection risk and adverse mood states. It has been shown to possess cancer-preventive and cytoprotective activities in both animal models and humans. It is well established that Se has a key role in redox regulation and antioxidant function, and hence in membrane integrity, energy metabolism and protection against DNA damage. Recent clinical trials have shown the importance of selenium in clinical oncology. Our own clinical study involving 48 patients suggest that selenium has a positive effect on radiation-associated secondary lymphedema in patients with limb edemas, as well as in the head and neck region, including endolaryngeal edema. Another randomized phase III study of our group was performed to examine the cytoprotective properties of selenium in radiation oncology. The aim was to evaluate whether sodium selenite is able to compensate a preexisting selenium deficiency and to prevent radiation induced diarrhea in adjuvant radiotherapy for pelvic gynecologic malignancies. Through this study, the significant benefits of sodium selenite supplementation with regards to selenium deficiency and radiotherapy induced diarrhea in patients with cervical and uterine cancer has been shown for the first time in a prospective randomized trial. Survival data imply that supplementation with

  1. Selenium in oncology: from chemistry to clinics.

    Micke, Oliver; Schomburg, Lutz; Buentzel, Jens; Kisters, Klaus; Muecke, Ralph

    2009-01-01

    The essential trace element selenium, which is a crucial cofactor in the most important endogenous antioxidative systems of the human body, is attracting more and more the attention of both laypersons and expert groups. The interest of oncologists mainly focuses in the following clinical aspects: radioprotection of normal tissues, radiosensitizing in malignant tumors, antiedematous effect, prognostic impact of selenium, and effects in primary and secondary cancer prevention. Selenium is a constituent of the small group of selenocysteine-containing selenoproteins and elicits important structural and enzymatic functions. Selenium deficiency has been linked to increased infection risk and adverse mood states. It has been shown to possess cancer-preventive and cytoprotective activities in both animal models and humans. It is well established that Se has a key role in redox regulation and antioxidant function, and hence in membrane integrity, energy metabolism and protection against DNA damage. Recent clinical trials have shown the importance of selenium in clinical oncology. Our own clinical study involving 48 patients suggest that selenium has a positive effect on radiation-associated secondary lymphedema in patients with limb edemas, as well as in the head and neck region, including endolaryngeal edema. Another randomized phase III study of our group was performed to examine the cytoprotective properties of selenium in radiation oncology. The aim was to evaluate whether sodium selenite is able to compensate a preexisting selenium deficiency and to prevent radiation induced diarrhea in adjuvant radiotherapy for pelvic gynecologic malignancies. Through this study, the significant benefits of sodium selenite supplementation with regards to selenium deficiency and radiotherapy induced diarrhea in patients with cervical and uterine cancer has been shown for the first time in a prospective randomized trial. Survival data imply that supplementation with selenium does not

  2. Clinical PET: changing the practice of oncology

    Until recently positron emission tomography (PET) has been largely confined to academic institutions with the capital and human resources to support this technologically advanced modality. More recently its utility in oncology has fuelled the wider dissemination of this modality into routine clinical practice. Small animal PET scanners allow tracers to be validated prior to use in human subjects. The Peter MacCallum Cancer Institute clinical PET program began operation in 1996 and since that time has grown to be the first Australian centre with 2 PET scanners, including the first combined PET/CT. Although the majority of the almost 10,000 studies performed in our facility have utilised FDG, new tracers are increasingly being used in clinical trials, particularly for therapeutic monitoring of novel chemotherapeutic agents. In establishing our facility we have sought to influence referral patterns to those situations where epidemiological and case control data suggest that conventional diagnostic algorithms currently fail us. This is particularly the case in situation where recognition of this failure leads to routine use of either a morbid procedure or treatment in an entire population of patients, even in the absence of abnormality after conventional staging. For example, CT scanning is recognised to have insufficient accuracy for staging the status of mediastinal lymph node spread of non-small cell lung cancer to determine operability. Accordingly, a large number of patients undergo mediastinoscopy and pathological sampling of lymph nodes. Other patients are subjected to futile open and close thoracotomies due to incorrect staging. FDG PET has convincingly been shown to be more accurate than CT for staging the mediastinum and in a recent randomised control trial was shown to significantly reduce unnecessary thoractomies. By trying to limit the use of PET to situations where a range of different management options are available depending on the true extent of

  3. Regulatory and clinical considerations for biosimilar oncology drugs

    Bennett, Charles L; Chen, Brian; Hermanson, Terhi; Wyatt, Michael D; Schulz, Richard M; Georgantopoulos, Peter; Kessler, Samuel; Raisch, Dennis W; Qureshi, Zaina P; Lu, Z Kevin; Love, Bryan L; Noxon, Virginia; Bobolts, Laura; Armitage, Melissa; Bian, John; Ray, Paul; Ablin, Richard J; Hrushesky, William J; Macdougall, Iain C; Sartor, Oliver; Armitage, James O

    2015-01-01

    Biological oncology products are integral to cancer treatment, but their high costs pose challenges to patients, families, providers, and insurers. The introduction of biosimilar agents—molecules that are similar in structure, function, activity, immunogenicity, and safety to the original biological drugs—provide opportunities both to improve healthcare access and outcomes, and to reduce costs. Several international regulatory pathways have been developed to expedite entry of biosimilars into global marketplaces. The first wave of oncology biosimilar use was in Europe and India in 2007. Oncology biosimilars are now widely marketed in several countries in Europe, and in Australia, Japan, China, Russia, India, and South Korea. Their use is emerging worldwide, with the notable exception of the USA, where several regulatory and cost barriers to biosimilar approval exist. In this Review, we discuss oncology biosimilars and summarise their regulatory frameworks, clinical experiences, and safety concerns. PMID:25456378

  4. Evidence-based integrative medicine in clinical veterinary oncology.

    Raditic, Donna M; Bartges, Joseph W

    2014-09-01

    Integrative medicine is the combined use of complementary and alternative medicine with conventional or traditional Western medicine systems. The demand for integrative veterinary medicine is growing, but evidence-based research on its efficacy is limited. In veterinary clinical oncology, such research could be translated to human medicine, because veterinary patients with spontaneous tumors are valuable translational models for human cancers. An overview of specific herbs, botanics, dietary supplements, and acupuncture evaluated in dogs, in vitro canine cells, and other relevant species both in vivo and in vitro is presented for their potential use as integrative therapies in veterinary clinical oncology. PMID:25174902

  5. Impact of radiation research on clinical trials in radiation oncology

    The authors present an outline review of the history of the formation of the cooperative group called International Clinical Trials in Radiation Oncology (ICTRO), and the following areas are briefly discussed together with some projections for the direction of clinical trials in radiation oncology into the 1990s:- radiosensitizers, radioprotectors, and their combination, drug-radiation interactions, dose/time/fractionation, hyperthermia, biological response modifiers and radiolabelled antibodies, high LET, particularly neutron therapy, large field irradiation and interoperative irradiation, research studies on specific sites. (U.K.)

  6. Clinical oncology - comparison of two-dimensional and three-dimensional acquisition in oncological patients

    Full text: The 3D acquisition mode presents the possibility of shorter scan times with decreased injection dose. In the present study, the clinical results in two-dimensional (2D) and three-dimensional (3D) acquisition mode were compared. We report our data of 3D PET imaging for clinical oncological patients using a Siemens ECAT Exact 47. 50 oncological patients were observed with F-18-FDG in a 2D whole body (WB) routine scan (5 or 6 bed positions). The 2D-FDG-PET studies are performed in 2D emission for 8 min and in 2D transmission for 2 min followed by one bedposition scan in 3D technique (5 min 3D emission scan and a 2 min transmission scan ) in a region with detected lesion. Both 2D and 3D data were reconstructed using iterative reconstruction (2 iterations with 8 subsets). A visual interpretation of contrast, identifiability, geometrical form and a quantitative evaluation (SUV and metabolic extension) was performed. No clinically relevant differences in detection of lesions between 2D and 3D mode were found by the qualitative and quantitative analysis. The contrast, geometrical form and the SUV compared side by side showed small differences. Based on this preliminary results, it seems that 3D technique is equal with 2D in clinical oncological PET with reduction in WB scan time. (author)

  7. Clinical presentation of abdominal tuberculosis in HIV seronegative adults

    Guran Mithat; Ince Ali T; Sokmen Mehmet H; Akbayir Nihat; Dalay Remzi A; Kendir Tulin; Bolukbas Fusun F; Bolukbas Cengiz; Ceylan Erkan; Kilic Guray; Ovunc Oya

    2005-01-01

    Abstract Background The accurate diagnosis of abdominal tuberculosis usually takes a long time and requires a high index of suspicion in clinic practice. Eighty-eight immune-competent patients with abdominal tuberculosis were grouped according to symptoms at presentation and followed prospectively in order to investigate the effect of symptomatic presentation on clinical diagnosis and prognosis. Methods Based upon the clinical presentation, the patients were divided into groups such as non-sp...

  8. Medical Oncology Pharmacy: A New Role for the Clinical Pharmacist

    Morris, Carl R.; Hickman, Mary Johne

    1977-01-01

    The University of Tennessee has established a training program for clinical pharmacists dealing with cancer chemotherapy patients. Health-care settings are described in which these individuals can contribute as unique health-care team members in oncology. (Author/LBH)

  9. Monitoring cancer stem cells: insights into clinical oncology

    Lin SC

    2016-02-01

    Full Text Available ShuChen Lin,1,* YingChun Xu,2,* ZhiHua Gan,1 Kun Han,1 HaiYan Hu,3 Yang Yao,3 MingZhu Huang,4 DaLiu Min1 1Department of Oncology, Shanghai Sixth People’s Hospital East Campus, Shanghai Jiao Tong University, 2Department of Oncology, Renji Hospital, Shanghai Jiao Tong University, 3Department of Oncology, The Sixth People’s Hospital, Shanghai Jiao Tong University, 4Department of Medical Oncology, Cancer Hospital of Fudan University, Shanghai, People’s Republic of China *These authors contributed equally to this work Abstract: Cancer stem cells (CSCs are a small, characteristically distinctive subset of tumor cells responsible for tumor initiation and progression. Several treatment modalities, such as surgery, glycolytic inhibition, driving CSC proliferation, immunotherapy, and hypofractionated radiotherapy, may have the potential to eradicate CSCs. We propose that monitoring CSCs is important in clinical oncology as CSC populations may reflect true treatment response and assist with managing treatment strategies, such as defining optimal chemotherapy cycles, permitting pretreatment cancer surveillance, conducting a comprehensive treatment plan, modifying radiation treatment, and deploying rechallenge chemotherapy. Then, we describe methods for monitoring CSCs. Keywords: cancer stem cells, glycolytic inhibition, watchful waiting, rechallenge, immunotherapy

  10. Translating clinical trials from human to veterinary oncology and back

    Fürdös, Irene; Fazekas, Judit; Singer, Josef; Jensen-Jarolim, Erika

    2015-01-01

    In human medicine clinical trials are legally required for drug development and approval. In contrast, clinical trials in small animal cancer patients are less common and legally perceived as animal experiments. Comparative oncology has been recognized as a method to speed up the development of medications by introducing animal patients with naturally developing tumours. In such cases, using animal patients would generate more robust data, as their spontaneous disease resembles the “real life...

  11. Sagittal Abdominal Diameter: Application in Clinical Practice

    Thaís Da Silva-Ferreira

    2014-05-01

    Full Text Available Excess visceral fat is associated with cardiovascular risk factors. Sagittal abdominal diameter (SAD has recently been highlighted as an indicator of abdominal obesity, and also may be useful in predicting cardiovascular risk. The purpose of the present study was to review the scientific literature on the use of SAD in adult nutritional assessment. A search was conducted for scientific articles in the following electronic databases: SciELO , MEDLINE (PubMed and Virtual Health Library. SAD is more associated with abdominal fat (especially visceral, and with different cardiovascular risk factors, such as, insulin resistance, blood pressure, and serum lipoproteins than the traditional methods of estimating adiposity, such as body mass index and waist-to-hip ratio. SAD can also be used in association with other anthropometric measures. There are still no cut-off limits established to classify SAD as yet. SAD can be an alternative measure to estimate visceral adiposity. However, the few studies on this diameter, and the lack of consensus on the anatomical site to measure SAD, are obstacles to establish cut-off limits to classify it.

  12. Clinical application of PET/MRI in oncology.

    Sotoudeh, Houman; Sharma, Akash; Fowler, Kathryn J; McConathy, Jonathan; Dehdashti, Farrokh

    2016-08-01

    Hybrid imaging with integrated positron emission tomography (PET) and magnetic resonance imaging (MRI) combines the advantages of the high-resolution anatomic data from MRI and functional imaging data from PET, and has the potential to improve the diagnostic evaluation of various types of cancers. The clinical oncologic applications of this newest hybrid imaging technology are evolving and substantial efforts are underway to define the role of PET/MRI in routine clinical use. The current published literature suggests that PET/MRI may play an important role in the evaluation of patients with certain types of malignancies, involving anatomic locations such as the pelvis and the liver. The purpose of this article is to review the current published PET/MRI literature in specific body oncologic applications. In addition, PET/MRI protocols and some of the technical issues of this hybrid imaging will be briefly discussed. J. Magn. Reson. Imaging 2016;44:265-276. PMID:27007987

  13. Selenium in Oncology: From Chemistry to Clinics

    Oliver Micke; Lutz Schomburg; Jens Buentzel; Klaus Kisters; Ralph Muecke

    2009-01-01

    The essential trace element selenium, which is a crucial cofactor in the most important endogenous antioxidative systems of the human body, is attracting more and more the attention of both laypersons and expert groups. The interest of oncologists mainly focuses in the following clinical aspects: radioprotection of normal tissues, radiosensitizing in malignant tumors, antiedematous effect, prognostic impact of selenium, and effects in primary and secondary cancer prevention. Selenium is a con...

  14. Integrating pain metrics into oncology clinical trials.

    Cleeland, Charles S; O'Mara, Ann; Zagari, Martin; Baas, Carole

    2011-11-01

    Cancer-related pain is highly prevalent and often severe, and as a result is often one of the defining experiences for patients with malignancy. Patients and patients' families almost always live with the ever-present reality that cancer treatment and progression may be accompanied by pain. For patients nearing the end of life, most fear that their final days will be spent living with the terrible effects of the disease, the most important of which is pain. Despite this, there is far less systematic research on the mechanisms of cancer-related pain or on the development of new agents to reduce or eliminate pain in cancer patients compared with research to combat the disease itself. Further, even when the focus of research is treatment of the tumor, the effects of anticancer treatments on pain are often underreported in publications and other forums. To illustrate the relative drought in the cancer pain control area, there have been no new drugs approved for cancer-related pain in recent years. A number of methodologic and logistical challenges that hinder the ability to assess pain response in clinical trials are discussed in this article. Possible ways to address these challenges are also discussed. PMID:22046026

  15. Clinical exercise interventions in pediatric oncology: a systematic review.

    Baumann, Freerk T; Bloch, Wilhelm; Beulertz, Julia

    2013-10-01

    Studies in pediatric oncology have shown a positive effect of physical activity on disease- and treatment-related side effects. Although several reviews have approved the benefits of therapeutic exercise for adult cancer patients, no systematic review exists summarizing the evidence of physical activity in pediatric oncology. We identified a total of 17 studies using the PubMed database and Cochrane library. To evaluate the evidence, we used the evaluation system of the Oxford Center for Evidence-Based Medicine 2001. The findings confirm that clinical exercise interventions are feasible and safe, especially with acute lymphoblastic leukemia (ALL) patients and during medical treatment. No adverse effects have been reported. Positive effects were found on fatigue, strength, and quality of life. Single studies present positive effects on the immune system, body composition, sleep, activity levels, and various aspects of physical functioning. Child-specific aspects such as cognitive abilities, growth, adolescence, and reintegration into peer-groups, school, and sports have barely been taken into consideration. The evidence for exercise interventions in pediatric oncology is rated level "3." Although the results are very promising, future research of high methodological quality and focusing on child-specific aspects is needed to establish evidence-based exercise recommendations, particularly for childhood cancer patients. PMID:23857296

  16. Prevalence of abdominal migraine and recurrent abdominal pain in a Japanese clinic.

    Hikita, Toshiyuki

    2016-07-01

    Prevalence of abdominal migraine (AM) and recurrent abdominal pain (RAP) was evaluated in patients who visited Hikita Pediatric Clinic between May 2010 and April 2015. Patient data were collected prospectively using a questionnaire. Out of a total of 3611 cases, observed prevalence was 2.44% for repeated abdominal pain over a period of ≥3 months, 1.47% for RAP, and 0.19% for AM. Duration of abdominal pain was longer for AM than for non-AM RAP. Certain clinical features were significantly different between AM and non-AM RAP. No correlations were found among age at onset, frequency of attack, and duration of attack for various types of RAP. It was difficult to determine useful diagnostic criteria for distinguishing between AM and non-AM RAP. They did not appear to be separate disease entities but, instead, lie on a disease spectrum. The present prevalence of AM (0.19%) was lower than that in many previous studies from countries other than Japan. PMID:27460403

  17. Clinical Positioning Space: Residents' Clinical Experiences in the Outpatient Oncology Clinic.

    Williams, Lars H; Christensen, Mette K; Rytter, Carsten; Musaeus, Peter

    2015-09-01

    In this article, we present a case study of residents' clinical experiences and communication in outpatient oncology consultations. We apply positioning theory, a dynamic alternative to role theory, to investigate how oncology residents and patients situate themselves as persons with rights and duties. Drawing from seven qualitative interviews and six days of observation, we investigate the residents' social positioning and their conversations with patients or supervisors. Our focus is on how (a) relational shifts in authority depend on each situation and its participants; (b) storylines establish acts and positions and narratively frame what participants can expect from a medical consultation viewed as a social episode; and (c) the positioning of rights and duties can lead to misunderstandings and frustrations. We conclude that residents and patients locate themselves in outpatient conversations as participants who jointly produce and are produced by patients' and nurses' storylines about who should take responsibility for treatment. PMID:25288406

  18. Clinical and CT imaging features of abdominal fat necrosis

    Fat necrosis is a common pathological change at abdominal cross-sectional imaging, and it may cause abdominal pain, mimic pathological change of acute abdomen, or be asymptomatic and accompany other pathophysiologic processes. Fat necrosis is actually the result of steatosis by metabolism or mechanical injury. Common processes that are present in fat necrosis include epiploic appendagitis, infarction of the greater omentum, pancreatitis, and fat necrosis related to trauma or ischemia. As a common fat disease, fat necrosis should be known by clinicians and radiologists. Main content of this text is the clinical symptoms and CT findings of belly fat necrosis and related diseases. (authors)

  19. Next-Generation Sequencing in Clinical Oncology: Next Steps Towards Clinical Validation

    Nigel C. Bennett

    2014-11-01

    Full Text Available Compelling evidence supports the transition of next generation sequencing (NGS technology from a research environment into clinical practice. Before NGS technologies are fully adopted in the clinic, they should be thoroughly scrutinised for their potential as powerful diagnostic and prognostic tools. The importance placed on generating accurate NGS data, and consequently appropriate clinical interpretation, has stimulated much international discussion regarding the creation and implementation of strict guidelines and regulations for NGS clinical use. In the context of clinical oncology, NGS technologies are currently transitioning from a clinical research background into a setting where they will contribute significantly to individual patient cancer management. This paper explores the steps that have been taken, and those still required, for the transition of NGS into the clinical area, with particular emphasis placed on validation in the setting of clinical oncology.

  20. Functional imaging in oncology. Clinical applications. Vol. 2

    Luna, Antonio [Case Western Reserve Univ., Cleveland, OH (United States). Dept. of Radiology; MRI Health Time Group, Jaen (Spain); Vilanova, Joan C. [Girona Univ. (Spain). Clinica Girona - Hospital Sta. Caterina; Hygino da Cruz, L. Celso Jr. (ed.) [CDPI and IRM, Rio de Janeiro (Brazil). Dept. of Radiology; Rossi, Santiago E. [Centro de Diagnostico, Buenos Aires (Argentina)

    2014-06-01

    Easy-to-read manual on new functional imaging techniques in oncology. Explains current clinical applications and outlines future avenues. Includes numerous high-quality illustrations to highlight the major teaching points. In the new era of functional and molecular imaging, both currently available imaging biomarkers and biomarkers under development are expected to lead to major changes in the management of oncological patients. This two-volume book is a practical manual on the various imaging techniques capable of delivering functional information on cancer, including diffusion MRI, perfusion CT and MRI, dual-energy CT, spectroscopy, dynamic contrast-enhanced ultrasonography, PET, and hybrid modalities. This second volume considers the applications and benefits of these techniques in a wide range of tumor types, including their role in diagnosis, prediction of treatment outcome, and early evaluation of treatment response. Each chapter addresses a specific malignancy and is written by one or more acclaimed experts. The lucid text is complemented by numerous high-quality illustrations that highlight key features and major teaching points.

  1. Functional imaging in oncology. Clinical applications. Vol. 2

    Easy-to-read manual on new functional imaging techniques in oncology. Explains current clinical applications and outlines future avenues. Includes numerous high-quality illustrations to highlight the major teaching points. In the new era of functional and molecular imaging, both currently available imaging biomarkers and biomarkers under development are expected to lead to major changes in the management of oncological patients. This two-volume book is a practical manual on the various imaging techniques capable of delivering functional information on cancer, including diffusion MRI, perfusion CT and MRI, dual-energy CT, spectroscopy, dynamic contrast-enhanced ultrasonography, PET, and hybrid modalities. This second volume considers the applications and benefits of these techniques in a wide range of tumor types, including their role in diagnosis, prediction of treatment outcome, and early evaluation of treatment response. Each chapter addresses a specific malignancy and is written by one or more acclaimed experts. The lucid text is complemented by numerous high-quality illustrations that highlight key features and major teaching points.

  2. Phase 0 clinical trials in oncology new drug development

    Umesh Chandra Gupta

    2011-01-01

    Full Text Available Research focus of pharmaceutical industry has expanded to a larger extent in last few decades putting many more new molecules, particularly targeted agents, for the clinical development. On the other hand, researchers are facing serious challenges due to high failure rates of new molecules in clinical studies. The United States Food and Drug Administration (FDA in combination with academia and industry experts identified many factors responsible for failures of new molecules, and with a vision of taking traditional drug development model toward an innovative paradigm shift, issued regulatory guidance on conduct of exploratory investigational new drug (exploratory IND studies, often called as phase 0 clinical trials, requiring reduced preclinical testing, which has special relevance to life-threatening diseases such as cancer. Phase 0 trials, utilizing much lower drug doses, provide an opportunity to explore the clinical behavior of new molecules very early in the drug development pathway, helping to identify the promising candidates and eliminating non-promising molecules, thus improving the efficiency of overall drug development with significant savings of resources. Being non-therapeutic in nature, these studies, however, pose certain ethical challenges requiring careful study designing and informed consent process. This article reviews the insights and perspectives for the feasibility, utility, planning, designing and conduct of phase 0 clinical trials, in addition to ethical issues and industrial perspective focused at oncology new drug development.

  3. A CLINICAL STUDY AND MANAGEMENT OF ABDOMINAL INJURIES

    Sreenidhi

    2014-09-01

    Full Text Available OBJECTIVE: 1. to evaluate the impact of blunt abdominal trauma on the Solid abdominal viscera’s, hollow viscera’s, mesentery and Retroperitoneal structures and various modes of presentation in early diagnosis. 2. To evaluate various modalities of management and complications. BACKGROUND DATA: Blunt abdominal trauma is one of the most common injuries caused mainly by road traffic accidents. They are usually not obvious. Hence, often missed unless, strong suspicion. In view of increasing number of motor vehicles and consequently road traffic accidents, this study has been chosen to study the cases of injury to solid organs in blunt abdominal trauma. MATERIAL AND METHODS: This is a prospective study of blunt injury abdomen during the period from September 2010 to September 2013. Number of cases studied is 100. Data were collected from the Patients by their clinical history, examination and appropriate investigations. Post-operative follow-up was done to note for complications. Documentation of patients, which included, identification, history, clinical findings, diagnostic test, operative findings, operative procedures, complications during the stay in the hospital and during subsequent follow-up period, were all recorded on a proforma specially prepared. The decision for operative or non-operative management depended on the outcome of the Hemodynamic status and Computed Tomography. RESULTS: The majority of the patients belonged to 11 to 20 years age group, followed by 21-30 years age group. 91 cases were males, with females accounting for only about 9 cases. 74 patients were operated and 26 patients were subjected for non- operative management. Road traffic accident was responsible for 62% of blunt abdominal trauma cases, while fall from heights accounted for 27% of cases and blow with blunt object was responsible for 11% of injuries. Majority of the patients presented with abdominal pain (90% and abdominal tenderness (82%. Average latent

  4. Clinical microdialysis in neuro-oncology: principles and applications

    J. Clay Goodman

    2011-01-01

    Clinical microdialysis allows a discrete volume of the brain to be sampled for neurochemical analysis of neurotransmitters, metabolites, biomarkers, and drugs. The technique can be safely used in humans intraoperatively, in the intensive care unit, and in ambulatory settings. Microdialysis probes, micropumps, and analytical equipment are commercially available and have been used extensively for neurochemical monitoring in traumatic brain injury, stroke, and subarachnoid hemorrhage. There has been very limited use of micredialysis in neuro-oncology, but this technique has groat promise in the study of the basic neurochemistry of brain tumors, alterations in neurochemistry in response to therapy, and the pharmacokinetics of chemotherapeutic agents. Microdialysis probes may also be used to deliver drugs while simultaneously permitting monitoring of neurochemical changes induced by this therapy.

  5. Contract research organizations in oncology clinical research: Challenges and opportunities.

    Roberts, Daniel A; Kantarjian, Hagop M; Steensma, David P

    2016-05-15

    Contract research organizations (CROs) represent a multibillion dollar industry that is firmly embedded in the contemporary clinical trial process. Over the past 30 years, and especially within the last decade, the reach of CROs has extended to service all phases of drug trials in an increasingly global research environment. The presence of CROs is particularly noticeable in medical oncology because of the large number of investigational compounds developed to treat cancer that are currently undergoing testing in human subjects. Although limited data are available with which to objectively define the effects that CROs have had on the clinical trial process, with the expansion of these organizations, several reports have called into question whether ethical and professional standards in research conduct are at times secondary to economic considerations. CROs can add considerable value to the clinical trial process, but difficulty communicating with CRO representatives and time spent answering trivial data queries generated by CROs are current obstacles for study site personnel interacting with CROs. Further study of the effect of the CRO industry on the clinical trial process is needed to ensure efficient data collection and patient safety while collaboratively developing novel therapies in an expedited fashion. Cancer 2016;122:1476-82. © 2016 American Cancer Society. PMID:27018651

  6. Clinical Training of Medical Physicists Specializing in Radiation Oncology

    The application of radiation in human health, for both diagnosis and treatment of disease, is an important component of the work of the IAEA. The responsibility for the increasing technical aspects of this work is undertaken by the medical physicist. To ensure good practice in this vital area structured clinical training programmes are required to complement academic learning. This publication is intended to be a guide to the practical implementation of such a programme for radiation therapy. There is a general and growing awareness that radiation medicine is increasingly dependant on well trained medical physicists that are based in the clinical setting. However an analysis of the availability of medical physicists indicates a large shortfall of qualified and capable professionals. This is particularly evident in developing countries. While strategies to increase academic educational opportunities are critical to such countries, the need for guidance on structured clinical training was recognised by the members of the Regional Cooperative Agreement (RCA) for research, development and training related to nuclear sciences for Asia and the Pacific. Consequently a technical cooperation regional project (RAS6038) under the RCA programme was formulated to address this need in the Asia Pacific region by developing suitable material and establishing its viability. Development of a clinical training guide for medical physicists specialising in radiation therapy was started in 2005 with the appointment of a core drafting committee of regional and international experts. Since 2005 the IAEA has convened two additional consultant group meetings including additional experts to prepare the present publication. The publication drew heavily, particularly in the initial stages, from the experience and documents of the Clinical Training Programme for Radiation Oncology Medical Physicists as developed by the Australasian College of Physical Scientists and Engineers in Medicine. Their

  7. Effects of Age Expectations on Oncology Social Workers' Clinical Judgment

    Conlon, Annemarie; Choi, Namkee G.

    2014-01-01

    Objective: This study examined the influence of oncology social workers' expectations regarding aging (ERA) and ERA with cancer (ERAC) on their clinical judgment. Methods: Oncology social workers (N = 322) were randomly assigned to one of four vignettes describing a patient with lung cancer. The vignettes were identical except for the…

  8. A national radiation oncology medical student clerkship survey: Didactic curricular components increase confidence in clinical competency

    Jagadeesan, Vikrant S.; Raleigh, David R.; Koshy, Matthew; Howard, Andrew R.; Chmura, Steven J.; Golden, Daniel W.

    2014-01-01

    Purpose/Objectives Students applying to radiation oncology residency programs complete one or more radiation oncology clerkships. This study assesses student experiences and perspectives during radiation oncology clerkships. The impact of didactic components and number of clerkship experiences in relation to confidence in clinical competency and preparation to function as a first year radiation oncology resident are evaluated. Methods and Materials An anonymous, internet-based survey was sent via direct e-mail to all applicants to a single radiation oncology residency program during the 2012–2013 academic year. The survey was composed of three main sections including questions regarding baseline demographic information and prior radiation oncology experience, rotation experiences, and ideal clerkship curriculum content. Results The survey response rate was 37% (70/188). Respondents reported 191 unique clerkship experiences. 27% of respondents (19/70) completed at least one clerkship with a didactic component geared towards their level of training. Completing a clerkship with a didactic component was significantly associated with a respondent’s confidence to function as a first- year radiation oncology resident (Wilcoxon rank-sum p = 0.03). However, the total number of clerkships completed did not correlate with confidence to pursue radiation oncology as a specialty (Spearman’s rho p = 0.48) or confidence to function as a first year resident (Spearman’s rho p = 0.43). Conclusions Based on responses to this survey, rotating students perceive that the majority of radiation oncology clerkships do not have formal didactic curricula. Survey respondents who completed a clerkship with a didactic curriculum reported feeling more prepared to function as a radiation oncology resident. However, completing an increasing number of clerkships does not appear to improve confidence in the decision to pursue radiation oncology as a career or to function as a radiation

  9. A National Radiation Oncology Medical Student Clerkship Survey: Didactic Curricular Components Increase Confidence in Clinical Competency

    Purpose: Students applying to radiation oncology residency programs complete 1 or more radiation oncology clerkships. This study assesses student experiences and perspectives during radiation oncology clerkships. The impact of didactic components and number of clerkship experiences in relation to confidence in clinical competency and preparation to function as a first-year radiation oncology resident are evaluated. Methods and Materials: An anonymous, Internet-based survey was sent via direct e-mail to all applicants to a single radiation oncology residency program during the 2012-2013 academic year. The survey was composed of 3 main sections including questions regarding baseline demographic information and prior radiation oncology experience, rotation experiences, and ideal clerkship curriculum content. Results: The survey response rate was 37% (70 of 188). Respondents reported 191 unique clerkship experiences. Of the respondents, 27% (19 of 70) completed at least 1 clerkship with a didactic component geared towards their level of training. Completing a clerkship with a didactic component was significantly associated with a respondent's confidence to function as a first-year radiation oncology resident (Wilcoxon rank–sum P=.03). However, the total number of clerkships completed did not correlate with confidence to pursue radiation oncology as a specialty (Spearman ρ P=.48) or confidence to function as a first year resident (Spearman ρ P=.43). Conclusions: Based on responses to this survey, rotating students perceive that the majority of radiation oncology clerkships do not have formal didactic curricula. Survey respondents who completed a clerkship with a didactic curriculum reported feeling more prepared to function as a radiation oncology resident. However, completing an increasing number of clerkships does not appear to improve confidence in the decision to pursue radiation oncology as a career or to function as a radiation oncology resident. These results

  10. Cancer-related fatigue. Clinical practice guidelines in oncology.

    2003-07-01

    These guidelines propose a treatment algorithm in which patients are evaluated regularly for fatigue using a brief screening instrument, and are treated as indicated by their fatigue level. The algorithm's goal is to identify and treat all patients with fatigue that causes distress or interferes with their daily activities or functioning. Management of fatigue begins with primary oncology team members who perform the initial screening and either provide basic education and counseling or expand the initial screening to a more focused evaluation for moderate or higher levels of fatigue. At this point the patient is assessed for current disease and treatment status, a review of body systems, and an in-depth fatigue evaluation. In addition, the patient is assessed for the presence of seven treatable factors known to contribute to fatigue: pain, emotional distress, sleep disturbance, anemia, alterations in nutrition, deconditioning, and comorbidities. If any of these conditions are present, they should be treated according to practice guidelines, with referral to other care professionals as appropriate, and the patient's fatigue should be reevaluated regularly. If none of the seven factors are present or the fatigue is unresolved, selection of appropriate fatigue management and treatment strategies is considered within the context of the patient's clinical status: receiving active cancer treatment, receiving disease-free long-term follow-up, or receiving care at the end of life. Management of fatigue is cause-specific when conditions known to cause fatigue can be identified and treated. When specific causes, such as infection, fluid and electrolyte imbalances, or cardiac dysfunction, cannot be identified and corrected, nonpharmacologic and pharmacologic treatment of the fatigue should be considered. Nonpharmacologic interventions may include a moderate exercise program to improve functional capacity and activity tolerance, psychosocial programs to manage stress and

  11. Guide to clinical PET in oncology: Improving clinical management of cancer patients

    Positron emission tomography (PET) has an approximately 50 year-history. It was developed as a tool of medical science to quantitatively measure metabolic rates of bio-substances in vivo and in particular the number of receptors in neuroscience. Until the late 1990s PET was, in most cases, research oriented activity. In 2001, positron emission tomography/X ray computed tomography (PET/CT) hybrid imaging system became commercially available. An era of clinical PET then emerged, in which PET images were utilized for clinical practice in the treatment and diagnosis of cancer patients. PET imaging could recognize areas of abnormal metabolic behaviour of cancers in vivo, and the addition of CT imaging underlines the site of malignancy. More accurate and precise interpretation of cancer lesions can therefore be performed by PET/CT imaging than PET or CT imaging alone. Clinical PET, in particular with fluorine-18-fluorodeoxyglucose (18F-FDG), has already proven itself to have considerable value in oncology. The indications include malignant lymphoma and melanoma, head and neck cancers, oesophageal cancer, breast cancer, lung cancer and colorectal cancer, and it is still being expanded. The roles of clinical PET could be for 1) preoperative staging of cancers, 2) differentiation between residual tumour and scarring, 3) demonstration of suspected recurrences, 4) monitoring response to therapy, 5) prognosis and 6) radiotherapy treatment planning. Clinical PET can be used to illustrate exactly which treatment should be applied for a cancer patient as well as where surgeons should operate and where radiation oncologists should target radiation therapy. An almost exponential rise in the introduction of clinical PET, as well as the installation of PET/CT has been seen throughout the world. Clinical PET is currently viewed as the most powerful diagnostic tool in its field. This IAEA-TECDOC presents an overview of clinical PET for cancer patients and a relevant source of

  12. Tracking the 2015 Gastrointestinal Cancers Symposium: bridging cancer biology to clinical gastrointestinal oncology

    Aprile G

    2015-05-01

    Full Text Available Giuseppe Aprile,1 Francesco Leone,2,3 Riccardo Giampieri,4 Mariaelena Casagrande,1 Donatella Marino,2,3 Luca Faloppi,4 Stefano Cascinu,4 Gianpiero Fasola,1 Mario Scartozzi5,6 1Department of Oncology, University and General Hospital, Udine, Italy; 2Medical Oncology Department, University of Turin, 3Institute for Cancer Research and Treatment, Candiolo, Turin, Italy; 4Medical Oncology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Universita Politecnica delle Marche, Ancona, Italy; 5Medical Oncology Department, University of Cagliari, 6General Hospital, Cagliari, Italy Abstract: The 2015 Gastrointestinal Cancers Symposium (San Francisco, CA, USA; January 15–17 is the world-class conference co-sponsored by the American Society of Clinical Oncology, the American Society for Radiation Oncology, the American Gastroenterological Association Institute, and the Society of Surgical Oncology, in which the most innovative research results in digestive tract oncology are presented and discussed. In its twelfth edition, the meeting has provided new insights focusing on the underpinning biology and clinical management of gastrointestinal malignancies. More than 3,400 health care professionals gathered from all over the world to share their experiences on how to bridge the recent novelties in cancer biology with everyday medical practice. In this article, the authors report on the most significant advances, didactically moving on three different anatomic tracks: gastroesophageal malignancies, pancreatic and biliary cancers, and colorectal adenocarcinomas. Keywords: colorectal cancer, gastric cancer, ramucirumab, pembrolizumab, target therapy, onartuzumab, AMG 337

  13. [Evidence and recommendations for oncologic clinical exercise - a personalized treatment concept for cancer patients].

    Baumann, Freerk Theeagnus; Hallek, Michael; Meyer, Janika; Galvão, Daniel Abido; Bloch, Wilhelm; Elter, Thomas

    2015-09-01

    Oncological treatments can lead to acute and chronic cancer related toxicities. In recent years, a large number of clinical studies have reported positive effects of exercise to the bio-psycho-social regeneration of cancer patients. However, very few evidence-based programs have been implemented into practice with little opportunity for cancer patients to engage in such programs. Reviews and RCT studies on exercise and cancer are showing that specific exercise programs have a positive impact on fatigue syndrome, urinary incontinence, lymphedema, polyneuropathy, arthralgia, and androgen deprivation related toxicities. With the increasing evidence for exercise oncology interventions, recommendations arising from clinical trials should be translated into clinical practice and this should be viewed as an important next step in this fast moving field of exercise oncology. For that the personalized treatment concept "Oncologic clinical exercise" (OTT) was developed. PMID:26402184

  14. Contribution for Invitation for The Chinese-German Journal of Clinical Oncology

    2003-01-01

    The Chinese-German Journal of Clinical Oncology isan international, professional, academic periodical on on-cology, co-edited by China and Germany. With the au-thors from around the world, especially from China, thejournal focuses on introducing clinical experience in diag-nosis and treatment and leading scientific research a-chievement in the tumor domain, in addition to reportingbasic theory research which help to teach the clinicalpractice of oncology and closely connect with the disci-pline. All manuscripts are published in English: the jour-nal is issued quarterly, with the International SerialStandard Number (ISSN) 1610-1979/CN/42-1654/R.

  15. An exploration of oncology specialist nurses’ roles in nurse-led chemotherapy clinics

    Farrell, Carole Denise

    2014-01-01

    The purpose of this study was to investigate nurses’ roles within nurse-led chemotherapy clinics. There has been a rapid expansion and development of nursing roles and responsibilities in oncology, but little understanding of how roles are enacted and their impact on patient experiences and outcomes. This was a two stage approach comprising a survey of UK oncology specialist nurses followed by an ethnographic study of nurses’ roles in nurse led chemotherapy clinics. Ethics approval was obtain...

  16. Lack of timely accrual information in oncology clinical trials: a cross-sectional analysis

    Mitchell, Aaron P.; Bradford R Hirsch; Abernethy, Amy P

    2014-01-01

    Background Poor accrual is a significant barrier to the successful completion of oncology clinical trials; half of all phase 3 oncology trials close due to insufficient accrual. Timely access to accrual data fosters an understanding of successful trial design and can be used to inform the design of new clinical trials prospectively. Accrual statistics are available within research networks, such as the cancer cooperative groups, but comprehensive data reflecting the overall portfolio of cance...

  17. Measurement of nurses' workload in an oncology outpatient clinic

    Célia Alves de Souza

    2014-02-01

    Full Text Available The growing demand and the degree of patient care in oncological outpatient services, as well as the complexity of treatment have had an impact on the workload of nurses. This study aimed at measuring the workload and productivity of nurses in an oncological outpatient service. An observational study using a work sampling technique was conducted and included seven nurses working in an oncological outpatient service in the south-eastern region of Brazil. A total of 1,487 intervention or activity samples were obtained. Nurses used 43.2% of their time on indirect care, 33.2% on direct care, 11.6% on associated activities, and 12% on personal activities. Their mean productivity was 88.0%. The findings showed that nurses in this service spend most of their time in indirect care activities. Moreover, the productivity index in this study was above that recommended in the literature.

  18. Project reconversion Service Hospital Radiation Oncology Clinics-Medical School

    Introduction: The Health Sector operates within the framework of Social Policy and it is therefore one of the ways of distribution of public benefit, like Housing, Education and Social Security. While public spending on health has grown in recent years, its distribution has been uneven and the sector faces funding and management problems. The Service Hospital Radiation Oncology has reduced its health care liavility , lack technological development and unsufficient human resources and training. Aim: developing an inclusive reform bill Service Hospital Radiation Oncology .Material and Methods: This project tends to form a network institutional, introducing concepts of evidence-based medicine, risk models, cost analysis, coding systems, system implementation of quality management (ISO-9000 Standards). Proposes redefining radiotherapy centers and their potential participation in training resource development goals humanos.Promueve scientific research of national interest. Separate strictly administrative function, management and teaching. The project takes into account the characteristics of demand, the need to order it and organize around her, institutional network system and within the Hospital das Clinicas own related services related to Service Hospital Radiation Oncology , Encourages freedom of choice, and confers greater equity in care. The project would managed by the Hospital Clínicas. Conclusions: We believe this proposal identifies problems and opportunities, Service Hospital Radiation Oncology proposes the development of institutional network under one management model

  19. The clinical picture of duodenal rupture after blunt abdominal trauma

    The case of a 30 years old woman who suffered a pneumoretroperitoneum due to a blunt abdominal trauma is reported. The characteristic roentgen signs showing the source of the retroperitoneal air trappings are discussed. The exact analysis of simple abdominal plain films allows early references to an often life-threatening disease without expensive additional examinations. (orig.)

  20. Contribution Invitation of The Chinese-German Journal of Clinical Oncology

    2005-01-01

    @@ The Chinese-German Journal of Clinical Oncology is an international professional academic periodical on oncology, being co-edited by China and Germany. The Journal, with the authors from around world, especially from China, is dominated in introducing the clinical experience of diagnosis and treatment as well as leading scientific research achievement in the tumor domain, in addition to report basic theory researches which help instruct the clinical practice of oncology and closely connect with the discipline. All the manuscripts are published in English, quarterly issued both internal and external, 64 -80pages, big 16 opens domains, art paper in offset printing, with lay-out by international customs, unified issuing number: ISSN 1610-1979 (Paper) 1613-9089 (Online)/CN 42-1654/R.

  1. Clinical practice guidelines and consensus statements in oncology--an assessment of their methodological quality.

    Carmel Jacobs

    Full Text Available BACKGROUND: Consensus statements and clinical practice guidelines are widely available for enhancing the care of cancer patients. Despite subtle differences in their definition and purpose, these terms are often used interchangeably. We systematically assessed the methodological quality of consensus statements and clinical practice guidelines published in three commonly read, geographically diverse, cancer-specific journals. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. METHODS: Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. FINDINGS: Thirty-four consensus statements and 67 clinical practice guidelines were evaluated. The rigour of development score for consensus statements over the three journals was 32% lower than that of clinical practice guidelines. The editorial independence score was 15% lower for consensus statements than clinical practice

  2. FDG PET/CT in clinical oncology. Case based approach with teaching points

    Organized according to the role of FDG PET/CT in the evaluation and management of oncology patients. 100 informative cases reflecting the issues that clinicians address in their daily practice. Ideal for all newcomers to the field, whether medical students, radiology, nuclear medicine, or oncology fellows, or practicing physicians. FDG PET/CT has rapidly emerged as an invaluable combined imaging modality that can identify tumors on the basis of not only anatomical alterations but also metabolic activity, thus allowing the detection of lesions that would otherwise be too small to distinguish. This book, comprising a collection of images from oncology cases, is organized according to the role of FDG PET/CT in the evaluation and management of oncology patients, and only secondarily by organ or tumor entity. In this way, it reflects the issues that clinicians actually address in their daily practice, namely: identification of an unknown or unsuspected primary; determination of the extent of disease; evaluation of response to therapy; and surveillance after response, i.e., detection of recurrent disease. In total, 100 cases involving different primary tumors are presented to illustrate findings in these different circumstances. FDG PET/CT in Clinical Oncology will be of great value to all newcomers to this field, whether medical students, radiology, nuclear medicine, or oncology fellows, or practicing physicians.

  3. FDG PET/CT in clinical oncology. Case based approach with teaching points

    Mihailovic, Jasna [Novi Sad Univ. (Serbia). Dept. of Nuclear Medicine; Goldsmith, Stanley J. [Weill Cornell Medical College, New York, NY (United States). Div. of Nuclear Medicine and Molecular Imging; Killeen, Ronan P. [St. Vincents Univ. Hospital, Dublin (Ireland)

    2012-07-01

    Organized according to the role of FDG PET/CT in the evaluation and management of oncology patients. 100 informative cases reflecting the issues that clinicians address in their daily practice. Ideal for all newcomers to the field, whether medical students, radiology, nuclear medicine, or oncology fellows, or practicing physicians. FDG PET/CT has rapidly emerged as an invaluable combined imaging modality that can identify tumors on the basis of not only anatomical alterations but also metabolic activity, thus allowing the detection of lesions that would otherwise be too small to distinguish. This book, comprising a collection of images from oncology cases, is organized according to the role of FDG PET/CT in the evaluation and management of oncology patients, and only secondarily by organ or tumor entity. In this way, it reflects the issues that clinicians actually address in their daily practice, namely: identification of an unknown or unsuspected primary; determination of the extent of disease; evaluation of response to therapy; and surveillance after response, i.e., detection of recurrent disease. In total, 100 cases involving different primary tumors are presented to illustrate findings in these different circumstances. FDG PET/CT in Clinical Oncology will be of great value to all newcomers to this field, whether medical students, radiology, nuclear medicine, or oncology fellows, or practicing physicians.

  4. Reiki as a clinical intervention in oncology nursing practice.

    Bossi, Larraine M; Ott, Mary Jane; DeCristofaro, Susan

    2008-06-01

    Oncology nurses and their patients are frequently on the cutting edge of new therapies and interventions that support coping, health, and healing. Reiki is a practice that is requested with increasing frequency, is easy to learn, does not require expensive equipment, and in preliminary research, elicits a relaxation response and helps patients to feel more peaceful and experience less pain. Those who practice Reiki report that it supports them in self-care and a healthy lifestyle. This article will describe the process of Reiki, review current literature, present vignettes of patient responses to the intervention, and make recommendations for future study. PMID:18515247

  5. Abdominal pain and syndrome of inappropriate antidiuretic hormone secretion as clinical presentation of acute intermittent porphyria.

    Valle Feijóo, M L; Bermúdez Sanjurjo, J R; González Vázquez, L; Rey Martínez, M; de la Fuente Aguado, J

    2015-01-01

    Acute intermittent porphyria (AIP) is a rare condition characterized by abdominal pain and a wide range of nonspecific symptoms. We report the case of a woman with abdominal pain and syndrome of inappropriate antidiuretic hormone secretion (SIADH) as clinical presentation of AIP. The diagnosis was achieved through the etiologic study of the SIADH. PMID:25796467

  6. Postgraduate Training in Clinical Oncology. Report on a WHO Working Group (The Hague, The Netherlands, December 6-8, 1978).

    World Health Organization, Copenhagen (Denmark). Regional Office for Europe.

    The 1978 report of the Working Group of Postgraduate Training in Clinical Oncology, convened by the World Health Organization (WHO) Regional Office for Europe in collaboration with the government of The Netherlands, is presented. The groups analyzed models of postgraduate training in clinical oncology and evaluated their suitability in relation to…

  7. Making the right software choice for clinically used equipment in radiation oncology

    The customer of a new system for clinical use in radiation oncology must consider many options in order to find the optimal combination of software tools. Many commercial systems are available and each system has a large number of technical features. However an appraisal of the technical capabilities, especially the options for clinical implementations, is hardly assessable at first view. The intention of this article was to generate an assessment of the necessary functionalities for high precision radiotherapy and their integration in ROKIS (Radiation oncology clinic information system) for future customers, especially with regard to clinical applicability. Therefore we analysed the clinically required software functionalities and divided them into three categories: minimal, enhanced and optimal requirements for high conformal radiation treatment

  8. A critical appraisal of the clinical utility of proton therapy in oncology

    Wang D

    2015-10-01

    Full Text Available Dongxu WangDepartment of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, USAAbstract: Proton therapy is an emerging technology for providing radiation therapy to cancer patients. The depth dose distribution of a proton beam makes it a preferable radiation modality as it reduces radiation to the healthy tissue outside the tumor, compared with conventional photon therapy. While theoretically beneficial, its clinical values are still being demonstrated from the increasing number of patients treated with proton therapy, from several dozen proton therapy centers around the world. High equipment and facility costs are often the major obstacle for its wider adoption. Because of the high cost and lack of definite clinical evidence of its superiority, proton therapy treatment faces criticism on its cost-effectiveness. Technological development is causing a gradual lowering of costs, and research and clinical studies are providing further evidence on its clinical utility.Keywords: proton therapy, radiation, cancer, oncology

  9. Factors Predicting Oncology Care Providers' Behavioral Intention to Adopt Clinical Decision Support Systems

    Wolfenden, Andrew

    2012-01-01

    The purpose of this quantitative correlation study was to examine the predictors of user behavioral intention on the decision of oncology care providers to adopt or reject the clinical decision support system. The Unified Theory of Acceptance and Use of Technology (UTAUT) formed the foundation of the research model and survey instrument. The…

  10. Scenario drafting for early technology assessment of next generation sequencing in clinical oncology

    Joosten, S.E.P.; Retel, V.P.; Coupé, V.M.H.; Heuvel, van den M.M.; Harten, van W.H.

    2016-01-01

    Background Next Generation Sequencing (NGS) is expected to lift molecular diagnostics in clinical oncology to the next level. It enables simultaneous identification of mutations in a patient tumor, after which targeted therapy may be assigned. This approach could improve patient survival and/or assi

  11. Music therapy services in pediatric oncology: a national clinical practice review.

    Tucquet, Belinda; Leung, Maggie

    2014-01-01

    This article presents the results of a national clinical practice review conducted in Australia of music therapy services in pediatric oncology hospitals. Literature specifically related to music therapy and symptom management in pediatric oncology is reviewed. The results from a national benchmarking survey distributed to all music therapists working with children with cancer in Australian pediatric hospitals are discussed. Patient and family feedback provided from a quality improvement activity conducted at a major pediatric tertiary hospital is summarized, and considerations for future growth as a profession and further research is proposed. PMID:25027188

  12. Assessing the Value of an Optional Radiation Oncology Clinical Rotation During the Core Clerkships in Medical School

    Purpose: Few medical students are given proper clinical training in oncology, much less radiation oncology. We attempted to assess the value of adding a radiation oncology clinical rotation to the medical school curriculum. Methods and Materials: In July 2010, Jefferson Medical College began to offer a 3-week radiation oncology rotation as an elective course for third-year medical students during the core surgical clerkship. During 2010 to 2012, 52 medical students chose to enroll in this rotation. The rotation included outpatient clinics, inpatient consults, didactic sessions, and case-based presentations by the students. Tests of students’ knowledge of radiation oncology were administered anonymously before and after the rotation to evaluate the educational effectiveness of the rotation. Students and radiation oncology faculty were given surveys to assess feedback about the rotation. Results: The students’ prerotation test scores had an average of 64% (95% confidence interval [CI], 61–66%). The postrotation test scores improved to an average of 82% (95% CI, 80–83%; 18% absolute improvement). In examination question analysis, scores improved in clinical oncology from 63% to 79%, in radiobiology from 70% to 77%, and in medical physics from 62% to 88%. Improvements in all sections but radiobiology were statistically significant. Students rated the usefulness of the rotation as 8.1 (scale 1–9; 95% CI, 7.3–9.0), their understanding of radiation oncology as a result of the rotation as 8.8 (95% CI, 8.5–9.1), and their recommendation of the rotation to a classmate as 8.2 (95% CI, 7.6–9.0). Conclusions: Integrating a radiation oncology clinical rotation into the medical school curriculum improves student knowledge of radiation oncology, including aspects of clinical oncology, radiobiology, and medical physics. The rotation is appreciated by both students and faculty.

  13. Single-Cell Sequencing Technology in Oncology: Applications for Clinical Therapies and Research

    Baixin Ye

    2016-01-01

    Full Text Available Cellular heterogeneity is a fundamental characteristic of many cancers. A lack of cellular homogeneity contributes to difficulty in designing targeted oncological therapies. Therefore, the development of novel methods to determine and characterize oncologic cellular heterogeneity is a critical next step in the development of novel cancer therapies. Single-cell sequencing (SCS technology has been recently employed for analyzing the genetic polymorphisms of individual cells at the genome-wide level. SCS requires (1 precise isolation of the single cell of interest; (2 isolation and amplification of genetic material; and (3 descriptive analysis of genomic, transcriptomic, and epigenomic data. In addition to targeted analysis of single cells isolated from tumor biopsies, SCS technology may be applied to circulating tumor cells, which may aid in predicting tumor progression and metastasis. In this paper, we provide an overview of SCS technology and review the current literature on the potential application of SCS to clinical oncology and research.

  14. American Society of Clinical Oncology Statement: Human Papillomavirus Vaccination for Cancer Prevention.

    Bailey, Howard H; Chuang, Linus T; duPont, Nefertiti C; Eng, Cathy; Foxhall, Lewis E; Merrill, Janette K; Wollins, Dana S; Blanke, Charles D

    2016-05-20

    American Society of Clinical Oncology (ASCO), the leading medical professional oncology society, is committed to lessening the burden of cancer and as such will promote underused interventions that have the potential to save millions of lives through cancer prevention. As the main providers of cancer care worldwide, our patients, their families, and our communities look to us for guidance regarding all things cancer related, including cancer prevention. Through this statement and accompanying recommendations, ASCO hopes to increase awareness of the tremendous global impact of human papillomavirus (HPV) -caused cancers, refocus the discussion of HPV vaccination on its likely ability to prevent millions of cancer deaths, and increase HPV vaccination uptake via greater involvement of oncology professionals in ensuring accurate public discourse about HPV vaccination and calling for the implementation of concrete strategies to address barriers to vaccine access and acceptance. PMID:27069078

  15. American Society of Clinical Oncology Policy Statement Update: Genetic and Genomic Testing for Cancer Susceptibility.

    Robson, Mark E; Bradbury, Angela R; Arun, Banu; Domchek, Susan M; Ford, James M; Hampel, Heather L; Lipkin, Stephen M; Syngal, Sapna; Wollins, Dana S; Lindor, Noralane M

    2015-11-01

    The American Society of Clinical Oncology (ASCO) has long affirmed that the recognition and management of individuals with an inherited susceptibility to cancer are core elements of oncology care. ASCO released its first statement on genetic testing in 1996 and updated that statement in 2003 and 2010 in response to developments in the field. In 2014, the Cancer Prevention and Ethics Committees of ASCO commissioned another update to reflect the impact of advances in this area on oncology practice. In particular, there was an interest in addressing the opportunities and challenges arising from the application of massively parallel sequencing-also known as next-generation sequencing-to cancer susceptibility testing. This technology introduces a new level of complexity into the practice of cancer risk assessment and management, requiring renewed effort on the part of ASCO to ensure that those providing care to patients with cancer receive the necessary education to use this new technology in the most effective, beneficial manner. The purpose of this statement is to explore the challenges of new and emerging technologies in cancer genetics and provide recommendations to ensure their optimal deployment in oncology practice. Specifically, the statement makes recommendations in the following areas: germline implications of somatic mutation profiling, multigene panel testing for cancer susceptibility, quality assurance in genetic testing, education of oncology professionals, and access to cancer genetic services. PMID:26324357

  16. Quantitative Assessment of Workload and Stressors in Clinical Radiation Oncology

    Mazur, Lukasz M., E-mail: lukasz_mazur@ncsu.edu [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Industrial Extension Service, North Carolina State University, Raleigh, North Carolina (United States); Biomedical Engineering, North Carolina State University, Raleigh, North Carolina (United States); Mosaly, Prithima R. [Industrial Extension Service, North Carolina State University, Raleigh, North Carolina (United States); Jackson, Marianne; Chang, Sha X.; Burkhardt, Katharin Deschesne; Adams, Robert D.; Jones, Ellen L.; Hoyle, Lesley [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Xu, Jing [Industrial Extension Service, North Carolina State University, Raleigh, North Carolina (United States); Rockwell, John; Marks, Lawrence B. [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States)

    2012-08-01

    Purpose: Workload level and sources of stressors have been implicated as sources of error in multiple settings. We assessed workload levels and sources of stressors among radiation oncology professionals. Furthermore, we explored the potential association between workload and the frequency of reported radiotherapy incidents by the World Health Organization (WHO). Methods and Materials: Data collection was aimed at various tasks performed by 21 study participants from different radiation oncology professional subgroups (simulation therapists, radiation therapists, physicists, dosimetrists, and physicians). Workload was assessed using National Aeronautics and Space Administration Task-Load Index (NASA TLX). Sources of stressors were quantified using observational methods and segregated using a standard taxonomy. Comparisons between professional subgroups and tasks were made using analysis of variance ANOVA, multivariate ANOVA, and Duncan test. An association between workload levels (NASA TLX) and the frequency of radiotherapy incidents (WHO incidents) was explored (Pearson correlation test). Results: A total of 173 workload assessments were obtained. Overall, simulation therapists had relatively low workloads (NASA TLX range, 30-36), and physicists had relatively high workloads (NASA TLX range, 51-63). NASA TLX scores for physicians, radiation therapists, and dosimetrists ranged from 40-52. There was marked intertask/professional subgroup variation (P<.0001). Mental demand (P<.001), physical demand (P=.001), and effort (P=.006) significantly differed among professional subgroups. Typically, there were 3-5 stressors per cycle of analyzed tasks with the following distribution: interruptions (41.4%), time factors (17%), technical factors (13.6%), teamwork issues (11.6%), patient factors (9.0%), and environmental factors (7.4%). A positive association between workload and frequency of reported radiotherapy incidents by the WHO was found (r = 0.87, P value=.045

  17. Quantitative Assessment of Workload and Stressors in Clinical Radiation Oncology

    Purpose: Workload level and sources of stressors have been implicated as sources of error in multiple settings. We assessed workload levels and sources of stressors among radiation oncology professionals. Furthermore, we explored the potential association between workload and the frequency of reported radiotherapy incidents by the World Health Organization (WHO). Methods and Materials: Data collection was aimed at various tasks performed by 21 study participants from different radiation oncology professional subgroups (simulation therapists, radiation therapists, physicists, dosimetrists, and physicians). Workload was assessed using National Aeronautics and Space Administration Task-Load Index (NASA TLX). Sources of stressors were quantified using observational methods and segregated using a standard taxonomy. Comparisons between professional subgroups and tasks were made using analysis of variance ANOVA, multivariate ANOVA, and Duncan test. An association between workload levels (NASA TLX) and the frequency of radiotherapy incidents (WHO incidents) was explored (Pearson correlation test). Results: A total of 173 workload assessments were obtained. Overall, simulation therapists had relatively low workloads (NASA TLX range, 30-36), and physicists had relatively high workloads (NASA TLX range, 51-63). NASA TLX scores for physicians, radiation therapists, and dosimetrists ranged from 40-52. There was marked intertask/professional subgroup variation (P<.0001). Mental demand (P<.001), physical demand (P=.001), and effort (P=.006) significantly differed among professional subgroups. Typically, there were 3-5 stressors per cycle of analyzed tasks with the following distribution: interruptions (41.4%), time factors (17%), technical factors (13.6%), teamwork issues (11.6%), patient factors (9.0%), and environmental factors (7.4%). A positive association between workload and frequency of reported radiotherapy incidents by the WHO was found (r = 0.87, P value=.045

  18. Current practices and guidelines for clinical next-generation sequencing oncology testing

    Samuel P. Strom

    2016-01-01

    Next-generation sequencing (NGS) has been rapidly integrated into molecular pathology, dramatically increasing the breadth genomic of information available to oncologists and their patients. This review will explore the ways in which this new technology is currently applied to bolster care for patients with solid tumors and hematological malignancies, focusing on practices and guidelines for assessing the technical validity and clinical utility of DNA variants identified during clinical NGS oncology testing.

  19. Multi-scale Modeling in Clinical Oncology: Opportunities and Barriers to Success.

    Yankeelov, Thomas E; An, Gary; Saut, Oliver; Luebeck, E Georg; Popel, Aleksander S; Ribba, Benjamin; Vicini, Paolo; Zhou, Xiaobo; Weis, Jared A; Ye, Kaiming; Genin, Guy M

    2016-09-01

    Hierarchical processes spanning several orders of magnitude of both space and time underlie nearly all cancers. Multi-scale statistical, mathematical, and computational modeling methods are central to designing, implementing and assessing treatment strategies that account for these hierarchies. The basic science underlying these modeling efforts is maturing into a new discipline that is close to influencing and facilitating clinical successes. The purpose of this review is to capture the state-of-the-art as well as the key barriers to success for multi-scale modeling in clinical oncology. We begin with a summary of the long-envisioned promise of multi-scale modeling in clinical oncology, including the synthesis of disparate data types into models that reveal underlying mechanisms and allow for experimental testing of hypotheses. We then evaluate the mathematical techniques employed most widely and present several examples illustrating their application as well as the current gap between pre-clinical and clinical applications. We conclude with a discussion of what we view to be the key challenges and opportunities for multi-scale modeling in clinical oncology. PMID:27384942

  20. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.

    Runowicz, Carolyn D; Leach, Corinne R; Henry, N Lynn; Henry, Karen S; Mackey, Heather T; Cowens-Alvarado, Rebecca L; Cannady, Rachel S; Pratt-Chapman, Mandi L; Edge, Stephen B; Jacobs, Linda A; Hurria, Arti; Marks, Lawrence B; LaMonte, Samuel J; Warner, Ellen; Lyman, Gary H; Ganz, Patricia A

    2016-02-20

    The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for

  1. Recent advances in gastrointestinal oncology - updates and insights from the 2009 annual meeting of the American Society of Clinical Oncology

    Hsueh Chung-Tsen

    2010-03-01

    Full Text Available Abstract We have reviewed the pivotal presentations related to gastrointestinal malignancies from 2009 annual meeting of the American Society of Clinical Oncology with the theme of "personalizing cancer care". We have discussed the scientific findings and the impact on practice guidelines and ongoing clinical trials. Adding trastuzumab to chemotherapy improved the survival of patients with advanced gastric cancer overexpressing human epidermal growth factor receptor 2. Gemcitabine plus cisplatin has become a new standard for first-line treatment of advanced biliary cancer. Octreotide LAR significantly lengthened median time to tumor progression compared with placebo in patients with metastatic neuroendocrine tumors of the midgut. Addition of oxaliplatin to fluoropyrimidines for preoperative chemoradiotherapy in patients with stage II or III rectal cancer did not improve local tumor response but increased toxicities. Bevacizumab did not provide additional benefit to chemotherapy in adjuvant chemotherapy for stage II or III colon cancer. In patients with resected stage II colon cancer, recurrence score estimated by multigene RT-PCR assay has been shown to provide additional risk stratification. In stage IV colorectal cancer, data have supported the routine use of prophylactic skin treatment in patients receiving antibody against epidermal growth factor receptor, and the use of upfront chemotherapy as initial management in patients with synchronous metastasis without obstruction or bleeding from the primary site.

  2. An exploration of the experience of compassion fatigue in clinical oncology nurses.

    Perry, Beth; Toffner, Greg; Merrick, Trish; Dalton, Janice

    2011-01-01

    Compassion fatigue (CF) is "debilitating weariness brought about by repetitive, empathic responses to the pain and suffering of others" (LaRowe, 2005, p. 21). The work performed by oncology nurses, and the experiences of the people they care for, place oncology nurses at high risk for CF (Pierce et al., 2007; Ferrell & Coyle, 2008). Thus oncology nurses were chosen as the study focus. This paper details a descriptive exploratory qualitative research study that investigated the experience of CF in Canadian clinical oncology registered nurses (RNs). A conceptual stress process model by Aneshensel, Pearlin, Mullan, Zarit, and Whitlatch (1995) that considers caregivers' stress in four domains provided the study framework (see Figure 1). Nineteen study participants were recruited through an advertisement in the Canadian Oncology Nursing Journal (CONJ). The advertisement directed potential participants to a university-based online website developed for this study. Participants completed a questionnaire and wrote a narrative describing an experience with CF and submitted these through the secure research website. Data were analyzed thematically. Five themes include: defining CF, causes of CF, factors that worsen CF, factors that lessen CF, and outcomes of CF. Participants had limited knowledge about CF, about lack of external support, and that insufficient time to provide high quality, care may precipitate CF. The gap between quality of care nurses wanted to provide and what they were able to do, compounded by coexisting physical and emotional stress, worsened CF. CF was lessened by colleague support, work-life balance, connecting with others, acknowledgement, and maturity and experience. Outcomes of CF included profound fatigue of mind and body, negative effects on personal relationships, and considering leaving the specialty. Recommendations that may enhance oncology nurse well-being are provided. PMID:21661623

  3. Integrating Personalized Medicine in the Canadian Environment: Efforts Facilitating Oncology Clinical Research.

    Syme, Rachel; Carleton, Bruce; Leyens, Lada; Richer, Etienne

    2015-01-01

    There is currently a rapid evolution of clinical practices based on the introduction of patient stratification and molecular diagnosis that is likely to improve health outcomes. Building on a strong research base, complemented by strong support from clinicians and health authorities, the oncology field is at the forefront of this evolution. Yet, clinical research is still facing many challenges that need to be addressed in order to conduct necessary studies and effectively translate medical breakthroughs based on personalized medicine into standards of care. Leveraging its universal health care system and on resources developed to support oncology clinical research, Canada is well positioned to join the international efforts deployed to address these challenges. Available resources include a broad range of structures and funding mechanisms, ranging from direct clinical trial support to post-marketing surveillance. Here, we propose a clinical model for the introduction of innovation for precision medicine in oncology that starts with patients' and clinicians' unmet needs to initiate a cycle of discovery, validation, translation and sustainability development. PMID:26565702

  4. Processes for Quality Improvements in Radiation Oncology Clinical Trials

    Quality assurance in radiotherapy (RT) has been an integral aspect of cooperative group clinical trials since 1970. In early clinical trials, data acquisition was nonuniform and inconsistent and computational models for radiation dose calculation varied significantly. Process improvements developed for data acquisition, credentialing, and data management have provided the necessary infrastructure for uniform data. With continued improvement in the technology and delivery of RT, evaluation processes for target definition, RT planning, and execution undergo constant review. As we move to multimodality image-based definitions of target volumes for protocols, future clinical trials will require near real-time image analysis and feedback to field investigators. The ability of quality assurance centers to meet these real-time challenges with robust electronic interaction platforms for imaging acquisition, review, archiving, and quantitative review of volumetric RT plans will be the primary challenge for future successful clinical trials

  5. Processes for quality improvements in radiation oncology clinical trials.

    FitzGerald, T J; Urie, Marcia; Ulin, Kenneth; Laurie, Fran; Yorty, Jeffrey; Hanusik, Richard; Kessel, Sandy; Jodoin, Maryann Bishop; Osagie, Gani; Cicchetti, M Giulia; Pieters, Richard; McCarten, Kathleen; Rosen, Nancy

    2008-01-01

    Quality assurance in radiotherapy (RT) has been an integral aspect of cooperative group clinical trials since 1970. In early clinical trials, data acquisition was nonuniform and inconsistent and computational models for radiation dose calculation varied significantly. Process improvements developed for data acquisition, credentialing, and data management have provided the necessary infrastructure for uniform data. With continued improvement in the technology and delivery of RT, evaluation processes for target definition, RT planning, and execution undergo constant review. As we move to multimodality image-based definitions of target volumes for protocols, future clinical trials will require near real-time image analysis and feedback to field investigators. The ability of quality assurance centers to meet these real-time challenges with robust electronic interaction platforms for imaging acquisition, review, archiving, and quantitative review of volumetric RT plans will be the primary challenge for future successful clinical trials. PMID:18406943

  6. Photoacoustic Imaging in Oncology: Translational Preclinical and Early Clinical Experience.

    Valluru, Keerthi S; Wilson, Katheryne E; Willmann, Jürgen K

    2016-08-01

    Photoacoustic imaging has evolved into a clinically translatable platform with the potential to complement existing imaging techniques for the management of cancer, including detection, characterization, prognosis, and treatment monitoring. In photoacoustic imaging, tissue is optically excited to produce ultrasonographic images that represent a spatial map of optical absorption of endogenous constituents such as hemoglobin, fat, melanin, and water or exogenous contrast agents such as dyes and nanoparticles. It can therefore provide functional and molecular information that allows noninvasive soft-tissue characterization. Photoacoustic imaging has matured over the years and is currently being translated into the clinic with various clinical studies underway. In this review, the current state of photoacoustic imaging is presented, including techniques and instrumentation, followed by a discussion of potential clinical applications of this technique for the detection and management of cancer. (©) RSNA, 2016. PMID:27429141

  7. PROCESSES FOR QUALITY IMPROVEMENTS IN RADIATION ONCOLOGY CLINICAL TRIALS

    FitzGerald, TJ; Urie, Marcia; Ulin, Kenneth; Laurie, Fran; Yorty, Jeffrey; Hanusik, Richard; Kessel, Sandy; Jodoin, Maryann Bishop; Osagie, Gani; Giulia Cicchetti, M.; Pieters, Richard; McCarten, Kathleen; Rosen, Nancy

    2008-01-01

    Quality assurance in radiation therapy has been an integral aspect of cooperative group clinical trials since 1970. In early clinical trials data acquisition was non-uniform and inconsistent; computational models for radiation dose calculation varied significantly. Process improvements developed for data acquisition, credentialing, and data management have provided the necessary infrastructure for uniform data. With continued improvement in the technology and delivery of radiation therapy, ev...

  8. Radiation doses to personnel in clinics for gynecologic oncology

    Radium or Cesium is used for radiotherapy of gynecologic cancer at six clinics in Sweden. This report gives a survey of the radiation doses the personnel is exposed to. The measurement were performed using TL-dosimeters. The dose equivalents for different parts of the body at specific working moments was deduced as well as the effective dose equivalent and the collective dose equivalent. 1983 the total collective dose equivalent for the six clinics was 1.3 manSv, which corresponds to 3.9 manmSv/g equivalent mass of Radium used at the treatments. (With 11 tables and 10 figures) (L.E.)

  9. Clinical and Outcome Research in oncology The need for integration

    Apolone Giovanni

    2003-04-01

    Full Text Available Abstract Cancer is one of the main healthcare problems in Europe. Although significant progress has recently been made, long-term survival is still disappointing for most common solid tumours. The explosion of information has strengthened the need to create and sustain coordinated interaction between technology, biology, clinical research, clinical practice and health policy. A simple process based on automatic and passive translation from bench to clinical research and eventually to the bed side is usually assumed but cannot be taken for granted. A critical role might be played by Outcome Research (OR, defined as the discipline that describes, interprets, and predicts the impact of various influences, especially interventions, on final endpoints (from survival to satisfaction with care that matter to decision makers (from patients to society at large, with special emphasis on the use of patient-reported outcomes (PRO. Recently, under pressure from several parts of society, the FDA, recognizing the need for faster drug approval, has modified existing regulations and created new rules to allow anti-cancer drugs to be approved more quickly and, in certain but quite common circumstances, single arm trials and surrogate endpoints to be used as measures of clinical benefit. In this context, the faster approval process may lead to drugs being marketed without there being a complete picture of how effective or safe they are. The FDA move to speed up drug approval, together with the use of not fully validated surrogate endpoints, give OR the unique opportunity to help understand the value of drugs that have received accelerated approval. Despite this opportunity, OR has yet to demonstrate its role in this specific setting and provide proof of the validity, reliability and added value of its primary endpoint measures when evaluated in a broader context. The implementation of lines of OR in the development and evaluation of anti-cancer drugs hinges upon

  10. Role of oncology clinical pharmacist: a case of life-saving interventions

    Osama M. Al-Quteimat; Al-Badaineh, Mariam A.

    2013-01-01

    The oncology clinical pharmacist (CP) has a crucial role in cancer patient care through improving medication use including chemotherapy and other high alert medications. As part of multidisciplinary team CP has major role in assuring safe, effective and cost-effective drug therapy. Herein we report a case of 45 years old male patient diagnosed with diffuse large B-cell lymphoma (DLBCL), treated with high dose methotrexate (MTX) as prophylaxis for central nervous system (CNS) lymphoma, and fol...

  11. Cancer stem cells in basic science and in translational oncology: can we translate into clinical application?

    Schulenburg, Axel; Blatt, Katharina; Cerny-Reiterer, Sabine; Sadovnik, Irina; Herrmann, Harald; Marian, Brigitte; Grunt, Thomas W.; Zielinski, Christoph C.; Valent, Peter

    2015-01-01

    Since their description and identification in leukemias and solid tumors, cancer stem cells (CSC) have been the subject of intensive research in translational oncology. Indeed, recent advances have led to the identification of CSC markers, CSC targets, and the preclinical and clinical evaluation of the CSC-eradicating (curative) potential of various drugs. However, although diverse CSC markers and targets have been identified, several questions remain, such as the origin and evolution of CSC,...

  12. Electronic clinical decision support systems attitudes and barriers to use in the oncology setting.

    Collins, I M

    2012-03-02

    BACKGROUND: There is little evidence regarding attitudes to clinical decision support systems (CDSS) in oncology. AIMS: We examined the current usage, awareness, and concerns of Irish medical oncologists and oncology pharmacists in this area. METHODS: A questionnaire was sent to 27 medical oncologists and 34 oncology pharmacists, identified through professional interest groups. Respondents ranked concerns regarding their use of a CDSS on a scale from 1 to 4, with 4 being most important. RESULTS: Overall, 67% (41\\/61) responded, 48% (13\\/27) of oncologists and 82% (28\\/34) of pharmacists surveyed. Concerns included "difficulty defining complex clinical situations with a set of rules" (mean ± SD) (3.2 ± 0.9), "ensuring evidence base is up to date and relevant" (3.2 ± 0.9) and "lack of clinically relevant suggestions" (2.9 ± 0.9). Ninety-three percent reported using a CDSS but 54% were unaware of this. CONCLUSION: While there are benefits to using a CDSS, concerns must be addressed through user education. This may be a starting point for a user-centred design approach to the development of future local systems through a consultative process.

  13. Clinical oncologic applications of PET/MRI: a new horizon

    Partovi, Sasan; Kohan, Andres; Rubbert, Christian; Vercher-Conejero, Jose Luis; Gaeta, Chiara; Yuh, Roger; Zipp, Lisa; Herrmann, Karin A.; Robbin, Mark R.; Lee, Zhenghong; Muzic, Raymond F.; Faulhaber, Peter; Ros, Pablo R

    2014-01-01

    Positron emission tomography/magnetic resonance imaging (PET/MRI) leverages the high soft-tissue contrast and the functional sequences of MR with the molecular information of PET in one single, hybrid imaging technology. This technology, which was recently introduced into the clinical arena in a few medical centers worldwide, provides information about tumor biology and microenvironment. Studies on indirect PET/MRI (use of positron emission tomography/computed tomography (PET/CT) images softw...

  14. Clinically relevant drug–drug interactions in oncology

    Mcleod, Howard L.

    1998-01-01

    Although anticancer agents are one of the most toxic classes of medication prescribed today, there is relatively little information available about clinically relevant drug–drug interactions. Pharmacokinetic drug interactions have been described, including alterations in absorption, catabolism, and excretion. For example, an increased bioavailability of 6-mercaptopurine has been observed when combined with either allopurinol or methotrexate, leading to increased toxicity in some patients. Ind...

  15. Nervous Plexopathies in oncologic patients: Anatomical, clinical and radiological Considerations

    Lumbosacral or brachial plexopathies are lesions of two or more roots of the same plexus. They are very frequent in cancer patients and are usually due to extra spinal involvement of these roots, by a primary or secondary neoplasm. The CT scan is very useful in the evaluation of patients with this disease. In the article anatomic al aspects, the main clinical symptoms and signs, and the performance of CT scan are reviewed with all these elements it is possible to make a diagnosis

  16. Clinical perspectives of cancer stem cell research in radiation oncology

    Radiotherapy has a proven potential to eradicate cancer stem cells which is reflected by its curative potential in many cancer types. Considerable progress has been made in identification and biological characterisation of cancer stem cells during the past years. Recent biological findings indicate significant inter- and intratumoural and functional heterogeneity of cancer stem cells and lead to more complex models which have potential implications for radiobiology and radiotherapy. Clinical evidence is emerging that biomarkers of cancer stem cells may be prognostic for the outcome of radiotherapy in some tumour entities. Perspectives of cancer stem cell based research for radiotherapy reviewed here include their radioresistance compared to the mass of non-cancer stem cells which form the bulk of all tumour cells, implications for image- and non-image based predictive bio-assays of the outcome of radiotherapy and a combination of novel systemic treatments with radiotherapy

  17. Role of French teams in the development of clinical and translational research in radiation oncology

    Many clinical studies have showed the key role of radiotherapy in anticancer treatment strategy. Radiations are delivered alone or in combination with systemic therapies. In recent years, the main goal of all clinical developments has focused on improving clinical benefit, with an increased tumour control and a higher normal tissue protection. This research was designed to reduce local recurrences, to increase recurrence-free or overall survival and to decrease acute and late effects. Technological and biological evolutions (or revolutions) accompanied clinicians to improve clinical benefit, namely with strong progress in radiology and better understanding of radiobiology, particularly at the molecular level. Differences in tumour and normal tissues radiosensitivity are nowadays integrated in daily clinical practice of radiation oncologists. The current report details the last 5-year developments of clinical and translational research in radiation oncology, especially the role of French teams in the development of personalized treatment. (authors)

  18. Role of American Society of Clinical Oncology in low- and middle-income countries.

    Patel, Jyoti D; Galsky, Matthew D; Chagpar, Anees B; Pyle, Doug; Loehrer, Patrick J

    2011-08-01

    The American Society of Clinical Oncology (ASCO) is a global community of health care professionals whose stated purpose is to "make a world of difference" by improving cancer care around the world. Unfortunately, cancer survival rates vary significantly among countries with differing financial and infrastructural resources. Because ASCO is a professional oncology society committed to conquering cancer through research, education, prevention, and delivery of high-quality patient care, it is ideally suited to address this issue. ASCO could bring together oncology professionals and other necessary stakeholders from around the world to improve cancer care and lessen suffering for patients worldwide. As part of the ongoing commitment of ASCO to the future of cancer care, the Leadership Development Program was created to foster the leadership skills of early and midcareer oncologists and provide these participants with a working knowledge of the depth and breadth of the organization. As participants in the inaugural class of the ASCO Leadership Development Program, we were charged with investigating how ASCO might favorably affect cancer prevention and treatment in resource-poor countries in a cost-effective, scalable, and sustainable fashion. ASCO can significantly influence cancer care in low- and middle-income countries through a comprehensive approach that promotes cancer awareness and education, improves clinical practice by identifying and removing barriers to delivery of quality cancer care, and fosters innovation to initiate novel solutions to complex problems. PMID:21709190

  19. Mucosal malignant melanoma - a clinical, oncological, pathological and genetic survey.

    Mikkelsen, Lauge H; Larsen, Ann-Cathrine; von Buchwald, Christian; Drzewiecki, Krzysztof T; Prause, Jan U; Heegaard, Steffen

    2016-06-01

    Mucosal melanomas constitute 1.3% of all melanomas and they may develop in any mucosal membrane. Conjunctival melanomas (0.5/million/year) and melanomas in the sinonasal cavity (0.5/million/year) are the most common, followed by anorectal melanomas (0.4/million/year) and melanomas in the oral cavity (0.2/million/year). Anorectal melanoma occurs slightly more often in females, whereas oral melanoma has a male predilection. Mucosal melanoma most commonly develops in a patient's sixth or seventh decade of life, and no differences between races have been found except for sinonasal melanoma and conjunctival melanoma, which are very rare in Black people. The symptoms are not tumour-specific and are related to the organ system affected, and the disease is most often diagnosed at an advanced clinical stage. The diagnosis of a primary tumour is difficult, and metastatic cutaneous melanoma and choroidal melanoma must be excluded. Mutations in KIT are frequently found, while BRAF and NRAS mutations are rarely found - except in conjunctival melanomas that carry BRAF mutations. Mutations in the TERT promotor region are also found in mucosal melanomas. Complete surgical resection with free margins is the treatment of choice. The prognosis is poor, with the 5-year survival rate ranging from 0% (gastric melanoma) to 80% (conjunctival melanoma). PMID:27004972

  20. Abdominal Tuberculosis: Analysis of Clinical Features and Outcome of Adult Patients in Southern Taiwan

    Ming-Luen Hu

    2009-10-01

    Full Text Available Background: Abdominal tuberculosis remains a serious health threat. This retrospectivereport aimed to analyze patients after the development of the tuberculosiscontrol program by the Center of Disease Control (Taiwan in January 2000.The study was conducted at the Chang Gung Memorial Hospital-Kaohsiung,Taiwan.Methods: Between January 2000 and December 2006, we evaluated 14 adult patientswith abdominal tuberculosis by reviewing their clinical information, therapeuticmethods and outcomes. Diagnosis of abdominal tuberculosis wasmade based on clinical features of abdominal infection with microbiologicalresults from culture, acid-fast bacilli stain and polymerase chain reaction forMycobacterium tuberculosis and/or histopathological confirmation frombiopsy and ascites.Results: Tuberculous peritonitis and intestinal tuberculosis were the most commontype of infections followed by hepatic tuberculosis, and intra-abdominaltuberculoma. 35.7% of these patients had the coexistence of extra-abdominalinfection. The most common clinical symptoms and signs were abdominalpain, abdominal distension, ascites and body weight loss. Fever was found in35.7% of patients and peritoneal signs were noted in 7.1%. Immunocompromisedstates and old age are relevant to adult abdominal tuberculosis.Overall, patients were diagnosed by bacteriology (35.7%, biopsy materialsfrom laparotomy (42.8%, liver biopsy (14.3%, and biopsy materials fromcolonoscopy (7.2%. Patients were cured after taking antituberculous drugsfor at least 6 months without relapse during regular follow-up for at least 2years. However, three patients died of sepsis and decompensated liver cirrhosisduring treatment.Conclusion: Extra vigilance in dealing with patients who present with unexplainedabdominal conditions is the key to the diagnosis of abdominal tuberculosis.Early diagnosis, early antituberculous therapy and surgical treatment of theassociated complications are essential for the survival of the patient.

  1. Clinical Studies of Sweet Bee Venom to The Effect of Abdominal Fat Accumulation

    Lim, Chung-San

    2008-06-01

    Full Text Available Objective The purpose of this study was to investigate the effects of Sweet Bee Venom to the abdominal fat accumulation clinically. Methods The 20 healthy women volunteers who showed the notice of this study by the home page of Sangji University were treated with Sweet Bee Venom(SBV during twenty times. To investigate the effects of Sweet Bee Venom of the abdominal fat accumulation, abdominal CT, LFT, Thermography, BMI, Inbody 3.0 etc. were performed during clinical trials. And statistical analysis was carried out the data of 10 volunteers who performed all the schedule of this study. Results Following results were obtained from the clinical studies Sweet Bee Venom showed the effect of decreased the body weight, thickness of abdominal skin and fat layer, BMI, and increased abdominal heat, but they are not showed statistical significant. Conclusions These results suggest that treatment Sweet Bee Venom on the abdomen was effective to decrease fat tissue but for the treatment of obesity was performed with right diet program and exercise.

  2. Approval procedures for clinical trials in the field of radiation oncology

    Application of ionizing radiation for the purpose of medical research in Germany needs to be approved by the national authority for radiation protection (Bundesamt fuer Strahlenschutz, BfS). For studies in the field of radiation oncology, differentiation between use of radiation for ''medical care (Heilkunde)'' versus ''medical research'' frequently leads to contradictions. The aim of this article is to provide principle investigators, individuals, and institutions involved in the process, as well as institutional review or ethics committees, with the necessary information for this assessment. Information on the legal frame and the approval procedures are also provided. A workshop was co-organized by the German Society for Radiation Oncology (DEGRO), the Working Party for Radiation Oncology (ARO) of the German Cancer Society (DKG), the German Society for Medical Physics (DGMP), and the German Cancer Consortium (DKTK) in October 2013. This paper summarizes the results of the workshop and the follow-up discussions between the organizers and the BfS. Differentiating between ''Heilkunde'' which does not need to be approved by the BfS and ''medical research'' is whether the specific application of radiation (beam quality, dose, schedule, target volume, etc.) is a clinically established and recognized procedure. This must be answered by the qualified physician(s) (''fachkundiger Arzt'' according to German radiation protection law) in charge of the study and the treatments of the patients within the study, taking into consideration of the best available evidence from clinical studies, guidelines and consensus papers. Among the important parameters for assessment are indication, total dose, and fractionation. Radiation treatments applied outside clinical trials do not require approval by the BfS, even if they are applied within a randomized or nonrandomized clinical trial

  3. The clinical application of multi-slice spiral CT angiography in abdominal aortic disease

    2005-01-01

    Objective: To evaluate the clinical application of multi-slice spiral CT angiography(MSCTA) in the assessment of abdominal aortic disease. Methods: Fifty-four patients underwent multi-slice spiral CT angiography of abdomen. Contrast agent (Omnipaque 300 I g/L) 1.5 ml/kg was injected and the injection rate was 3 ml/s. The delay time was determined by bolus tracking technique,Tll level abdominal aorta was set as the target vessel and the threshold was 180-200 Hu, slice width was 3 mm and with a pitch of 4-6.Original data were transferred to working-station to perform functional reconstruction. Results: Ten cases were normal, twenty-eight cases were abdominal aortic aneurysms, five abdominal aortic dissecting aneurysms (Debakay type Ⅲ ) and eleven aortic sclerosis. SSD showed the body of aneurysm and the relationship between aneurysm and adjacent blood vessel, MIP better displayed calcification of blood vessel wall and condition of the stent, MPR demonstrated true and false lumen, rupture site of abdominal aorta intima and mural thrombus. Conclusion: MSCTA axial and reconstruction image can show the extent of abdominal aortic disease and the relationship with adjacent blood vessels. It is a safe, simple and non-invasive examination method.

  4. STUDY OF CLINICAL PROFILE OF ABDOMINAL TUBERCULOSI S WITH SELECTED CASES OF SURGICAL INTERVENTION

    Atish

    2013-05-01

    Full Text Available ABSTRACT :- BACKGROUND: Recent reports have suggested increased in inciden ce of abdominal tuberculosis (TB worldwide, particularly in high r isk groups, especially in developing countries. OBJECTIVES : The aim of this study is to review clinical spect rum of abdominal TB and surgical management of its complications. METHODS : The prospective review of all histopathologically proven cases of abdominal TB notified to our instit ution requiring surgical intervention during 2 year period. RESULTS : There were 28 patients with abdominal TB. Maximum incidence was found in 11-30 years (57% with a median age of 30.14 (4-66 years and male to female ratio of 1:1.33. Pain being most common symptom (96% while abdominal ten derness and anemia were the most common signs . None of the patient was HIV positive. Active pulmon ary TB was present in 25% cases. Major complications of abdominal TB were int estinal obstruction (60% and perforation peritonitis (21%. All 28 patients underwent surger y with 24 patients undergoing on an emergency basis and rest 4 electively. Mesenteric lymphadenop athy was present in 14 patients, 10 had strictures and underwent small bowel resection, isolated biops y was done in 3, adhesiolysis was done in 5 and 5 had stricturoplasty. Right hemicolectomy, ileotra nsverse bypass, localized ileocecal resection, sigmoid colectomy were done in one patient each. AK T was given postoperatively to all patients. Morbidity rate was 32% and mortality rate was 17.86 %. 21 patients recovered completely and 2 were lost in follow up. CONCLUSION : Abdominal tuberculosis affects young adults with female preponderance of low socioeconomic status, presenti ng as acute illness when complications develops otherwise it remains silent. With proper chemothera peutic drugs and timely correct surgery for complications and supportive treatment the morbidit y and mortality of abdominal tuberculosis can be reduced significantly

  5. Total Laparoscopic Hysterectomy Compared with Abdominal Hysterectomy; Clinical Outcomes

    Cem Celik

    2013-10-01

    Full Text Available Aim: The purpose of this study was to confirm the positive intraoperative and postoperative outcomes of total laparoscopic hysterectomy (TLH and total abdominal hysterectomy (TAH. Material and Method: We presented surgical procedures performed at Namik Kemal University Faculty of Medicine, Department of Obstetrics and Gynecology between September 2010 and December 2012, 47 patients who underwent TLH and 30 patients who underwent TAH  were included in the present study. Results: Operating time in TLH group was significantly longer than in the TAH group (202.56±61.53 vs 138.06±40.52 min. There were no significant differences between the two groups regarding complications, conversion to laparotomy, intraoperative bleeding. We observed no differences in reoperation and transfusion rates between the two groups. Duration of hospital stay was statistically shorter in TLH group compared to the TAH group (3.93±0.70 vs 5.26±1.63 day. Discussion: Laparoscopic hysterectomy, compared to laparotomy regarding equal outcomes and lower perioperative morbidity, improvement of quality of life, shorter hospital stay and faster return to activity.

  6. Abdominal aortic aneurysm and histological, clinical, radiological correlation.

    Rodella, Luigi Fabrizio; Rezzani, Rita; Bonomini, Francesca; Peroni, Michele; Cocchi, Marco Angelo; Hirtler, Lena; Bonardelli, Stefano

    2016-04-01

    To date, the pathogenesis of abdominal aortic aneurism (AAA) still remains unclear. As such, the aim of this study was to evaluate changes of the aortic structure during AAA. We analysed the microscopic frame of vessels sections, starting from the primum movens leading to abnormal dilatation. AAA samples were collected and processed through various staining methods (Verhoeff-Van Gieson, Masson Goldner, Sirius Red). Subsequently, the vessel morphology and collagenic web of the tunica media and adventitia were determined and the amount of type I and type III collagen was measured. We also applied immune-histochemistry markers for CD34 and PGP 9.5 in order to identify vascular and nerve structures in the aorta. Immune-positivity quantification was used to calculate the percentage of the stained area. We found increasing deposition of type I collagen and reduced type III collagen in both tunica media and adventitia of AAA. The total amount of vasa vasorum, marked with CD34, and nerva vasorum, marked with PGP 9.5, was also higher in AAA samples. Cardiovascular risk factors (blood pressure, dyslipidemia, cigarette smoking) and radiological data (maximum aneurism diameter, intra-luminal thrombus, aortic wall calcification) increased these changes. These results suggest that the tunica adventitia may have a central role in the pathogenesis of AAA as clearly there are major changes characterized by rooted inflammatory infiltration. The presence of immune components could explain these modifications within the framework of the aorta. PMID:26858185

  7. Comparison of diagnostic performance of CT and MRI for abdominal staging of pediatric renal tumors: a report from the Children's Oncology Group

    Servaes, Sabah [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Khanna, Geetika [Washington University School of Medicine, Pediatric Radiology, St. Louis Children' s Hospital, Mallinckrodt Institute for Radiology, 510 S. Kingshighway, Campus Box 8131-MIR, St. Louis, MO (United States); Naranjo, Arlene [University of Florida, Department of Biostatistics, Gainesville, FL (United States); Geller, James I. [Cincinnati Children' s Hospital Medical Center, Division of Oncology, Cincinnati, OH (United States); Ehrlich, Peter F. [University of Michigan, Department of Surgery, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States); Gow, Kenneth W. [Seattle Children' s Hospital, Pediatric Surgery, Seattle, WA (United States); Perlman, Elizabeth J. [Ann and Robert H. Lurie Children' s Hospital of Chicago, Department of Pathology, Chicago, IL (United States); Dome, Jeffrey S. [Children' s National Medical Center, Center for Cancer and Blood Disorders, Washington, DC (United States); Gratias, Eric; Mullen, Elizabeth A. [Harvard University, Dana Farber Cancer Institute and Boston Children' s Hospital, Boston, MA (United States)

    2014-08-19

    CT and MRI are both used for abdominal staging of pediatric renal tumors. The diagnostic performance of the two modalities for local and regional staging of renal tumors has not been systematically evaluated. To compare the diagnostic performance of CT and MRI for local staging of pediatric renal tumors. The study population was derived from the AREN03B2 study of the Children's Oncology Group. Baseline abdominal imaging performed with both CT and MRI within 30 days of nephrectomy was available for retrospective review in 82 renal tumor cases. Each case was evaluated for capsular penetration, lymph node metastasis, tumor thrombus, preoperative tumor rupture, and synchronous contralateral lesions. The surgical and pathological findings at central review were the reference standard. The sensitivity of CT and MRI for detecting capsular penetration was 68.6% and 62.9%, respectively (P = 0.73), while specificity was 86.5% and 83.8% (P = 1.0). The sensitivity of CT and MRI for detecting lymph node metastasis was 76.5% and 52.9% (P = 0.22), and specificity was 90.4% and 92.3% (P = 1.0). Synchronous contralateral lesions were identified by CT in 4/9 cases and by MRI in 7/9 cases. CT and MRI have similar diagnostic performance for detection of lymph node metastasis and capsular penetration. MR detected more contralateral synchronous lesions; however these were present in a very small number of cases. Either modality can be used for initial loco-regional staging of pediatric renal tumors. (orig.)

  8. Comparison of diagnostic performance of CT and MRI for abdominal staging of pediatric renal tumors: a report from the Children's Oncology Group

    CT and MRI are both used for abdominal staging of pediatric renal tumors. The diagnostic performance of the two modalities for local and regional staging of renal tumors has not been systematically evaluated. To compare the diagnostic performance of CT and MRI for local staging of pediatric renal tumors. The study population was derived from the AREN03B2 study of the Children's Oncology Group. Baseline abdominal imaging performed with both CT and MRI within 30 days of nephrectomy was available for retrospective review in 82 renal tumor cases. Each case was evaluated for capsular penetration, lymph node metastasis, tumor thrombus, preoperative tumor rupture, and synchronous contralateral lesions. The surgical and pathological findings at central review were the reference standard. The sensitivity of CT and MRI for detecting capsular penetration was 68.6% and 62.9%, respectively (P = 0.73), while specificity was 86.5% and 83.8% (P = 1.0). The sensitivity of CT and MRI for detecting lymph node metastasis was 76.5% and 52.9% (P = 0.22), and specificity was 90.4% and 92.3% (P = 1.0). Synchronous contralateral lesions were identified by CT in 4/9 cases and by MRI in 7/9 cases. CT and MRI have similar diagnostic performance for detection of lymph node metastasis and capsular penetration. MR detected more contralateral synchronous lesions; however these were present in a very small number of cases. Either modality can be used for initial loco-regional staging of pediatric renal tumors. (orig.)

  9. PET-Based Personalized Management in Clinical Oncology: An Unavoidable Path for the Foreseeable Future.

    Basu, Sandip; Alavi, Abass

    2016-07-01

    It is imperative that the thrust of clinical practice in the ensuing years would be to develop personalized management model for various disorders. PET-computed tomography (PET-CT) based molecular functional imaging has been increasingly utilized for assessment of tumor and other nonmalignant disorders and has the ability to explore disease phenotype on an individual basis and address critical clinical decision making questions related to practice of personalized medicine. Hence, it is essential to make a concerted systematic effort to explore and define the appropriate place of PET-CT in personalized clinical practice in each of malignancies, which would strengthen the concept further. The potential advantages of PET based disease management can be classified into broad categories: (1) Traditional: which includes assessment of disease extent such as initial disease staging and restaging, treatment response evaluation particularly early in the course and thus PET-CT response adaptive decision for continuing the same regimen or switching to salvage schedules; there has been continuous addition of newer application of PET based disease restaging in oncological parlance (eg, Richter transformation); (2) Recent and emerging developments: this includes exploring tumor biology with FDG and non-FDG PET tracers. The potential of multitracer PET imaging (particularly new and novel tracers, eg, 68Ga-DOTA-TOC/NOC/TATE in NET, 68Ga-PSMA and 18F-fluorocholine in prostate carcinoma, 18F-fluoroestradiol in breast carcinoma) has provided a scientific basis to stratify and select appropriate targeted therapies (both radionuclide and nonradionuclide treatment), a major boost for individualized disease management in clinical oncology. Integrating the molecular level information obtained from PET with structural imaging further individualizing treatment plan in radiation oncology, precision of interventions and biopsies of a particular lesion and forecasting disease prognosis. PMID

  10. Professional practice assessment. Pertinence of positron emission tomography clinical indications in oncology

    Introduction As part of the health care quality and safety policy in France, Professional Practice Assessment (P.P.A.) are mandatory in the health services 'certification' process. We present our study regarding the pertinence of Positron Emission Tomography (PET) indications in oncology. Materials and methods A multidisciplinary task group used the Quick Audit method with two rounds of 100 request forms each. The assessment list of criteria comprised four items of decreasing relevance grading the PET scans clinical indications, which were derived from the three French published guidelines (S.O.R. [F.N.C.L.C.C]., 'Guide du bon usage des examens d'imagerie medicale' [S.F.R.-S.F.M.N.], 'Guide pour la redaction de protocoles pour la TEP au F.D.G. en cancerologie' [S.F.M.N.]) and five additional items: clinical information, patient's body weight, previous treatments dates, diabetes, claustrophobia. Results The first round showed that 68% of the requested scans corresponded to the two most relevant groups of indications (S.O.R. Standards and Options). The request forms were correctly filled in regarding the clinical information, but this was not the case for the other items we tested. Several actions were conducted: dedicated PET request form, availability of the S.O.R. on the hospital intranet, boost of the referring physicians awareness during the multidisciplinary oncology meetings (Reunions de Concertation Pluridisciplinaires RCP). The second round showed a better pertinence of the PET scans indications (75% versus 68%); the patient's body weight was more frequently mentioned on the request form. Discussion This study is an example of P.P.A. in our discipline. It led to an improvement of the oncologic PET scans clinical indications in our hospital. This work is pursued in everyday discussion with the referring clinicians, especially during the RCP. (authors)

  11. [Rethinking clinical research in surgical oncology. From comic opera to quality control].

    Evrard, Serge

    2016-01-01

    The evidence base for the effectiveness of surgical interventions is relatively poor and data from large, randomized prospective studies are rare with often a poor quality. Many efforts have been made to increase the number of high quality randomized trials in surgery and theoretical proposals have been put forward to improve the situation, but practical implementation of these proposals is seriously lacking. The consequences of this policy are not trivial; with very few patients included in surgical oncology trials, this represents wasted opportunity for advances in cancer treatment. In this review, we cover the difficulties inherent to clinical research in surgical oncology, such as quality control, equipoise, accrual, and funding and promote alternative designs to the randomized controlled trial. Although the classic randomized controlled trial has a valid but limited place in surgical oncology, other prospective designs need to be promoted as a new deal. This new deal not only implicates surgeons but also journal editors, tender jury, as well as regulatory bodies to cover legal gaps currently surrounding surgical innovation. PMID:26610367

  12. New evidence-based adaptive clinical trial methods for optimally integrating predictive biomarkers into oncology clinical development programs

    Robert A.Beckman; Cong Chen

    2013-01-01

    Predictive biomarkers are important to the future of oncology; they can be used to identify patient populations who will benefit from therapy,increase the value of cancer medicines,and decrease the size and cost of clinical trials while increasing their chance of success.But predictive biomarkers do not always work.When unsuccessful,they add cost,complexity,and time to drug development.This perspective describes phases 2 and 3 development methods that efficiently and adaptively check the ability of a biomarker to predict clinical outcomes.In the end,the biomarker is emphasized to the extent that it can actually predict.

  13. Clinical PET/CT Atlas: A Casebook of Imaging in Oncology

    Integrated positron emission tomography/computed tomography (PET/CT) has evolved since its introduction into the commercial market more than a decade ago. It is now a key procedure, particularly in oncological imaging. Over the last years in routine clinical service, PET/CT has had a significant impact on diagnosis, treatment planning, staging, therapy, and monitoring of treatment response and has therefore played an important role in the care of cancer patients. The high sensitivity from the PET component and the specificity of the CT component give this hybrid imaging modality the unique characteristics that make PET/CT, even after over 10 years of clinical use, one of the fastest growing imaging modalities worldwide. This publication combines over 90 comprehensive cases covering all major indications of fluorodeoxyglucose (18F-FDG)-PET/CT as well as some cases of clinically relevant special tracers. The cases provide an overview of what the specific disease can look like in PET/CT, the typical pattern of the disease’s spread as well as likely pitfalls and teaching points. This PET/CT Atlas will allow professionals interested in PET/CT imaging to embrace the variety of oncological imaging by providing clinically relevant teaching files on the effectiveness and diagnostic quality of FDG-PET/CT imaging in routine applications

  14. Clinical findings and diagnostic imaging of small intestinal rupture due to blunt abdominal trauma

    Eight patients with small intestinal rupture due to blunt abdominal trauma were analyzed by their clinical findings and diagnostic imaging (plain film, ultrasound and computed tomography). Computed tomography was most useful for identification of intraabdominal extraluminal free air (pneumoperitoneum) and this finding was obtained in seven out of the eight patients (87.5 %). Intraabdominal fluid collection was observed in All the patients and was most clearly detectable by ultrasound and computed tomography. These examinations may be applied to identification of properties of the fluid collection. All the patients eventually developed peritonitis when laparotomy was decided. Thus, close follow up observation of abdominal physical signs was also of critical importance. (author)

  15. An ICT infrastructure to integrate clinical and molecular data in oncology research

    Segagni Daniele; Tibollo Valentina; Dagliati Arianna; Zambelli Alberto; Priori Silvia G; Bellazzi Riccardo

    2012-01-01

    Abstract Background The ONCO-i2b2 platform is a bioinformatics tool designed to integrate clinical and research data and support translational research in oncology. It is implemented by the University of Pavia and the IRCCS Fondazione Maugeri hospital (FSM), and grounded on the software developed by the Informatics for Integrating Biology and the Bedside (i2b2) research center. I2b2 has delivered an open source suite based on a data warehouse, which is efficiently interrogated to find sets of...

  16. Clinical Observation on the Effects of Bo's Abdominal Acupuncture in 40 Cases of Chronic Fatigue Syndrome

    HUANG Yong; LIAO Xiao-ming; LI xiao-xi; SONG Yuan-bin

    2008-01-01

    objective;To observe the curative effect of Bo's abdominal acupuncture on chronic fatigue syndrome(CFS).Methods;Forty cases with CFS were treated by Bo's abdominal acupuncture at me points for conducting qi back to its origin and 4 points on the abdomen once a dav for 2 weeks.Scores for symptoms and scores for fatigue questionnaires were compared before and after treatment.Results;After treatment,the clinical symptoms of patients were differently alleviated,and scores for symptoms,mental condition and neural feeling in questionnaires on fatigue were obviously reduced(P<0.01-0.05).Conclusion;Bo's abdominal acupuncture has a good curative effect on general disease with complex symptoms,especially on lassitude,anorlexia,insomnia,amnesia,diarrhea,and general pain.

  17. Vision 20/20: Automation and advanced computing in clinical radiation oncology

    Moore, Kevin L., E-mail: kevinmoore@ucsd.edu; Moiseenko, Vitali [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California 92093 (United States); Kagadis, George C. [Department of Medical Physics, School of Medicine, University of Patras, Rion, GR 26504 (Greece); McNutt, Todd R. [Department of Radiation Oncology and Molecular Radiation Science, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21231 (United States); Mutic, Sasa [Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri 63110 (United States)

    2014-01-15

    This Vision 20/20 paper considers what computational advances are likely to be implemented in clinical radiation oncology in the coming years and how the adoption of these changes might alter the practice of radiotherapy. Four main areas of likely advancement are explored: cloud computing, aggregate data analyses, parallel computation, and automation. As these developments promise both new opportunities and new risks to clinicians and patients alike, the potential benefits are weighed against the hazards associated with each advance, with special considerations regarding patient safety under new computational platforms and methodologies. While the concerns of patient safety are legitimate, the authors contend that progress toward next-generation clinical informatics systems will bring about extremely valuable developments in quality improvement initiatives, clinical efficiency, outcomes analyses, data sharing, and adaptive radiotherapy.

  18. Vision 20/20: Automation and advanced computing in clinical radiation oncology

    This Vision 20/20 paper considers what computational advances are likely to be implemented in clinical radiation oncology in the coming years and how the adoption of these changes might alter the practice of radiotherapy. Four main areas of likely advancement are explored: cloud computing, aggregate data analyses, parallel computation, and automation. As these developments promise both new opportunities and new risks to clinicians and patients alike, the potential benefits are weighed against the hazards associated with each advance, with special considerations regarding patient safety under new computational platforms and methodologies. While the concerns of patient safety are legitimate, the authors contend that progress toward next-generation clinical informatics systems will bring about extremely valuable developments in quality improvement initiatives, clinical efficiency, outcomes analyses, data sharing, and adaptive radiotherapy

  19. Application of next-generation sequencing in clinical oncology to advance personalized treatment of cancer

    Yan-Fang Guan; Gai-Rui Li; Rong-Jiao Wang; Yu-Ting Yi; Ling Yang; Dan Jiang; Xiao-Ping Zhang; Yin Peng

    2012-01-01

    With the development and improvement of new sequencing technology,next-generation sequencing (NGS) has been applied increasingly in cancer genomics research over the past decade.More recently,NGS has been adopted in clinical oncology to advance personalized treatment of cancer.NGS is used to identify novel and rare cancer mutations,detect familial cancer mutation carriers,and provide molecular rationale for appropriate targeted therapy.Compared to traditional sequencing,NGS holds many advantages,such as the ability to fully sequence all types of mutations for a large number of genes (hundreds to thousands) in a single test at a relatively low cost.However,significant challenges,particularly with respect to the requirement for simpler assays,more flexible throughput,shorter turnaround time,and most importantly,easier data analysis and interpretation,will have to be overcome to translate NGS to the bedside of cancer patients.Overall,continuous dedication to apply NGS in clinical oncology practice will enable us to be one step closer to personalized medicine.

  20. Application of organ tolerance dose-constraints in clinical studies in radiation oncology

    In modern radiation oncology, tolerance dose-constraints for organs at risk (OAR) must be considered for treatment planning, but particularly in order to design clinical studies. Tolerance dose tables, however, only address one aspect of the therapeutic ratio of any clinical study, i.e., the limitation of adverse events, but not the desired potential improvement in the tumor effect of a novel treatment strategy. A sensible application of ''tolerance doses'' in a clinical situation requires consideration of various critical aspects addressed here: definition of tolerance dose, specification of an endpoint/symptom, consideration of radiation quality and irradiation protocol, exposed volume and dose distribution, and patient-related factors of radiosensitivity. The currently most comprehensive estimates of OAR radiation tolerance are in the QUANTEC compilations (2010). However, these tolerance dose values must only be regarded as a rough orientation and cannot answer the relevant question for the patients, i.e., if the study can achieve a therapeutic advantage; this can obviously be answered only by the final scientific analysis of the study results. Despite all limitations, the design of clinical studies should currently refer to the QUANTEC values for appreciation of the risk of complications, if needed supplemented by one's own data or further information from the literature. The implementation of a consensus on the safety interests of the patients and on an application and approval process committed to progress in medicine, with transparent quality-assuring requirements with regard to the structural safeguarding of the study activities, plays a central role in clinical research in radiation oncology. (orig.)

  1. Who Enrolls Onto Clinical Oncology Trials? A Radiation Patterns of Care Study Analysis

    Purpose: To identify factors significantly influencing accrual to clinical protocols by analyzing radiation Patterns of Care Study (PCS) surveys of 3,047 randomly selected radiotherapy (RT) patients. Methods and Materials: Patterns of Care Study surveys from disease sites studied for the periods 1992-1994 and 1996-1999 (breast cancer, n = 1,080; prostate cancer, n = 1,149; esophageal cancer, n = 818) were analyzed. The PCS is a National Cancer Institute-funded national survey of randomly selected RT institutions in the United States. Patients with nonmetastatic disease who received RT as definitive or adjuvant therapy were randomly selected from eligible patients at each institution. To determine national estimates, individual patient records were weighted by the relative contribution of each institution and patients within each institution. Data regarding participation in clinical trials were recorded. The factors age, gender, race, type of insurance, and practice type of treating institution (academic or not) were studied by univariate and multivariate analyses. Results: Overall, only 2.7% of all patients were accrued to clinical protocols. Of these, 57% were enrolled on institutional review board-approved institutional trials, and 43% on National Cancer Institute collaborative group studies. On multivariate analysis, patients treated at academic facilities (p = 0.0001) and white patients (vs. African Americans, p = 0.0002) were significantly more likely to participate in clinical oncology trials. Age, gender, type of cancer, and type of insurance were not predictive. Conclusions: Practice type and race significantly influence enrollment onto clinical oncology trials. This suggests that increased communication and education regarding protocols, particularly focusing on physicians in nonacademic settings and minority patients, will be essential to enhance accrual

  2. CLINICAL STUDY OF ABDOMINAL HOLLOW VISCERAL PERFORATION-NON TRAUMATIC

    Vinod Kumar

    2014-07-01

    Full Text Available : INTRODUCTION: Perforation of any part of gastrointestinal track usually gives rise to a life threatening emergency. A high index of suspicion is essential to diagnose visceral perforation early as significant morbidity and mortality results from diagnostic delay. This study was undertaken to analyse regarding sex incidence, seasonal factors, etiological factors, clinical features, investigations, treatment, complications of hollow perforation and results were compared with results of previous similar studies. METHODS: The total number 31 cases of hollow visceral perforation in abdomen have been studied prospectively in detail during the period from October 2009 to September 2011. RESULTS: Among the 31cases of gastrointestinal perforation, perforation of duodenal ulcer 9 cases (29.3% was the commonest, there was male predominance constituting 21(67.7%, peptic ulcer perforation maximum is seen between June and September. The most common complication recorded was wound infection 5 cases (16.1%, death 4 cases (12.9%.Median length of the stay was 13days (2-44days. CONCLUSION: From our study of 31 cases of hollow viscous perforation the following can be concluded most common age group affected is 40-60 years, more commonly seen in males. Duodenum is the most common site perforation. In general peptic ulcer perforation maximum is seen between June and September, in rainy season. Most presented with hollow viscous perforation after 24 hours to the hospital. Wound infection, septicemia was, most common cause of morbidity and mortality respectively.

  3. Bioluminescent imaging: a critical tool in pre-clinical oncology research.

    O'Neill, Karen

    2010-02-01

    Bioluminescent imaging (BLI) is a non-invasive imaging modality widely used in the field of pre-clinical oncology research. Imaging of small animal tumour models using BLI involves the generation of light by luciferase-expressing cells in the animal following administration of substrate. This light may be imaged using an external detector. The technique allows a variety of tumour-associated properties to be visualized dynamically in living models. The increasing use of BLI as a small-animal imaging modality has led to advances in the development of xenogeneic, orthotopic, and genetically engineered animal models expressing luciferase genes. This review aims to provide insight into the principles of BLI and its applications in cancer research. Many studies to assess tumour growth and development, as well as efficacy of candidate therapeutics, have been performed using BLI. More recently, advances have also been made using bioluminescent imaging in studies of protein-protein interactions, genetic screening, cell-cycle regulators, and spontaneous cancer development. Such novel studies highlight the versatility and potential of bioluminescent imaging in future oncological research.

  4. Minimal-invasive core needle biopsy of head and neck malignancies: Clinical evaluation for radiation oncology

    Background and purpose: Neck masses are common presentations of cancer and require tissue sampling to establish a diagnosis prior to the institution of adequate therapy. The purpose of this study was to evaluate the specific use and potential advantages of core needle biopsy (CNB) for radiation oncology in the head and neck. Materials and methods: We performed a retrospective analysis of 346 CNB procedures implemented in 165 patients with cervicofacial masses over a period of 56 months. Seventy-three patients had a history of malignancy, 43 had previously received radiation. Results: High-quality tissue cores were obtained from all patients. The target lesion was correctly sampled in 92.1% of patients. Final diagnosis was malignant in 115 patients, of whom 78 received radiotherapy. One biopsy result was false-negative. CNB was equally successful in the pre-irradiated patients and enabled institution of therapy in 92.3% of lymphoma patients. Conclusions: CNB is an efficient tool for tissue sampling of head and neck masses. The potential advantages of CNB for radiation oncology over fine needle aspiration and open surgical biopsy are discussed. CNB enables clinicians to make optimal therapeutic strategies and facilitates prompt referral to the relevant clinical team, both at initial presentation and during follow-up

  5. Clinically unsuspected pulmonary embolism-an important secondary finding in oncology CT

    AIM: To determine the rate of finding incidental pulmonary embolisms (PE) at staging or follow-up chest computed tomography (CT) in oncology patients. MATERIALS AND METHODS: Three hundred and eighty-five consecutive chest CT examinations, performed in patients with cancer, were prospectively assessed during a 9-month period between October 2003 and June 2004. These were spiral acquisitions between 5 and 8 mm collimation acquired 25 s after intravenous contrast medium administration. PE was diagnosed if a filling defect was seen in the central pulmonary arteries on two or more consecutive slices. RESULTS: Ten of 385 (2.6%) of these patients had incidentally detected PE. This was not attributable to any specific malignancy or chemotherapeutic regimen. These emboli were all central, between the main pulmonary artery and the lobar level. Although the significance of these findings in patients not clinically suspected of having PE could be contentious, all the patients were started on therapeutic anticoagulation as a result of this observation. CONCLUSION: Over one in 40 oncology patients have incidental central PE visible on the CT images performed to assess their malignancy. Formal review of the pulmonary arteries, using a work station, is advised in patients with malignancy

  6. Ethical issues of clinical trials in paediatric oncology from 2003 to 2013: a systematic review.

    Dupont, Jean-Claude K; Pritchard-Jones, Kathy; Doz, François

    2016-05-01

    A state-of-the art approach to the debates on ethical issues is key in order to gain guidance on research practices involving sick children and adolescents, as well as to identify research avenues in which it might be worth cooperating, to generate better or supplementary evidence. Based on a systematic literature search using MEDLINE, we report the main ethical developments in paediatric oncology clinical trials from 2003-13. The present knowledge about normative and empirical ethical demands in this setting is quantified and summarised in a list of 46 issues. This list primarily aims to provide readers with a comprehensive account of the main decision nodes and professional attitudes that enable families to make a safe, competent, and satisfactory decision about their child's enrolment, or non-participation, in cancer clinical trials. Our systematic Review shows how important it is for professionals to engage in a constant reflection on optimum trial designs, on the effect of offering trial participation on key family dynamics, and on the ways to understand families' needs and values accurately. In view of present scientific developments, we further emphasise the need to enhance societal awareness about research in children and adolescents, to prevent so-called research fatigue in small populations due to multiple solicitations or inadequate legal demands, and to reassess longstanding ethical certainties in the strictest view of promoting sick children's interests. This systematic Review allows a series of questions to be drawn to guide and encourage collective and individual endeavours that should lead to constant improvements in our research practices in paediatric clinical oncology research. PMID:27301046

  7. Increasing Minority Enrollment Onto Clinical Trials: Practical Strategies and Challenges Emerge From the NRG Oncology Accrual Workshop.

    Brooks, Sandra E; Muller, Carolyn Y; Robinson, William; Walker, Eleanor M; Yeager, Kate; Cook, Elise D; Friedman, Sue; Somkin, Carol P; Brown, Carol Leslie; McCaskill-Stevens, Worta

    2015-11-01

    Racial and ethnic diversity has historically been difficult to achieve in National Cancer Institute-sponsored clinical trials, even while as many as 80% of those trials have faced difficulty in meeting overall recruitment targets. In an attempt to address these issues, NRG Oncology recently convened a comprehensive workshop titled "Clinical Trials Enrollment: Challenges and Opportunities." Discussants at the workshop included representatives of the three legacy groups of the NRG (ie, Gynecologic Oncology Group, National Surgical Adjuvant Breast and Bowel Program, and Radiation Therapy Oncology Group), a minority-based community clinical oncology program, a large integrated health care system, the leadership of the National Cancer Institute, and a large patient advocacy group. This article summarizes the concepts discussed at the workshop, which included: needs assessments, infrastructural support, training of investigators and research staff, specific clinical trial recruitment strategies (both system and community based), and development and mentoring of young investigators. Many new, more specific tactics, including use of diverse cancer care settings, direct-to-consumer communication, and the need for centralized information technology such as the use of software to match trials to special populations, are presented. It was concluded that new, innovative trial designs and the realities of limited funding would require the adoption of effective and efficient recruiting strategies, specialized training, and stakeholder engagement. US clinical research programs must generate and embrace new ideas and pilot test novel recruitment strategies if they are to maintain their historic role as world leaders in cancer care innovation and delivery. PMID:26464496

  8. The roots of modern oncology: from discovery of new antitumor anthracyclines to their clinical use.

    Cassinelli, Giuseppe

    2016-06-01

    In May 1960, the Farmitalia CEO Dr. Bertini and the director of the Istituto Nazionale dei Tumori of Milan Prof. Bucalossi (talent scout and city's Mayor) signed a research agreement for the discovery and development up to clinical trials of new natural antitumor agents. This agreement can be considered as a pioneering and fruitful example of a translational discovery program with relevant transatlantic connections. Owing to an eclectic Streptomyces, found near Castel del Monte (Apulia), and to the skilled and motivated participants of both institutions, a new natural antitumor drug, daunomycin, was ready for clinical trials within 3 years. Patent interference by the Farmitalia French partner was overcome by the good quality of the Italian drug and by the cooperation between Prof. Di Marco, director of the Istituto Ricerche Farmitalia Research Laboratories for Microbiology and Chemotherapy, and Prof. Karnofsky, head of the Sloan-Kettering Cancer Institute of New York, leading to the first transatlantic clinical trials. The search for daunomycin's sister anthracyclines led to the discovery and development of adriamycin, one of the best drugs born in Milan. This was the second act prologue of the history of Italian antitumor discovery and clinical oncology, which started in July 1969 when Prof. Di Marco sent Prof. Bonadonna the first vials of adriamycin (doxorubicin) to be tested in clinical trials. This article reviews the Milan scene in the 1960s, a city admired and noted for the outstanding scientific achievements of its private and public institutions in drugs and industrial product discovery. PMID:27103205

  9. Impact of an oncology palliative care clinic on access to home care services.

    Jang, Raymond W; Burman, Debika; Swami, Nadia; Kotler, Jennifer; Banerjee, Subrata; Ridley, Julia; Mak, Ernie; Bryson, John; Rodin, Gary; Le, Lisa W; Zimmermann, Camilla

    2013-08-01

    Home care (HC) is important for patients with cancer as performance status declines. Our study of 1224 patients at a Canadian cancer center examined the impact of an oncology palliative care clinic (OPCC) on HC referral. The HC referral frequency was calculated before and after the first OPCC consultation, in total and according to performance status (Palliative Performance Scale, PPS). Characteristics associated with HC referral were investigated. After the first OPCC consultation, there was an increase in HC referral from 39% (477 of 1224; 49% of those with PPS ≤60) to 69% (841 of 1224; 88% of those with PPS ≤60). Factors independently associated with HC referral were poor PPS (P < .001) and older age (P = .003). Thus OPCC involvement resulted in markedly increased HC referrals, particularly for older patients with poor performance status. PMID:22777408

  10. Research biopsies in the context of early phase oncology studies: clinical and ethical considerations

    Matilde Saggese

    2013-08-01

    Full Text Available The Personalized Medicine approach in oncology is a direct result of an improved understanding of complex tumor biology and advances in diagnostic technologies. In recent years, there has been an increased demand for archival and fresh tumor analysis in early clinical trials to foster proof-of-concept biomarker development, to understand resistance mechanisms, and ultimately to assess biological response. Although phase I studies are aimed at defining drug safety, pharmacokinetics, and to recommend a phase II dose for further testing, there is now increasing evidence of mandatory tumor biopsies even at the earliest dose-finding stages of drug development. The increasing demand for fresh tumor biopsies adds to the complexity of novel phase I studies and results in different challenges, ranging from logistical support to ethical concerns. This paper investigates key issues, including patients’ perceptions of research biopsies, the need for accurate informed consent, and alternative strategies that may guide the drug development process.

  11. Research biopsies in the context of early phase oncology studies: clinical and ethical considerations

    Matilde Saggese

    2013-04-01

    Full Text Available The ‘Personalised medicine’ approach in oncology is a direct result of improved understanding of complex tumour biology and advances in diagnostic technologies. In recent years there has been an increased demand for archival and fresh tumour analysis in early clinical trials to foster-proof-of-concept biomarker development, understand resistance mechanisms and ultimately to assess biological response. Although phase-1 studies are aimed to define drug safety, pharmacokinetics and to recommend a phase-2 dose for further testing, there is now increasing evidence of mandatory tumour biopsies even at the earliest dose-finding stages of drug development. The increasing demand for fresh tumour biopsies adds to the complexity of novel phase-1 studies and results in different challenges ranging from logistical support to ethical concerns. This paper investigates key issues including patients’ perceptions towards research biopsies, the need for accurate informed consent and alternative strategies that may guide in the drug development process.

  12. Clinical guidance on the perioperative use of targeted agents in solid tumor oncology.

    Mellor, James D; Cassumbhoy, Michelle; Jefford, Michael

    2011-06-01

    The use of targeted anti-cancer agents is increasing. It is common to utilize a multi-modal treatment approach towards solid tumors, often including surgical resection, and it has become apparent that some targeted agents can impair wound healing or cause an increased risk of perioperative complications. This article reviews targeted agents used in solid tumor oncology with an emphasis on clinically relevant details. Overall, the evidence of targeted agents causing surgical complications is limited. The greatest amount of evidence exists for bevacizumab causing perioperative complications, possibly due to its extended half-life. There are limited data for cetuximab, sorafenib and sunitinib and very little for other solid tumor targeted agents. Our findings suggest that there should be heightened pharmacovigilence around targeted agents with respect to perioperative complications and increased post-surgical support for patients to aid early detection of postoperative complications until definitive data become available. PMID:21585689

  13. RADIATION THERAPY ONCOLOGY GROUP TRANSLATIONAL RESEARCH PROGRAM STEM CELL SYMPOSIUM : INCORPORATING STEM CELL HYPOTHESES INTO CLINICAL TRIALS

    Woodward, Wendy A.; Bristow, Robert G.; Clarke, Michael F.; Coppes, Robert P.; Cristofanilli, Massimo; Duda, Dan G.; Fike, John R.; Hambardzumyan, Dolores; Hill, Richard P.; Jordan, Craig T.; Milas, Luka; Pajonk, Frank; Curran, Walter J.; Dicker, Adam P.; Chen, Yuhchyau

    2009-01-01

    At a meeting of the Translation Research Program of the Radiation Therapy Oncology Group held in early 2008, attendees focused on updating the current state of knowledge in cancer stem cell research and discussing ways in which this knowledge can be translated into clinical use across all disease si

  14. Clinical trends and outcomes of male breast cancer: Experience of a tertiary oncology centre in India

    Anindya Mukherjee

    2014-08-01

    Full Text Available Purpose: Because of its rarity in any oncology centre, the clinical trends of male breast cancer specific to its geographical distribution have remained relatively unexplored. This study was done to analyze the clinico-pathological data, treatment given and survival patterns of male breast cancer patients visiting our tertiary medical centre and compare our results with available literature. Methods: All male breast cancer patients registered at our clinic from 2003 to 2009 were included. Frequency distribution analysis of the demographic and clinico-pathological data and treatment variables was done. Treatment outcome was examined from Kaplan-Meir survival estimates. Results: Thirty-three male breast cancer patients were encountered. The median age of presentation was sixty years. Mostly (87.9% they presented with lump in breast or axilla and were clinically staged to be ‘3’ (57.6%.Obesity and alcohol were the commonest risk factors identified. Modified radical mastectomy was the commonest (69.6% definitive therapy rendered with (only for clinically staged 3 patients or without neo-adjuvant chemotherapy. Infiltrating ductal carcinoma was identified in most cases. Twenty-two patients received adjuvant chemotherapy and twenty-four received adjuvant radiotherapy. Eighteen (54.5% patients were hormone-receptor positive and received tamoxifen. The median Overall survival (OS and Progression-free survival (PFS came out to be 14.3 months (standard error, SE of 1.185; 95% confidence interval, CI 12-16.6 and 15.7 (SE 5.35, 95% CI 5.2-26.19 months respectively.Conclusion: Male breast cancers usually carry a poor prognosis due to presentation at later stages. Most of our results correlate with previous literature. Multi-centric prospective studies are required to validate the etiological factors and prognostic determinants of survival.-----------------------------Cite this article as: Mukherjee A, Saha A, Chattopadhyay S, Sur P. Clinical trends and

  15. The role of radiation therapy in pediatric oncology as assessed by cooperative clinical trials

    Major advances have been made in pediatric oncology, and many are due to the advent of the cooperative clinical trial. This important research tool was originally developed for the testing of various therapeutic strategies for the management of children with acute leukemia. Such trials were eminently successful, as the consistently better long-term survival rates for children with this hitherto uniformly lethal disease can attest. The method soon found favor for the investigation of patients with so-called solid tumors. These trails were originally concerned with the elucidation of the value of various chemotherapeutic agents. Radiation therapists soon became involved, however, and this discipline became more heavily represented in study design and data analyses. Much radiation therapy information has been gained, some through prospective, randomized clinical investigations and some through retrospective reviews of roentgen therapy as it was employed in protocols accenting other aspects of care. Voluminous, important radiation therapy data have been deduced through the latter retrospective kinds of analyses, but this review will be confined largely to the published results of prospective, randomized cooperative clinical trials where radiation therapy was a governing variable. Certain investigations of historical interest will also be cited together with other results that established important principles even though not so rigorous in design

  16. Next-Generation Sequencing in Clinical Oncology: Next Steps Towards Clinical Validation

    Nigel C Bennett; Farah, Camile S.

    2014-01-01

    Compelling evidence supports the transition of next generation sequencing (NGS) technology from a research environment into clinical practice. Before NGS technologies are fully adopted in the clinic, they should be thoroughly scrutinised for their potential as powerful diagnostic and prognostic tools. The importance placed on generating accurate NGS data, and consequently appropriate clinical interpretation, has stimulated much international discussion regarding the creation and implementatio...

  17. Clinical analysis of abdominal aorta block in operation of gynecologic tumor

    MU Yu-lan; TANG Chun-sheng; WEN Ze-qing; YIN Fu-bo; LIU Ming

    2006-01-01

    Objective:To evaluate the clinical effects of the abdominal aorta block in controlling haemorrhage during operations of the gynecologic tumor. Methods: From July 1965 to January 2005, we collected patients (n= 49) of gynecologic tumor complicated with haemorrhage during operations, who were divided into 3 groups: preventive blocking group (PG, n= 12), treatment blocking group (TG, n= 20) used abdominal aorta block technique with sterilized cotton band and silica gel tube, and control group (CG, n=17) which were used the regular haemostatic methods, such as ligature, suture and ribbon gauze packing.During operations, the vital signs including the amount of bleeding and transfusion were measured. Results: Compared with the CG, the amount of bleeding and transfusion in the PG and TG decreased significantly (P<0.01). After using the technique, 32 cases of haemorrhage were controlled completely. All patients finished operation smoothly in the end and the vital signs were stable. The vision field of operation was clear and the operating time was shortened dramatically (3.0 h vs 5.7 h and 3.8 h vs 5.7 h, P<0.01). No complications caused by the block occurred in the post-operation. Conclusion: Lower abdominal aorta block is safe and effective in controlling haemorrhage during operations of the gynecologic tumor.

  18. Clinical Training of Medical Physicists Specializing in Radiation Oncology (French Ed.)

    The application of radiation in human health, for both diagnosis and treatment of disease, is an important component of the work of the IAEA. The responsibility for the increasing technical aspects of this work is undertaken by the medical physicist. To ensure good practice in this vital area structured clinical training programmes are required to complement academic learning. This publication is intended to be a guide to the practical implementation of such a programme for radiation therapy. There is a general and growing awareness that radiation medicine is increasingly dependant on well trained medical physicists that are based in the clinical setting. However an analysis of the availability of medical physicists indicates a large shortfall of qualified and capable professionals. This is particularly evident in developing countries. While strategies to increase academic educational opportunities are critical to such countries, the need for guidance on structured clinical training was recognised by the members of the Regional Cooperative Agreement (RCA) for research, development and training related to nuclear sciences for Asia and the Pacific. Consequently a technical cooperation regional project (RAS6038) under the RCA programme was formulated to address this need in the Asia Pacific region by developing suitable material and establishing its viability. Development of a clinical training guide for medical physicists specialising in radiation therapy was started in 2005 with the appointment of a core drafting committee of regional and international experts. Since 2005 the IAEA has convened two additional consultant group meetings including additional experts to prepare the present publication. The publication drew heavily, particularly in the initial stages, from the experience and documents of the Clinical Training Programme for Radiation Oncology Medical Physicists as developed by the Australasian College of Physical Scientists and Engineers in Medicine. Their

  19. Clinical Training of Medical Physicists Specializing in Radiation Oncology (Spanish Ed.)

    The application of radiation in human health, for both diagnosis and treatment of disease, is an important component of the work of the IAEA. The responsibility for the increasing technical aspects of this work is undertaken by the medical physicist. To ensure good practice in this vital area structured clinical training programmes are required to complement academic learning. This publication is intended to be a guide to the practical implementation of such a programme for radiation therapy. There is a general and growing awareness that radiation medicine is increasingly dependant on well trained medical physicists that are based in the clinical setting. However an analysis of the availability of medical physicists indicates a large shortfall of qualified and capable professionals. This is particularly evident in developing countries. While strategies to increase academic educational opportunities are critical to such countries, the need for guidance on structured clinical training was recognised by the members of the Regional Cooperative Agreement (RCA) for research, development and training related to nuclear sciences for Asia and the Pacific. Consequently a technical cooperation regional project (RAS6038) under the RCA programme was formulated to address this need in the Asia Pacific region by developing suitable material and establishing its viability. Development of a clinical training guide for medical physicists specialising in radiation therapy was started in 2005 with the appointment of a core drafting committee of regional and international experts. Since 2005 the IAEA has convened two additional consultant group meetings including additional experts to prepare the present publication. The publication drew heavily, particularly in the initial stages, from the experience and documents of the Clinical Training Programme for Radiation Oncology Medical Physicists as developed by the Australasian College of Physical Scientists and Engineers in Medicine. Their

  20. Clinical Training of Medical Physicists Specializing in Radiation Oncology (Russian Ed.)

    The application of radiation in human health, for both diagnosis and treatment of disease, is an important component of the work of the IAEA. The responsibility for the increasing technical aspects of this work is undertaken by the medical physicist. To ensure good practice in this vital area structured clinical training programmes are required to complement academic learning. This publication is intended to be a guide to the practical implementation of such a programme for radiation therapy. There is a general and growing awareness that radiation medicine is increasingly dependant on well trained medical physicists that are based in the clinical setting. However an analysis of the availability of medical physicists indicates a large shortfall of qualified and capable professionals. This is particularly evident in developing countries. While strategies to increase academic educational opportunities are critical to such countries, the need for guidance on structured clinical training was recognised by the members of the Regional Cooperative Agreement (RCA) for research, development and training related to nuclear sciences for Asia and the Pacific. Consequently a technical cooperation regional project (RAS6038) under the RCA programme was formulated to address this need in the Asia Pacific region by developing suitable material and establishing its viability. Development of a clinical training guide for medical physicists specialising in radiation therapy was started in 2005 with the appointment of a core drafting committee of regional and international experts. Since 2005 the IAEA has convened two additional consultant group meetings including additional experts to prepare the present publication. The publication drew heavily, particularly in the initial stages, from the experience and documents of the Clinical Training Programme for Radiation Oncology Medical Physicists as developed by the Australasian College of Physical Scientists and Engineers in Medicine. Their

  1. Automatic registration of PET and CT studies for clinical use in thoracic and abdominal conformal radiotherapy

    Aim. Implementation and validation of an automatic registration method based on mutual information (MI) for the integration of thoracic and abdominal positron emission tomography (PET)/computed tomography (CT) studies, with the purpose to facilitate in a clinical context the inclusion of PET metabolic information in conformal radiotherapy (RT). Methods. Registration was obtained by modeling a rigid spatial transformation between CT and PET transmission studies. The registration method was based on Normalized Mutual Information (NMI), by iteratively transforming the PET volume, until its optimal alignment to the CT study is achieved, in correspondence of the maximum of NMI. To avoid entrapment in Iocal maxima and to improve convergence speed we introduced a multi resolution scheme. Accuracy of the proposed approach was investigated in experimental data, relative to phantom and patient studies, acquired in conditions similar to clinical situations. Results. In phantom studies the mean error in the 3D space is 3.6 mm (range 3-4 mm) in thoracic region and 3.2 mm (range 2.9-3.7 mm) in abdominal region, considerably Iess than PET spatial resolution. In patient studies the spatial mean error increases with respect to phantom studies (5.4 mm and 5.2 mm for thorax and abdomen, respectively) but remains comparable to the PET spatial resolution. The accuracy of spatial realignment was thus found adequate for the registration of PET/CT registration, if good patient repositioning was adopted. Conclusion. The proposed registration method, based on MI, was validated for the integration of PET/CT studies of patients candidate for thoracic and abdominal conformaI RT. The method is automatic and provided with a user interface, thus suitable for clinical use

  2. Clinical significance of pulmonary nodules detected on abdominal CT in pediatric patients

    Breen, Micheal; Lee, Edward Y. [Boston Children' s Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States); Zurakowski, David [Boston Children' s Hospital and Harvard Medical School, Departments of Anesthesiology and Surgery, Boston, MA (United States)

    2015-11-15

    The clinical significance of a pulmonary nodule that is detected incidentally on CT studies in children is unknown. In addition, there is limited information regarding the management of incidentally detected pulmonary nodules discovered on abdominal CT studies in children. The purpose of this study was to investigate the clinical significance of incidental pulmonary nodules detected on abdominal CT studies in children. This was a retrospective study performed following institutional review board approval. Abdominal CT reports in patients younger than 18 years of age from July 2004 to June 2011 were reviewed for the terms ''nodule,'' ''nodular'' or ''mass'' in reference to the lung bases. The study population included those pediatric patients in whom pulmonary nodules were initially detected on abdominal CT studies. The largest pulmonary nodules detected on CT studies were evaluated for their features (size, shape, margin, attenuation, location, and presence of calcification and cavitation). Follow-up CT studies and clinical records were reviewed for demographic information, history of underlying malignancies and the clinical outcome of the incidental pulmonary nodules. Comparison of malignant versus benign pulmonary nodules was performed with respect to the size of the nodule, imaging features on CT, and patient history of malignancy using the Student's t-test and Fisher exact test. Youden J-index in receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off size for suggesting a high risk of malignancy of incidentally detected pulmonary nodules. Pulmonary nodules meeting inclusion criteria were detected in 62 (1.2%) of 5,234 patients. The mean age of patients with nodules was 11.2 years (range: 5 months-18 years). Thirty-one patients (50%) had follow-up CT studies and two of these patients (6%) were subsequently found to have malignant pulmonary nodules. Both of these

  3. Clinical significance of pulmonary nodules detected on abdominal CT in pediatric patients

    The clinical significance of a pulmonary nodule that is detected incidentally on CT studies in children is unknown. In addition, there is limited information regarding the management of incidentally detected pulmonary nodules discovered on abdominal CT studies in children. The purpose of this study was to investigate the clinical significance of incidental pulmonary nodules detected on abdominal CT studies in children. This was a retrospective study performed following institutional review board approval. Abdominal CT reports in patients younger than 18 years of age from July 2004 to June 2011 were reviewed for the terms ''nodule,'' ''nodular'' or ''mass'' in reference to the lung bases. The study population included those pediatric patients in whom pulmonary nodules were initially detected on abdominal CT studies. The largest pulmonary nodules detected on CT studies were evaluated for their features (size, shape, margin, attenuation, location, and presence of calcification and cavitation). Follow-up CT studies and clinical records were reviewed for demographic information, history of underlying malignancies and the clinical outcome of the incidental pulmonary nodules. Comparison of malignant versus benign pulmonary nodules was performed with respect to the size of the nodule, imaging features on CT, and patient history of malignancy using the Student's t-test and Fisher exact test. Youden J-index in receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off size for suggesting a high risk of malignancy of incidentally detected pulmonary nodules. Pulmonary nodules meeting inclusion criteria were detected in 62 (1.2%) of 5,234 patients. The mean age of patients with nodules was 11.2 years (range: 5 months-18 years). Thirty-one patients (50%) had follow-up CT studies and two of these patients (6%) were subsequently found to have malignant pulmonary nodules. Both of these

  4. Perceptions and Referral Trends into Phase I Oncology Trials: Results of a Clinical Survey

    Andre Brunetto

    2011-01-01

    Full Text Available Introduction. A survey was sent to referring oncologists (ROs to explore the reasons behind their referral patterns and perceptions of Phase I studies before and after being provided with outcome data from advanced colorectal cancer (ACRC patients who participated in Phase I trials at the Royal Marsden Hospital (RMH. Results. The response rate was 32/50 (64%. The most common reason for referral was exhaustion of standard treatments (31%, and the main reason for referring to the RMH was proximity to patients (28%. The most frequent clinical parameter assessed prior to referral was performance status (93%. ROs spent a median of 15 min (range: 5–45 min discussing general aspects of Phase I trials. In the second part of the questionnaire, after reviewing clinical outcome data of ACRC patients who participated in Phase I trials, 47% would change their approach, specifically, spend more time to discuss risks and benefits of Phase I trials (9%, consider prognostic factors before referral (13%, and increase the number of referrals (25%. Conclusion. This is the first report focusing on communication between ROs and a specialist Phase I unit. Outcome reporting can improve communication with ROs and importantly has the potential for better patient selection considered for Phase I oncology trials.

  5. Soft Tissue Sarcoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology.

    von Mehren, Margaret; Randall, R Lor; Benjamin, Robert S; Boles, Sarah; Bui, Marilyn M; Conrad, Ernest U; Ganjoo, Kristen N; George, Suzanne; Gonzalez, Ricardo J; Heslin, Martin J; Kane, John M; Koon, Henry; Mayerson, Joel; McCarter, Martin; McGarry, Sean V; Meyer, Christian; O'Donnell, Richard J; Pappo, Alberto S; Paz, I Benjamin; Petersen, Ivy A; Pfeifer, John D; Riedel, Richard F; Schuetze, Scott; Schupak, Karen D; Schwartz, Herbert S; Tap, William D; Wayne, Jeffrey D; Bergman, Mary Anne; Scavone, Jillian

    2016-06-01

    Soft tissue sarcomas (STS) are rare solid tumors of mesenchymal cell origin that display a heterogenous mix of clinical and pathologic characteristics. STS can develop from fat, muscle, nerves, blood vessels, and other connective tissues. The evaluation and treatment of patients with STS requires a multidisciplinary team with demonstrated expertise in the management of these tumors. The complete NCCN Guidelines for Soft Tissue Sarcoma (available at NCCN.org) provide recommendations for the diagnosis, evaluation, and treatment of extremity/superficial trunk/head and neck STS, as well as intra-abdominal/retroperitoneal STS, gastrointestinal stromal tumor, desmoid tumors, and rhabdomyosarcoma. This manuscript discusses guiding principles for the diagnosis and staging of STS and evidence for treatment modalities that include surgery, radiation, chemoradiation, chemotherapy, and targeted therapy. PMID:27283169

  6. Clinical Observation on Abdominal Cluster-Needling for Treatment of Chronic Annexitis

    2001-01-01

    @@Chronic annexitis is a frequently encountered disease at clinic. According to clinical experience in acupuncture treatment of annexitis, the author has developed an effective acupuncture method called abdominal cluster-needling, with quite good therapeutic results as reported in the following. Clinical Data There were altogether 66 cases of chronic annexitis in this series, which were divided randomly into the treatment group and control group. The treatment group consisted of 36 cases, ranging in age from 20-40 years, and duration of illness from 0.5-9 years. The control group consisted of 30 cases, ranging in age from 21-38 years, and duration of illness from 1-8 years.

  7. Radiation oncology

    The Radiation Oncology Division has had as its main objectives both to operate an academic training program and to carry out research on radiation therapy of cancer. Since fiscal year 1975, following a directive from ERDA, increased effort has been given to research. The research activities have been complemented by the training program, which has been oriented toward producing radiation oncologists, giving physicians short-term experience in radiation oncology, and teaching medical students about clinical cancer and its radiation therapy. The purpose of the research effort is to improve present modalities of radiation therapy of cancer. As in previous years, the Division has operated as the Radiation Oncology Program of the Department of Radiological Sciences of the University of Puerto Rico School of Medicine. It has provided radiation oncology support to patients at the University Hospital and to academic programs of the University of Puerto Rico Medical Sciences Campus. The patients, in turn, have provided the clinical basis for the educational and research projects of the Division. Funding has been primarily from PRNC (approx. 40%) and from National Cancer Institute grants channeled through the School of Medicine (approx. 60%). Special inter-institutional relationships with the San Juan Veterans Administration Hospital and the Metropolitan Hospital in San Juan have permitted inclusion of patients from these institutions in the Division's research projects. Medical physics and radiotherapy consultations have been provided to the Radiotherapy Department of the VA Hospital

  8. Tumor thrombus of inferior vena cava in patients with renal cell carcinoma – clinical and oncological outcome of 50 patients after surgery

    Kocot Arkadius

    2012-06-01

    Full Text Available Abstract Background To evaluate oncological and clinical outcome in patients with renal cell carcinoma (RCC and tumor thrombus involving inferior vena cava (IVC treated with nephrectomy and thrombectomy. Methods We identified 50 patients with a median age of 65 years, who underwent radical surgical treatment for RCC and tumor thrombus of the IVC between 1997 and 2010. The charts were reviewed for pathological and surgical parameters, as well as complications and oncological outcome. Results The median follow-up was 26 months. In 21 patients (42% distant metastases were already present at the time of surgery. All patients underwent radical nephrectomy, thrombectomy and lymph node dissection through a flank (15 patients/30%, thoracoabdominal (14 patients/28% or midline abdominal approach (21 patients/42%, depending upon surgeon preference and upon the characteristics of tumor and associated thrombus. Extracorporal circulation with cardiopulmonary bypass (CPB was performed in 10 patients (20% with supradiaphragmal thrombus of IVC. Cancer-specific survival for the whole cohort at 5 years was 33.1%. Survival for the patients without distant metastasis at 5 years was 50.7%, whereas survival rate in the metastatic group at 5 years was 7.4%. Median survival of patients with metastatic disease was 16.4 months. On multivariate analysis lymph node invasion, distant metastasis and grading were independent prognostic factors. There was no statistically significant influence of level of the tumor thrombus on survival rate. Indeed, patients with supradiaphragmal tumor thrombus (n = 10 even had a better outcome (overall survival at 5 years of 58.33% than the entire cohort. Conclusions An aggressive surgical approach is the most effective therapeutic option in patients with RCC and any level of tumor thrombus and offers a reasonable longterm survival. Due to good clinical and oncological outcome we prefer the use of CPB with extracorporal

  9. Abdominal trauma

    The potential for multiple intraperitoneal and retroperitoneal organ injuries often makes accurate clinical evaluation of abdominal trauma patients difficult. Additionally, patients may be unresponsive, have unreliable abdominal physical examinations, or have concurrent serious head and cervical spine injuries which delay diagnosis of and attention to abdominal problems. In these situations radiologic abdominal imaging is often requested. To expedite patient evaluation, close cooperation between the emergency physician and the radiologist is essential. It is the clinical stability of the traumatized patient that dictates the extent of radiologic imaging. Life-threatening hypotension, positive peritoneal signs, or clear evidence of penetrating abdominal injury are indications for immediate surgery. Stable patients with signs suggesting intra-abdominal injury will benefit by further radiologic evaluation with appropriate imaging modalities. The selection of an appropriate modality in any one clinical situation depends upon many criteria including accessibility to diagnostic equipment, the sensitivity and specificity of each technique, and the expertise and preference of the attending radiologist. A suggested scheme for evaluating abdominal trauma patients is presented. Most aspects of this evaluation scheme will be discussed in depth

  10. Clinical significance of hepatic artery variations originating from the superior mesenteric artery in abdominal tumor surgery

    HUANG Yuan; LIU Chao; LIN Jin-ling

    2013-01-01

    Background Hepatic artery variations are frequent clinical occurrences.The aim of this study was to investigate the characteristic course of variant hepatic arteries originating from the superior mesenteric artery for the purpose of providing instructions for abdominal tumor surgery.Methods The course of variant hepatic arteries originating from the superior mesenteric artery was studied in 400 patients with liver cancer confirmed by digital subtraction angiography (DSA) and multi-slice spiral computed tomography angiography (MSCTA),and 86 patients with gastric cancer confirmed by preoperative MSCTA between June 2008 and June 2010 in the First Affiliated Hospital of Guangxi Medical University.Results Hepatic artery variations originating from the superior mesenteric artery were noticed in 49 liver cancer patients and 14 gastric cancer patients (total 63 cases),with a variation rate of 12.96%,including two cases (3.17%) where the hepatic arteries ran along the anterior pancreas,and 61 cases (96.83%) where the hepatic arteries ran along the posterior pancreas.Conclusions Hepatic artery variations originating from the superior mesenteric artery present as two types:the pre-pancreas type and the post-pancreas type with the latter predominating.This finding is of clinical significance in abdominal tumor surgeries where clearance of portal lymph nodes is needed.

  11. The script concordance test in radiation oncology: validation study of a new tool to assess clinical reasoning

    The Script Concordance test (SCT) is a reliable and valid tool to evaluate clinical reasoning in complex situations where experts' opinions may be divided. Scores reflect the degree of concordance between the performance of examinees and that of a reference panel of experienced physicians. The purpose of this study is to demonstrate SCT's usefulness in radiation oncology. A 90 items radiation oncology SCT was administered to 155 participants. Three levels of experience were tested: medical students (n = 70), radiation oncology residents (n = 38) and radiation oncologists (n = 47). Statistical tests were performed to assess reliability and to document validity. After item optimization, the test comprised 30 cases and 70 questions. Cronbach alpha was 0.90. Mean scores were 51.62 (± 8.19) for students, 71.20 (± 9.45) for residents and 76.67 (± 6.14) for radiation oncologists. The difference between the three groups was statistically significant when compared by the Kruskall-Wallis test (p < 0.001). The SCT is reliable and useful to discriminate among participants according to their level of experience in radiation oncology. It appears as a useful tool to document the progression of reasoning during residency training

  12. Monitoring of patients in the Oncology department of the Clinical Hospital

    An important number of patients that visit the Oncology department o the Clinicas Hospital lost sight at some stage of their evolution. Our objective was to quantify the proportion of patients who are lost and describe the time spent in the service and its relationship with variables such as age, sex, origin of the patient and progress of the disease, for which we performed a descriptive observational study with an analytical component of 435 stories clinics patients with confirmed diagnosis of cancer, treated from January 2001 to December 2004, in order to have a minimum of 5 years of follow-up potential. Data were processed with Excel 2003. Patients had between 15-85 years old with a mean and median of 52 ± 14 years DS. Two hundred Seventy women and 165 were men, 232 were from the metropolitan area. The time of length of service was 0-114 months with a median of 8 and an average DS 21 months ± 27 months. As of December 2009 31 117 patients had died 36 remained in control and 282 were lost from sight. We found no relationship between age (p = 0.1) nor the state of progress of the disease at diagnosis (p = 0.21) If there were significant differences with greater probability of loss tracking men (p = 0.009) and from sites outside the metropolitan area (p = 0.04). The number of patients who are lost is very large and we must develop strategies more effective monitoring

  13. IAEA training course series TCS-37 clinical training of medical physicists specializing in radiation oncology

    Training program IAEA TCS-37 (Training course series No.37) 'Clinical Training Specializing in Radiation Oncology (2009)' was fixed to practical training syllabus at faculty and graduate course of medical physics of a university. TCS-47 for diagnostic radiology (2010) and TCS-50 for nuclear medicine (2011) were also involved in the syllabus. These training courses had been developed by IAEA RCA RAS6038 project since 2002. In this paper, first, comparison with other training programs in the world was made in terms of (1) Degree of extent of subject or field, (2) Concreteness or specificity, (3) Degree of completion, (4) Method of certification and (5) Practicability. IAEA TCS series got the most points among ten programs such as EMERALD/EMIT, AAPM rpt. No.90 and CAMPEP accredited programs. Second, TCS-37, TCS-47 and TCS-50 were broken down to 6, 5 and 6 subjects of training course respectively. Third, each subject was further broken down to 15 times of training schedule where every time was composed by 3 hours of training. Totally 45 hours of a subject were assigned to one semester for getting one unit of credit. Seventeen units should be credited up to three years in graduate course to finish the whole program. (author)

  14. Integrative oncology drug discovery accompanied by preclinical translational research as prerequisite for clinical development.

    Hoffmann, Jens

    2014-06-01

    The molecular heterogeneity of cancer calls for individualized therapies to become the standard of care. It is now generally accepted that target-specific compounds require specific new development programs. But, even for new drugs with general mode of action (i.e., chemotherapy), tailored treatment approaches, such as specific schedules or combinations, have been shown to improve the therapeutic outcome. Therefore, the preclinical development of new therapeutic agents needs, next to the "classical pharmacodynamic studies", the implementation of integrative translational research (TR) as early as possible. New TR approaches, starting already at target identification and validation (TIV) will allow to defining the optimal patient population for clinical development, to tailor individual treatment of the tumor disease and to choose a rational basis among the manifold options for treatment combinations. We will discuss several examples from TR studies, which have initially been started to evaluate the molecular mode of action and to recognize mechanisms which can lead to resistance. Research was extended later to identify predictive response biomarkers and establish a rationale for combination with different therapies. A detailed gene expression analysis of lung cancer cells and apoptotic pathway interference studies in colon cancer cells provided insight in the molecular mechanisms of action. These new findings are correlated with results from other studies performed during the preclinical development program. We discuss pros and cons, successes and failures of our integrative preclinical development program and provide recommendations for future oncology projects. PMID:25841411

  15. Clinical Manifestations of Aortocaval Fistulas in Ruptured Abdominal Aortic Aneurysm: Report of Two Cases

    Emmanouil D. Psathas

    2012-01-01

    Full Text Available Aortocaval fistula (ACF is an unusual complication of ruptured abdominal aortic aneurysm (AAA, involving less than 3–6% of all ruptured cases. The clinical presentation is often obscure, depending on the coexistence of retroperitoneal rupture and hemodynamic instability. Prompt preoperative diagnosis is essential in order to plan the operative approach and improve patient’s outcome. We report the surgical treatment of two patients presented in the emergency department with ACF due to ruptured AAA, each with different clinical presentation, emphasizing the high index of suspicion needed by the clinician to early diagnose and treat this often lethal condition. Operative strategy and special considerations in the management of this subgroup of patients are also discussed.

  16. American Society of Clinical Oncology policy statement update: genetic testing for cancer susceptibility.

    2003-06-15

    As the leading organization representing cancer specialists involved in patient care and clinical research, the American Society of Clinical Oncology (ASCO) reaffirms its commitment to integrating cancer risk assessment and management, including molecular analysis of cancer predisposition genes, into the practice of oncology and preventive medicine. The primary goal of this effort is to foster expanded access to, and continued advances in, medical care provided to patients and families affected by hereditary cancer syndromes. The 1996 ASCO Statement on Genetic Testing for Cancer Susceptibility set forth specific recommendations relating to clinical practice, research needs, educational opportunities, requirement for informed consent, indications for genetic testing, regulation of laboratories, and protection from discrimination, as well as access to and reimbursement for cancer genetics services. In updating this Statement, ASCO endorses the following principles: Indications for Genetic Testing: ASCO recommends that genetic testing be offered when 1) the individual has personal or family history features suggestive of a genetic cancer susceptibility condition, 2) the test can be adequately interpreted, and 3) the results will aid in diagnosis or influence the medical or surgical management of the patient or family members at hereditary risk of cancer. ASCO recommends that genetic testing only be done in the setting of pre- and post-test counseling, which should include discussion of possible risks and benefits of cancer early detection and prevention modalities. Special Issues in Testing Children for Cancer Susceptibility: ASCO recommends that the decision to offer testing to potentially affected children should take into account the availability of evidence-based risk-reduction strategies and the probability of developing a malignancy during childhood. Where risk-reduction strategies are available or cancer predominantly develops in childhood, ASCO believes that

  17. Genetic Risk Assessment for Women with Epithelial Ovarian Cancer: Referral Patterns and Outcomes in a University Gynecologic Oncology Clinic

    Petzel, Sue v.; Vogel, Rachel Isaksson; Bensend, Tracy; Leininger, Anna; Argenta, Peter A.; Geller, Melissa A.

    2013-01-01

    Little is known about genetic service utilization and ovarian cancer. We identified the frequency and outcome of genetic counseling referral, predictors of referral, and referral uptake for ovarian cancer patients. Using pathology reports, we identified all epithelial ovarian cancer patients seen in a university gynecologic oncology clinic (1/04–8/06). Electronic medical records (EMR) were used to document genetic service referral, time from diagnosis-to-referral, point-in-treatment at referr...

  18. GNOSIS: Guidelines for neuro-oncology: Standards for investigational studies—reporting of phase 1 and phase 2 clinical trials

    Chang, Susan M.; Reynolds, Sharon L.; Butowski, Nicholas; Lamborn, Kathleen R.; Buckner, Jan C.; Kaplan, Richard S.; Bigner, Darell D.

    2005-01-01

    We present guidelines to standardize the reporting of phase 1 and phase 2 neuro-oncology trials. The guidelines are also intended to assist with accurate interpretation of results from these trials, to facilitate the peer-review process, and to expedite the publication of important and accurate manuscripts. Our guidelines are summarized in a checklist format that can be used as a framework from which to construct a phase 1 or 2 clinical trial. PMID:16212807

  19. Invited Commentary: “Risk Factors for Renal Cell Cancer in a Japanese Population” Published in Clinical Medicine: Oncology

    Esther Uña Cidon

    2009-01-01

    The well-written and researched article reported in Clinical Medicine: Oncology by Dr. Washio and Dr. Mori entitled “Risk factors for renal cell cancer in a Japanese population”1 makes evident the differences in incidence and mortality rates from renal cell carcinoma (RCC) between different populations and highlights the relevance of carrying out epidemiological studies, investigating additional risk factors which may explain the differences.

  20. Invited Commentary: “Risk Factors for Renal Cell Cancer in a Japanese Population” Published in Clinical Medicine: Oncology

    Esther Uña Cidon

    2009-01-01

    Full Text Available The well-written and researched article reported in Clinical Medicine: Oncology by Dr. Washio and Dr. Mori entitled “Risk factors for renal cell cancer in a Japanese population”1 makes evident the differences in incidence and mortality rates from renal cell carcinoma (RCC between different populations and highlights the relevance of carrying out epidemiological studies, investigating additional risk factors which may explain the differences.

  1. The usage of three-dimensional nanostructurized biomaterials in experimental and clinical oncology

    Sergeeva; N.; S.; Reshetov; I.; V.; Sviridova; I.; K.; Kirsanova; V.; A.; Achmedova; S.; A.; Barinov; S.; M.; Komlev; V.; S.; Samoylovich; M.; I.; Belyanin; A.; F.; Kleshcheva; S.; M.; Elinson; V.; M.

    2005-01-01

    The usage of biotransplants for substitution of tissue defects (in particular in reconstructive surgery in oncology) require both he suitable cell cultures and different biomaterials with definite and regulate properties.……

  2. The usage of three-dimensional nanostructurized biomaterials in experimental and clinical oncology

    2005-01-01

    @@ The usage of biotransplants for substitution of tissue defects (in particular in reconstructive surgery in oncology) require both he suitable cell cultures and different biomaterials with definite and regulate properties.

  3. Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement

    Chen, RC; Rumble, RB; Loblaw, DA; Finelli, A.; Ehdaie, B; Cooperberg, MR; Morgan, SC; Tyldesley, S; Haluschak, JJ; Tan, W.; Justman, S; Jain, S

    2016-01-01

    To endorse Cancer Care Ontario's guideline on Active Surveillance for the Management of Localized Prostate Cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines developed by other professional organizations.The Active Surveillance for the Management of Localized Prostate Cancer guideline was reviewed for developmental rigor by methodologists. The ASCO Endorsement Panel then reviewed the content and the recommenda...

  4. Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study

    Loy, Bryan A.; Shkedy, Clive I.; Powell, Adam C.; Happe, Laura E.; Royalty, Julie A.; Miao, Michael T.; Smith, Gary L.; Long, James W.; Gupta, Amit K.

    2016-01-01

    Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011) and after (2013) the payment method introduction using relative risks (RR). After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, p<0.05). For the aggregate of all cancers, the under-treatment rate significantly declined (p = 0.008) from 4% to 0% after the introduction of case rate payments, while the over-treatment rate remained steady at 9%, with no significant change (p = 0.20). These findings suggest that the introduction of case rate payments did not adversely affect the rate of guideline-based care at the provider examined. Additional research is needed to isolate the effect of the payment model and assess implications in other populations. PMID:26870963

  5. Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study.

    Bryan A Loy

    Full Text Available Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011 and after (2013 the payment method introduction using relative risks (RR. After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, p<0.05. For the aggregate of all cancers, the under-treatment rate significantly declined (p = 0.008 from 4% to 0% after the introduction of case rate payments, while the over-treatment rate remained steady at 9%, with no significant change (p = 0.20. These findings suggest that the introduction of case rate payments did not adversely affect the rate of guideline-based care at the provider examined. Additional research is needed to isolate the effect of the payment model and assess implications in other populations.

  6. Compliance with therapeutic guidelines in Radiation Therapy Oncology Group prospective gastrointestinal clinical trials

    Background: This report analyzes the adherence to radiation therapy protocol guidelines in contemporary Radiation Therapy Oncology Group (RTOG) gastrointestinal trials. We aim to provide insight into current standards and compliance of radiation therapy field design and administration. Methods: From 1994 to 2006, the Gastrointestinal Cancer Committee of the RTOG initiated and completed 15 phase I–III clinical trials utilizing radiation therapy in the multimodality treatment of gastrointestinal cancers. In each protocol, details for planning and executing radiation therapy were outlined and each protocol contained scoring criteria for these components of radiation therapy, characterized according to per-protocol, variation acceptable and deviation unacceptable. Review of treatment planning and implementation was performed in all studies following therapy completion. Results: Radiation therapy planning and implementation was reviewed in 2309 of 2312 (99.9%) patients. The mean rate of compliance over all for the 15 protocols was 65% (total of the 2309 analyzed patients). The mean variation acceptable rate was 21% whereas the mean deviation unacceptable rate was 5%. The mean “other” rate (no RT given or incomplete RT due to death, progression or refusal) was 8%. Two of the 15 trials (13%) had deviation unacceptable rates >10%. In four studies incorporating pre-treatment review of radiation therapy planning and treatment, compliance with protocol therapy was enhanced. Conclusions: The fidelity of radiation planning and execution detailed in protocol to actual therapy is heterogeneous, with a mean per-protocol rate of 65%. As clinical trials evolve, available technology should permit efficient pre-treatment review processes, thus facilitating compliance to protocol therapy. These analyses should also permit prospective analysis of outcome measures by compliance to therapy.

  7. Randomized Clinical Trial on the postoperative use of an abdominal binder after laparoscopic umbilical and epigastric hernia repair

    Christoffersen, Mette; Olsen, B H; Rosenberg, J; Bisgaard, T

    2015-01-01

    PURPOSE: Application of an abdominal binder is often part of a standard postoperative regimen after ventral hernia repair to reduce pain and seroma formation. However, there is lack of evidence of the clinical effects. The aim of the present study was to investigate the pain- and seroma-reducing ......PURPOSE: Application of an abdominal binder is often part of a standard postoperative regimen after ventral hernia repair to reduce pain and seroma formation. However, there is lack of evidence of the clinical effects. The aim of the present study was to investigate the pain- and seroma...... abdominal binders during the first postoperative week. Standardized surgical technique, anaesthesia, and analgesic regimens were used and study observers were blinded towards the intervention. Postoperative pain (visual analogue score) on day 1 was the primary outcome. In addition, ultrasonographic...... the abdominal binder were found. CONCLUSIONS: There were no effects of an abdominal binder on pain, movement limitation, fatigue, seroma formation, general well-being, or quality of life. However, most patients claimed a subjective beneficial effect of using their abdominal binder....

  8. Update on Abdominal Aortic Aneurysm Research: From Clinical to Genetic Studies

    Helena Kuivaniemi

    2014-01-01

    Full Text Available An abdominal aortic aneurysm (AAA is a dilatation of the abdominal aorta with a diameter of at least 3.0 cm. AAAs are often asymptomatic and are discovered as incidental findings in imaging studies or when the AAA ruptures leading to a medical emergency. AAAs are more common in males than females, in individuals of European ancestry, and in those over 65 years of age. Smoking is the most important environmental risk factor. In addition, a positive family history of AAA increases the person’s risk for AAA. Interestingly, diabetes has been shown to be a protective factor for AAA in many large studies. Hallmarks of AAA pathogenesis include inflammation, vascular smooth muscle cell apoptosis, extracellular matrix degradation, and oxidative stress. Autoimmunity may also play a role in AAA development and progression. In this Outlook paper, we summarize our recent studies on AAA including clinical studies related to surgical repair of AAA and genetic risk factor and large-scale gene expression studies. We conclude with a discussion on our research projects using large data sets available through electronic medical records and biobanks.

  9. Sociodemographic analysis of patients in radiation therapy oncology group clinical trials

    Purpose: To assess the degree to which the sociodemographic characteristics of patients enrolled in Radiation Therapy Oncology Group (RTOG) clinical trails are representative of the general population. Methods and Materials: Sociodemographic data were collected on 4016 patients entered in 33 open RTOG studies between July 1991 and June 1994. The data analyzed included educational attainment, age, gender, and race. For comparison, we obtained similar data from the U.S. Department of Census. We also compared our RTOG data with Surveillance Epidemiology and End Results (SEER) data for patients who received radiation therapy, to determine how RTOG patients compared with cancer patients in general, and with patients with cancers at sites typically treated with radiotherapy. Results: Overall, the sociodemographic characteristics of patients entered in RTOG trials were similar to those of the Census data. We found that, in every age group of African-American men and at nearly every level of educational attainment, the proportion of RTOG trial participants mirrored the proportion in the census data. Significant differences were noted only in the youngest category of African-American men, where the RTOG accrues more in the lower educational categories and fewer with college experience. For African-American women, we found a similar pattern in every age group and at each level of educational attainment. As with men, RTOG trials accrued a considerably larger proportion of younger, less educated African-American women than the census reported. Using SEER for comparison, the RTOG enrolled proportionately more African-American men to trials all cancer sites combined, and for prostate and head and neck cancer. In head and neck trials, the RTOG enrolled nearly twice as many African-American men than would be predicted by SEER data. In lung cancer trials, RTOG underrepresented African-American men significantly; however, there was no difference for brain cancer trials. There were

  10. Radiation Therapy Oncology Group Translational Research Program Stem Cell Symposium: Incorporating Stem Cell Hypotheses into Clinical Trials

    At a meeting of the Translation Research Program of the Radiation Therapy Oncology Group held in early 2008, attendees focused on updating the current state of knowledge in cancer stem cell research and discussing ways in which this knowledge can be translated into clinical use across all disease sites. This report summarizes the major topics discussed and the future directions that research should take. Major conclusions of the symposium were that the flow cytometry of multiple markers in fresh tissue would remain the standard technique of evaluating cancer-initiating cells and that surrogates need to be developed for both experimental and clinical use.

  11. Clinical Significance of Myocardial Uptake on F-18 FDG PET/CT Performed in Oncologic Patients

    F-18 fluorodeoxyglucose (FDG) uptake of myocardium is influenced by various factors. Increased glycolysis, and subsequent increased F-18 FDG uptake has been reported in ischemic cardiomyopathy. However, clinical significance of incidentally found myocardial F-18 FDG uptake has not been clarified. We retrospectively reviewed the degree and pattern of myocardial uptake in patients without history of ischemic heart disease who underwent torso F-18 FDG PET/CT for evaluation of neoplastic disease. From January 2005 to June 2009, 77 patients who underwent F-18 FDG PET/CT and Tc-99m sestamibi stress/rest SPECT within 3 months were enrolled. Of 77 patients, 55 (71.4%) showed increased F-18 FDG uptake in the myocardium. In this population, 40 showed uniform uptake pattern, while 15 showed focal uptake. In patients with uniform uptake, 17 showed decreased uptake in the septum without perfusion defect on myocardial SPECT. Remaining 23 patients showed uniform uptake, with 1 reversible perfusion defect and 1 fixed perfusion defect. In 15 patients with focal uptake, 9 showed increased F-18 FDG uptake in the base, and only 1 of them showed reversible perfusion defect on myocardial SPECT. In the remaining 6 focal uptake group, 4 had reversible perfusion defect in the corresponding wall, and 1 had apical hypertrophy. We demonstrated that septal defect pattern and basal uptake pattern in the myocardium may represent normal variants. Focal myocardial uptake other than normal variants on oncologic torso F-18 FDG PET/CT with routine fasting protocol may suggest ischemic heart disease, thus further evaluation is warranted

  12. The role of stereotactic ablative radiotherapy in oncological and non-oncological clinical settings: highlights from the 7th Meeting of AIRO--Young Members Working Group (AIRO Giovani).

    Franco, Pierfrancesco; De Bari, Berardino; Ciammella, Patrizia; Fiorentino, Alba; Chiesa, Silvia; Amelio, Dante; Pinzi, Valentina; Bonomo, Pierluigi; Vagge, Stefano; Fiore, Michele; Comito, Tiziana; Cecconi, Agnese; Mortellaro, Gianluca; Bruni, Alessio; Trovò, Marco; Filippi, Andrea Riccardo; Greto, Daniela; Alongi, Filippo

    2014-01-01

    Stereotactic ablative radiotherapy is a modern cancer treatment strategy able to deliver highly focused radiation in one or a few fractions with a radical intent in several clinical settings. Young radiation oncologists need a constant and tailored update in this context to improve patient care in daily clinical practice. A recent meeting of AIRO Giovani (AIRO--Young Members Working Group) was specifically addressed to this topic, presenting state-of-the-art knowledge, based on the latest evidence in this field. Highlights of the congress are summarized and presented in this report, including thorough contributions of the speakers dealing with the role of stereotactic ablative radiotherapy in both oncological and non-oncological diseases, divided according to anatomical and clinical scenarios: intra-cranial settings (brain malignant primary tumors, metastases, benign tumors and functional disorders) and extra-cranial indications (lung primary tumors and metastases, thoracic re-irradiation, liver, lymph node and bone metastases, prostate cancer). With literature data discussed during the congress as a background, stereotactic ablative radiotherapy has proved to be a consolidated treatment approach in specific oncological and non-oncological scenarios, as well as a promising option in other clinical settings, requiring a further prospective validation in the near future. We herein present an updated overview of stereotactic ablative radiotherapy use in the clinic. PMID:25688503

  13. Microarray analysis in clinical oncology: pre-clinical optimization using needle core biopsies from xenograft tumors

    DNA microarray profiling performed on clinical tissue specimens can potentially provide significant information regarding human cancer biology. Biopsy cores, the typical source of human tumor tissue, however, generally provide very small amounts of RNA (0.3–15 μg). RNA amplification is a common method used to increase the amount of material available for hybridization experiments. Using human xenograft tissue, we sought to address the following three questions: 1) is amplified RNA representative of the original RNA profile? 2) what is the minimum amount of total RNA required to perform a representative amplification? 3) are the direct and indirect methods of labeling the hybridization probe equivalent? Total RNA was extracted from human xenograft tissue and amplified using a linear amplification process. RNA was labeled and hybridized, and the resulting images yielded data that was extracted into two categories using the mAdb system: 'all genes' and 'outliers'. Scatter plots were generated for each slide and Pearson Coefficients of correlation were obtained. Results show that the amplification of 5 μg of total RNA yields a Pearson Correlation Coefficient of 0.752 (N = 6,987 genes) between the amplified and total RNA samples. We subsequently determined that amplification of 0.5 μg of total RNA generated a similar Pearson Correlation Coefficient as compared to the corresponding original RNA sample. Similarly, sixty-nine percent of total RNA outliers were detected with 5 μg of amplified starting RNA, and 55% of outliers were detected with 0.5 μg of starting RNA. However, amplification of 0.05 μg of starting RNA resulted in a loss of fidelity (Pearson Coefficient 0.669 between amplified and original samples, 44% outlier concordance). In these studies the direct or indirect methods of probe labeling yielded similar results. Finally, we examined whether RNA obtained from needle core biopsies of human tumor xenografts, amplified and indirectly

  14. Quality Research in Radiation Oncology Analysis of Clinical Performance Measures in the Management of Gastric Cancer

    -based planning with use of DVH to evaluate normal tissue doses. Most patients completed adjuvant RT in the prescribed time frame. IMRT and IGRT were not routinely incorporated into clinical practice during the 2005-2007 period. These data will be a benchmark for future Quality Research in Radiation Oncology GC surveys.

  15. Clinical significance of abdominal scintigraphy using {sup 99m}Tc-HMPAO-labelled leucocytes in patients with seronegative spondyloarthropathies

    Alonso Farto, J.C.; Almoguera Arias, I.; Ortega Valle, A.; Perez Vazquez, J.M. [Department of Nuclear Medicine, Univ. Complutense, Madrid (Spain); Lopez Longo, F.J.; Gonzalez Fernandez, C.M.; Monteagudo Saez, I.; Bascones, M.; Carreno Perez, L. [Department of Rheumatology, ' ' Hospital Universitario Gregorio Maranon' ' , Universidad Complutense, Madrid (Spain)

    2000-12-01

    Abdominal scintigraphy shows silent gut inflammation in patients with spondyloarthropathies (Sp) without clinical evidence of gut inflammation. Abdominal scintigraphy images are different than those obtained in patients with ulcerative colitis or Crohn's disease and are not related to the anti-inflammatory drugs administered. The aim of this study was to examine the clinical associations of findings on abdominal scintigraphy in patients with Sp. A total of 204 Sp patients (European Spondylarthropathy Study Group 1991 criteria) and 54 non-Sp controls receiving non-steroidal anti-inflammatory drugs were studied. Abdominal scintigraphy images were obtained at 30 and 120 min after injection of technetium-99m hexamethylpropylene amine oxime ({sup 99m}Tc-HMPAO)-labelled leucocytes. {sup 99m}Tc-HMPAO-labelled leucocyte scans were positive in 104 Sp patients (50.9%) and in six non-Sp controls (2.9%) (P<0.001; OR=8.32; 95% CI=3.23-22.67). Silent gut inflammation was not associated with any of the following: age of onset, duration of evolution, sex, family history of Sp or psoriasis, articular manifestations, extra-articular manifestations, radiological findings or HLA-B27 positivity. Positive abdominal scintigraphy was associated with active disease (P<0.0001; OR=52.7; 95% CI=19-145.6) and an increase in the C-reactive protein (P<0.005; OR=3.4; 95% CI=1.5-7.4). It is concluded that (a) abdominal scintigraphy using {sup 99m}Tc-HMPAO-labelled leucocytes is of value in detecting the silent gut inflammation in Sp patients, and (b) silent gut inflammation is related to the clinical activity, but is not associated with any particular type of illness or with HLA-B27. (orig.)

  16. Clinical research on abdominal acupuncture plus conventional acupuncture for knee osteoarthritis

    Meng, Chang-rong; Fan, Li; Fu, Wen-bin;

    2009-01-01

    OBJECTIVE: To probe the therapeutic effect of abdominal acupuncture plus conventional acupuncture on knee osteoarthritis. METHODS: PEMS3.1 software was used. The 105 patients with knee osteoarthritis were randomly divided into an abdominal acupuncture group, a conventional acupuncture group and a...... combined group (abdominal acupuncture plus conventional acupuncture). For the abdominal acupuncture group, the abdominal acupuncture was performed at Zhongwan (CV 12), Guanyuan (CV 4), Wailing (ST 26), Daheng (SP 15), Lower Rheumatism point and Qipang with needles retained for 30 minutes. For the....... Lysholm knee scoring scale was used to score the functions of knee before and after treatment. RESULTS: Of 35 cases in the abdominal acupuncture group, 8 cases were remarkably relieved, 10 cases relieved, 14 cases improved, and 3 cases failed, the total effective rate was 91.4%. Of 35 cases in the...

  17. [Introduction of a clinical protocol for extravasation at the National Institute of Oncology, Budapest, Hungary].

    Bartal, Alexandra; Mátrai, Zoltán; Rosta, András; Szûcs, Attila

    2011-03-01

    Extravasation of cytostatics occurs when an infusion containing a cytotoxic drug leaks into the surrounding perivascular and subcutaneous tissues. Incidence of cytostatic extravasation is found to be 0.1-6% according to the literature. Depending on the severity of complications, pain, loss of function in the extremities, or in extreme cases tissue necrosis necessitating an amputation may develop, drawing consequences like delay or interruption of the chemotherapy. Extent of complications is greatly influenced by the type of medication administered, general condition of the patient, and professional preparedness of staff providing the oncological health service. The protocol recently implemented in the National Institute of Oncology is a short, compact guidance for physicians and nurses providing oncological care, so by quick and adequate management of extravasation cases, severe complications could be prevented. More complex practical guidelines including algorithms could be created as a result of a wider collaboration, with the help of which oncological health professionals could easily cope with this rare problem. The authors describe in their review the implementation of the use of dry warm and cold packs, dymethylsulfoxide and hyaluronidase and their function within the algorithm of extravasation treatment. PMID:21617787

  18. Group Therapy with Patients in the Waiting Room of an Oncology Clinic.

    Arnowitz, Edward; And Others

    1983-01-01

    Describes a therapy group for cancer patients, conducted by cotherapists in an oncology waiting room. Group members provided mutual support and shared concerns and coping methods. Medical staff members became more involved and were more able to address the affective needs of the patients and their families. (JAC)

  19. Oncologic emergencies. Analysis of surgical outcomes

    Selecting the optimal treatment strategy for oncologic emergencies requires appropriate condition assessment. In the present study, we report on an algorithm which we developed for such cases. Preoperative pathological conditions, clinical course and prognosis were analyzed using abdominal X-ray and computed tomography images from 11 patients (male: n=8; age range, 42 to 73 years median age, 57 years; female: n=3; age range, 53 to 90 years; median age, 54 years) with oncologic emergencies who underwent laparotomy at our department between January 2003 and December 2007. The carcinoma type comprised seven cases of colon and rectum cancer, and one each of esophageal, intrahepatic cholangiocellular, hepatocellular and cervical cancers. The eight patients with residual tumors died, while the three without residual tumors (all with colon cancer) remained alive over the 26-month follow-up period. We conclude that patients with colon cancer without residual tumors have a greater rate of recurrence-free survival. (author)

  20. Evolution of modern nuclear medicine tumor-imaging diagnostics in clinical oncology

    The evolution of current nuclear medicine diagnostic is closely related to the technical progress in imaging equipment development, and application of radiopharmaceuticals (Rphs) with a different tumor-uptake mechanism. It is the aim of the study to present groups of tumor-imaging Rphs differing by tumor uptake mechanisms, used in clinical oncology. The obtained results are described, and compared with the ones reported by other researchers. Sensitivity and specificity of Rphs for cardio-scintigraphy with 99mTc - MIBI and 201Tl are relatively high, amounting to 93.7% and 60% respectively, in the various tumors. These indicators depend on the stage, location, histopathology, level of malignancy and biological activity of the neoplasm. 99mTc - MIBI scintigraphy is endowed with considerable diagnostic potential for assaying multiple drug resistance (MDR), and is also a good criterion for its elimination following anti-MDR therapy. The obtained results show that radioimmunoscintigraphy (RIS) using different radiolabeled monoclonal antibodies (MoAb) have high sensitivity and specificity respectively: 86% and 80% in ovarian carcinoma with B72.3 antiTAG; 68.6% and 92.5% in colorectal carcinoma with B73.2 antiTAG, antiCEA, antiCA 19-9; 92% and 83% in breast cancer with antiCEA, 86.8% and 67-69% in malignant melanoma with 225.28s. Receptor scintigraphy may reach up to 86% sensitivity and 100% specificity in tumors saturated with somatostatin receptors. Positron emission tomography (PET) with 18F-FDG enhances the metabolic activity of tumor cells, and attains tumor-detecting rate amounting to 97%. Tumor imaging evolution characterized by the introduction and practical implementation of different Rphs, visualizing the functional and biochemical activity of tumor cells in the primary neoplasm, sentinel lymph nodes and distant metastases. radiolabelling of a variety of new biochemical substances, including DNA and RNA, drugs and lysosomes contributes to a successful imaging of

  1. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk

    Jie, Bin; Jiang, Zhu-Ming; Nolan, Marie T;

    2012-01-01

    This multicenter, prospective cohort study evaluated the effect of preoperative nutritional support in abdominal surgical patients at nutritional risk as defined by the Nutritional Risk Screening Tool 2002 (NRS-2002).......This multicenter, prospective cohort study evaluated the effect of preoperative nutritional support in abdominal surgical patients at nutritional risk as defined by the Nutritional Risk Screening Tool 2002 (NRS-2002)....

  2. Bioinformatics for precision medicine in oncology: principles and application to the SHIVA clinical trial

    Servant, Nicolas; Roméjon, Julien; Gestraud, Pierre; La Rosa, Philippe; Lucotte, Georges; Lair, Séverine; Bernard, Virginie; Zeitouni, Bruno; Coffin, Fanny; Jules-Clément, Gérôme; Yvon, Florent; Lermine, Alban; Poullet, Patrick; Liva, Stéphane; POOK, Stuart

    2014-01-01

    Precision medicine (PM) requires the delivery of individually adapted medical care based on the genetic characteristics of each patient and his/her tumor. The last decade witnessed the development of high-throughput technologies such as microarrays and next-generation sequencing which paved the way to PM in the field of oncology. While the cost of these technologies decreases, we are facing an exponential increase in the amount of data produced. Our ability to use this information in daily pr...

  3. Emerging molecular targets in oncology: clinical potential of MET/hepatocyte growth-factor inhibitors

    Smyth EC; Sclafani F; Cunningham D

    2014-01-01

    Elizabeth C Smyth, Francesco Sclafani, David Cunningham Department of Gastrointestinal Oncology, Royal Marsden Hospital, Sutton, UK Abstract: The MET/hepatocyte growth-factor (HGF) signaling pathway plays a key role in the processes of embryogenesis, wound healing, and organ regeneration. Aberrant activation of MET/HGF occurs through multiple mechanisms including gene amplification, mutation, protein overexpression, and abnormal gene splicing interrupting autocrine and paracrine regulatory f...

  4. QIN. Promise and pitfalls of quantitative imaging in oncology clinical trials

    Kurland, Brenda F; Gerstner, Elizabeth R.; Mountz, James M; Schwartz, Lawrence H.; Ryan, Christopher W.; Graham, Michael M.; Buatti, John M.; Fennessy, Fiona M.; Eikman, Edward A.; Kumar, Virendra; Forster, Kenneth M.; Wahl, Richard L.; Lieberman, Frank S.

    2012-01-01

    Quantitative imaging using CT, MRI, and PET modalities will play an increasingly important role in the design of oncology trials addressing molecularly targeted, personalized therapies. The advent of molecularly targeted therapies, exemplified by antiangiogenic drugs, creates new complexities in the assessment of response. The Quantitative Imaging Network (QIN) addresses the need for imaging modalities which can accurately and reproducibly measure not just change in tumor size, but changes in...

  5. Abdominal Sacrohysteropexy in Women with Uterovajinal Prolapse: Our 3 Years Clinical Experience

    Atilla Karateke

    2015-11-01

    Full Text Available Aim: Weakening of uterine supporting ligaments, especially cardinal and uterosacral ligaments, causes uterovaginal prolapse. Although uterovaginal prolapse is not related to uterus, hysterectomy has been the most preferred surgery in these situations. However, in recent years, uterine preservation surgery has become popular because patients begin to prefer uterus preservation for psychological reasons and site specific surgery has been developed. One of the most important uterine preservation surgery is abdominal sacrohysteropexy(ASH. In this study, we aim to present our clinical result of ASH surgey in women with uterovaginal prolapsus. Material and Method: Of 27 patients who had ASH operation due to uterovaginal prolapsus between January 2010- March 2013 in our clinic were included in the study. All the patients had preoperative urogenital examination and transvaginal ultrasonography were performed before operation. Pelvic organ prolapsus degree were recorded according to the pelvic organ prolapsus quantification system(POP-Q. ASH operation was performed by laparatomy to all patients. Of 5 patients who had stress type incontinance had %u2018Burch%u2019 operation concomitantly. Results: The mean hospitalization day of patients who had ASH operation was 2.6 days(range 2-5days and the mean age of patients were 52.8 ±7.5. None of the patients had bladder, ureter or intestine injury due to operation. While anatomical success rate were 92.6%, recurrence rate was 7.4 % at the end of first year. Ileus was not observed and only one patient who had burch operation had recurrent urinary incontinance symptoms at the end of the first year. Discussion: Our study results showed that ASH operation is a successfull operation in pelvic organ prolapse. This method also was found to be superior to others in terms of minimal complications.

  6. Epidemiologic and Malignancy Indices of Gastric Cancer in Patients Referred to Oncology Clinic at Ramsar Emam Sajjad Hospital During 2002-2009

    Z Fotoukian

    2012-05-01

    Full Text Available Introduction: Gastric cancer is considered as one of the most prevalent cancers, such that in our country it is on the top of prevalent cancers. Because of the high prevalence of this cancer in north of Iran, in spite of its incidence decrease in many regions of the world, we decided to determine the epidemiological and malignancy properties of gastric cancer in this region Methods: This research is a descriptive study (based on existing data. The study population consisted of gastric cancer patients referred to oncology clinic at Ramsar Imam Sajjad hospital during 2002- 2009. Necessary information was extracted from their medical files and pathology reports, and statistically analyzed. Results: In this Study, 144 patients were assessed (103 males and 47 females. In 95.8% of patients, tumor was adenocarcinoma. In 45.1% tumor was located in antrum. In 48.6% tumor was poorly differentiated. 72.9% of subjects had positive lymphatic involvement. There was metastatic involvement in 31.9% of patients, and the most common organ for metastasis was liver. 46.5% of Patients were in stage 4 at the time of referring to hospital and in 38.2% of cases tumor has been progressed to T2 Level. Conclusion: By considering this fact that most referring patients (46.5% were in stage 4 when were diagnosed and had poorly differentiated carcinoma, it is recommended that people should consider abdominal discomfort as a serious problem and do necessary diagnostic methods especially in ages above 45 years with especial emphasis on early diagnosis of disease and reduction of death rate for at risk population.

  7. Practicing radiation oncology in the current health care environment - Part II: Designing a radiation oncology department and setting up a clinical practice program

    Objective: Identify the business practices necessary to develop a successful radiation oncology department in the current health care environment. Course content will be of interest to new practitioners establishing first time programs or joining existing groups as well as experienced radiation oncologists who are challenged with redesigning programs to be competitive. Course Content: During this session, the following topics will be discussed: 1) Space planning and equipment selection 2) Personnel; creating efficiencies while promoting productivity 3) Professional and Technical Billing; establishing proper fee structures and coding procedures 4) Utilizing benchmarking as a tool to improve operations 5) Information technology in radiation oncology 6) Current and Future Trends: a) Oncology networks b) Reimbursement: managed care and capitation c) Downsizing d) Relative Value Units

  8. Robot-Assisted Gynecologic Oncology Surgery

    Full Text Available ... abdominal cases into laparoscopic cases, and that's the beauty of the platform. And that's what oncology is ... that's been liberalized, and people are seeing the beauty of minimally invasive surgery. So Dr. Molpus, on ...

  9. Medication double-checking procedures in clinical practice: a cross-sectional survey of oncology nurses' experiences

    Pfeiffer, Yvonne; Taxis, Katja

    2016-01-01

    Background Double-checking is widely recommended as an essential method to prevent medication errors. However, prior research has shown that the concept of double-checking is not clearly defined, and that little is known about actual practice in oncology, for example, what kind of checking procedures are applied. Objective To study the practice of different double-checking procedures in chemotherapy administration and to explore nurses' experiences, for example, how often they actually find errors using a certain procedure. General evaluations regarding double-checking, for example, frequency of interruptions during and caused by a check, or what is regarded as its essential feature was assessed. Methods In a cross-sectional survey, qualified nurses working in oncology departments of 3 hospitals were asked to rate 5 different scenarios of double-checking procedures regarding dimensions such as frequency of use in practice and appropriateness to prevent medication errors; they were also asked general questions about double-checking. Results Overall, 274 nurses (70% response rate) participated in the survey. The procedure of jointly double-checking (read-read back) was most commonly used (69% of respondents) and rated as very appropriate to prevent medication errors. Jointly checking medication was seen as the essential characteristic of double-checking—more frequently than ‘carrying out checks independently’ (54% vs 24%). Most nurses (78%) found the frequency of double-checking in their department appropriate. Being interrupted in one's own current activity for supporting a double-check was reported to occur frequently. Regression analysis revealed a strong preference towards checks that are currently implemented at the responders' workplace. Conclusions Double-checking is well regarded by oncology nurses as a procedure to help prevent errors, with jointly checking being used most frequently. Our results show that the notion of independent checking needs to be

  10. Prevention of respiratory complications after abdominal surgery: a randomised clinical trial.

    Hall, J. C.; Tarala, R. A.; Tapper, J.; Hall, J L

    1996-01-01

    OBJECTIVE--To evaluate the prevention of respiratory complications after abdominal surgery by a comparison of a global policy of incentive spirometry with a regimen consisting of deep breathing exercises for low risk patients and incentive spirometry plus physiotherapy for high risk patients. DESIGN--Stratified randomised trial. SETTING--General surgical service of an urban teaching hospital. PATIENTS--456 patients undergoing abdominal surgery. Patients less than 60 years of age with an Ameri...

  11. Diagnosis and treatment of abdominal aortic endoleaks using color Doppler US: Two clinical cases

    G. Nano; Stegher, S.; Spinazzola, A.

    2008-01-01

    Endovascular treatment of abdominal aortic aneurysm (AAA) involves placement of an endoluminal graft inside the aneurysmal sac in order to exclude it from blood circulation and thereby prevent the risk of aneurysmal sac rupture. A possible complication is endoleak, i.e. persistent blood flow outside the lumen of the endograft into the aneurysmal sac. The protocol for treatment monitoring includes abdominal computed tomography (CT) and color Doppler ultrasound (US). The aim of this case report...

  12. "Green Oncology": the Italian medical oncologists' challenge to reduce the ecological impact of their clinical activity.

    Bretti, Sergio; Porcile, Gianfranco; Romizi, Roberto; Palazzo, Salvatore; Oliani, Cristina; Crispino, Sergio; Labianca, Roberto

    2014-01-01

    For decades Western medicine has followed a biomedical model based on linear thinking and an individualized, disease-oriented doctor-patient relationship. Today this framework must be replaced by a biopsychosocial model based on complexity theory and a person-oriented medical team-patient relationship, taking into account the psychological and social determinants of health and disease. However, the new model is already proving no longer adequate or appropriate, and current events are urging us to develop an ecological model in which the medical team takes into account both individual illness and population health as a whole, since we are all part of the biosphere. In recent years, the rising costs of cancer treatment have raised a serious issue of economic sustainability. As the population of our planet, we now need to rapidly address this issue, and everyone of us must try to reduce their ecological footprint, measured as CO2 production. Medical oncologists need to reduce the ecological footprint of their professional activity by lowering the consumption of economic resources and avoiding environmental damage as much as possible. This new paradigm is endorsed by the Italian College of Hospital Medical Oncology Directors (CIPOMO). A working group of this organization has drafted the "Green Oncology Position Paper": a proposal of Italian medical oncology (in accordance with international guidelines) that oncologists, while aiming for the same end results, make a commitment toward the more appropriate management of health care and the careful use of resources in order to protect the environment and the ecosphere during the daily exercise of their professional activities. PMID:25076260

  13. The utility of ultrasonography in the the diagnostics and monitoring of treatment of acute abdominal pain in children with neoplasms

    The aim of this study was to estimate the results of the diagnostic imaging modalities, especially ultrasonography (US) in children during the oncological therapy with the acute abdominal symptoms. Acute abdominal symptoms in children with neoplasms causing a very difficult clinical and diagnostic problems and can occur in any stage of disease. The high-resolution ultrasound has a very important role in diagnosis in all patients with acute abdominal pain and with neoplasms. The authors consider that the US should be the first imaging method in the differential diagnosis of the abdominal changes in children with neutropenia and oncological disease. Proper diagnosis should be established only with clinical information. We analyzed 249 ultrasounds examinations of the abdominal cavity in 144 girls and 105 boys aged from 1 to 18 years (mean age 10, 3 years). The more important indication for the US exam in 133 cases was acute abdominal symptoms. We took exams during pre- and postoperative chemotherapy, radiotherapy and after the hematopoietic stem cell transplantation. All the patients were under routine hematological control. Based on the clinical symptoms and the laboratory tests we analysed two groups of children with oncological disease and acute abdomen: I group - 111 children with neutropenia, II group - 22 children without neutropenia. In the patients who underwent operation procedure the final diagnosis was established on histopathology. In the other cases diagnosis was based on clinical, laboratory and radiological exams, especially ultrasonography. We analyzed clinical picture of disease, the results of therapy and the US changes in examined patients using statistic parameters as: sensitivity, specificity and efficiency. In the group of 133 children with acute abdominal symptoms the most (92- 69,1%) patients suffer from ALL (acute lymphoblastic leukaemia) and 16(12%) - from AML (acute lymphoblastic leukaemia), Ewing sarcoma-3(2,2%), osteosarcoma - 3(2,2%), NHL

  14. Clinical impact of Positron Emission Tomography (PET) on oncological patients and their potentially application context

    (PET) Positron Emission Tomography is a technique of nuclear medicine that has ability of detecting cancer through mechanisms based on molecular alterations of neoplastic processes. This review describes the PET Oncology applications and discusses the potential application of this technology in the sanitary and national academic framework . The most widely used in Oncology plotter is an analogue of laglucosa labelled with fluo: 18F-2-fluoro-2-Deoxy-D-glucose (FDG). In this way, the PET detects tumour retention of FDG, due to the highest glycolytic of cancer cells. In addition, the PET allow the study of the entire body at the same exploratory and some teams are coupled to systems of axial tomography (PET-CT). By ET-FDG, it is possible to diagnose, staging and restaged the majority of cancers, with diagnostic accuracy close to 90 per cent higher than the values provided by the conventional imaging techniques such. It is also possible to know early response to cancer treatments and obtain relevant medical prognosis information. (author)

  15. Integrated 18FDG PET/CT: Utility and Applications in Clinical Oncology

    Nieves Gómez-León

    2008-01-01

    Full Text Available Accurate diagnosis and staging are essential for an optimal management of cancer patients. Positron emision tomography with 2-deoxy-2-fluorine-18-fluoro-D-glucose (18FDG-PET and, more recently, 18FDG-PET/computed tomography (18FDG-PET/CT have emerged as powerful imaging tools in oncology, because of the valuable functional information they provide. The combined acquisition of PET and CT has synergistic advantages over its isolated constituents and minimizes their limitations. It decreases examination times by 25%–40%, leads to a higher patient throughput and unificates two imaging procedures in a single session. There is evidence that 18FDG-PET/CT is a more accurate test than either of its components for the evaluation of various tumors. It is a particularly valuable tool for detection of recurrence, especially in asymptomatic patients with rising tumor markers and those with negative or equivocal findings on conventional imaging tests. Yet, there are some limitations and areas of uncertainty, mainly regarding the lack of specificity of the 18FDG uptake and the variable 18FDG avidity of some cancers. This article reviews the advantages, limitations and main applications of 18FDG-PET/CT in oncology, with especial emphasis on lung cancer, colorectal cancer, lymphomas, melanoma and head and neck cancers.

  16. Clinical Research on Abdominal Acupuncture plus Conventional Acupuncture for Knee Osteoarthritis

    MENG Chang-rong; FAN Li; FU Wen-bin; LI Yong; DUAN Shu-min

    2009-01-01

    Objective: To probe the therapeutic effect of abdominal acupuncture plus conventional acupuncture on knee osteoarthritis. Methods: PEMS3.1 software was used. The 105 patients with knee osteoarthritis were randomly divided into an abdominal acupuncture group, a conventional acupuncture group and a combined group (abdominal acupuncture plus conventional acupuncture). For the abdominal acupuncture group, the abdominal acupuncture was performed at Zhongwan (CV 12), Guanyuan (CV 4), Wailing (ST 26), Daheng (SP 15), Lower Rheumatism point and Qipang with needles retained for 30 minutes. For the conventional acupuncture group, the acupuncture was practiced at Neixiyan (EX-LE4) and Dubi (ST 35) of the affected limb, Yanglingquan (GB 34), Liangqiu (ST 34), Xuehai (SP 10) and Xiyangguan (GB 33). For the combined group, both methods were applied. Treatment was given once a day, 6 times a week, for 4 weeks. Lysholm knee scoring scale was used to score the functions of knee before and after treatment. Results: Of 35 cases in the abdominal acupuncture group, 8 cases were remarkably relieved, 10 cases relieved, 14 cases improved, and 3 cases failed, the total effective rate was 91.4%. Of 35 cases in the conventional acupuncture group, 7 cases were remarkably relieved, 8 cases relieved, 16 cases improved, and 4 cases failed, the total effective rate was 88.6%. Of 35 cases in the combined group, 13 cases were remarkably relieved, 16 cases relieved, 5 cases improved, and 1 cases failed, the total effective rate was 97.1%. There was a remarkable difference in the effect among 3 groups (P<0.05). The difference in scores of Lysholm knee scoring scale for knee joint after treatment among 3 groups was very significant (P<0.01). Conclusion: Abdominal acupuncture has reliable effect for knee osteoarthritis and it has the synergized function when combined with conventional acupuncture.

  17. A web-based 'patterns of care study' system for clinical radiation oncology in Korea: development, launching, and characteristics

    We report upon a web-based system for Patterns of Care Study (PCS) devised for Korean radiation oncology, This PCS was designed to establish standard tools for clinical quality assurance, to determine basic parameters for radiation oncology processes, to offer a solid system for cooperative clinical studies and a useful standard database for comparisons with other national databases. The system consisted of a main server with two back-ups in other locations. The program uses a Linux operating system and a MySQL database. Cancers with high frequencies in radiotherapy departments in Korea from 1998 to 1999 were chosen to have a developmental priority. The web-based clinical PCS system for radiotherapy in www.pcs.re.kr was developed in early 2003 for cancers of the breast, rectum, esophagus, larynx and lung, and for brain metastasis. The total number of PCS study items exceeded one thousand. Our PCS system features user-friendliness, double entry checking, data security, encryption, hard disc mirroring, double back-up, and statistical analysis. Alphanumeric data can be input as well as image data. In addition, programs were constructed for IRB submission, random sampling of data, and departmental structure. For the first time in the field of PCS, we have developed a web-based system and associated working programs. With this system, we can gather sample data in a short period and thus save, cost, effort and time. Data should be performed to validate input data. We propose that this system should be considered as a standard method for PCS or similar types of data collection systems

  18. Adjuvant continuous infusion 5-FU, whole-abdominal radiation, and tumor bed boost in high-risk stage III colon carcinoma: a southwest oncology group pilot study

    Purpose: Results of a combined modality adjuvant pilot program of low-dose continuous-infusion 5-fluorouracil, whole-abdominal radiation, and tumor bed boost in patients with colon cancer with involved nodes and serosal involvement are presented. Methods and Materials: Forty-one eligible patients with completely resected T3N1-2M0 colon cancer (modified Astler-Coller C2) were treated with 5-fluorouracil (5-FU) at a dose of 200 mg/m2/day by continuous infusion and 30 Gy of concomitant whole-abdominal radiation in 1 Gy fractions. An additional 16 Gy boost to the tumor bed was administered in 1.6 Gy fractions. After completion of combined modality treatment and a 21-day rest period, patients received 4 days of 5-FU at a dose of 1000 mg/m2 by continuous infusion every 28 days for nine cycles. Results: Five-year disease-free and overall survival estimates were 58 and 67%, respectively, for all T3N1-2 patients. Five-year disease-free and overall survival estimates for the 19 patients with four or fewer nodes were both 61%. Five-year disease-free survival and overall survival estimates for the 20 patients with more than four involved nodes were 55% and 74%, respectively (the exact number of involved nodes were unknown for two patients). Disease-free and overall survival estimates for patients treated with 5-FU and radiation compare favorably to the 5-FU plus levamisole arm of the intergroup adjuvant colon study (Int 0035/SWOG 8591) in patients with more than four positive nodes where the 5-year disease-free and overall survival estimates were 35% and 39%, respectively. Disease-free and overall survival estimates for patients with four or fewer nodes in the 5-FU plus levamisole arm of the intergroup study were 64 and 68%, which is not markedly different from results obtained with radiation and 5-FU in the current study. There were no treatment-related fatalities. Seventeen percent of patients had severe and 7% had life-threatening toxicity of any kind. One patient had an

  19. What Medical Oncologist Residents Think about the Italian Speciality Schools: A Survey of the Italian Association of Medical Oncology (AIOM) on Educational, Clinical and Research Activities

    Moretti, Anna; De Angelis, Carmine; Lambertini, Matteo; Cremolini, Chiara; Imbimbo, Martina; Berardi, Rossana; Di Maio, Massimo; Cascinu, Stefano; La Verde, Nicla

    2016-01-01

    Background and objectives Relevant heterogeneity exists among Postgraduate Schools in Medical Oncology, also within the same country. In order to provide a comprehensive overview of the landscape of Italian Postgraduate Schools in Medical Oncology, the Italian Association of Medical Oncology (AIOM) undertook an online survey, inviting all the residents to describe their daily activities and to express their overall satisfaction about their programs. Methods A team composed of five residents and three consultants in medical oncology prepared a 38 items questionnaire that was published online in a reserved section, accessible through a link sent by e-mail. Residents were invited to anonymously fill in the questionnaire that included the following sub-sections: quality of teaching, clinical and research activity, overall satisfaction. Results Three-hundred and eleven (57%) out of 547 invited residents filled in the questionnaire. Two-hundred and twenty-three (72%) participants declared that attending lessons was frequently difficult and 153 (49%) declared they did not gain substantial improvement in their knowledge from them. Fifty-five percent stated that they did not receive lessons on palliative care. Their overall judgment about didactic activity was low in 63% of the interviewed. The satisfaction for clinical activity was in 86% of cases good: 84% recognized that, during the training period, they acquired a progressive independence on patients' management. About research activity, the majority (79%) of participants in the survey was actively engaged in managing patients included in clinical trials but the satisfaction level for the involvement in research activities was quite low (54%). Overall, 246 residents (79%) gave a positive global judgment of their Medical Oncology Schools. Conclusions The landscape of Italian Postgraduate Schools in Medical Oncology is quite heterogeneous across the country. Some improvements in the organization of teaching and in the

  20. Radiologist-initiated double reading of abdominal CT: retrospective analysis of the clinical importance of changes to radiology reports

    Andersen, Jack Gunnar; Stokke, Mali Victoria; Tennstrand, Anne Lise; Aamodt, Rolf; Heggelund, Thomas; Dahl, Fredrik A; Sandbæk, Gunnar; Hurlen, Petter

    2016-01-01

    Background Misinterpretation of radiological examinations is an important contributing factor to diagnostic errors. Consultant radiologists in Norwegian hospitals frequently request second reads by colleagues in real time. Our objective was to estimate the frequency of clinically important changes to radiology reports produced by these prospectively obtained double readings. Methods We retrospectively compared the preliminary and final reports from 1071 consecutive double-read abdominal CT examinations of surgical patients at five public hospitals in Norway. Experienced gastrointestinal surgeons rated the clinical importance of changes from the preliminary to final report. The severity of the radiological findings in clinically important changes was classified as increased, unchanged or decreased. Results Changes were classified as clinically important in 146 of 1071 reports (14%). Changes to 3 reports (0.3%) were critical (demanding immediate action), 35 (3%) were major (implying a change in treatment) and 108 (10%) were intermediate (requiring further investigations). The severity of the radiological findings was increased in 118 (81%) of the clinically important changes. Important changes were made less frequently when abdominal radiologists were first readers, more frequently when they were second readers, and more frequently to urgent examinations. Conclusion A 14% rate of clinically important changes made during double reading may justify quality assurance of radiological interpretation. Using expert second readers and a targeted selection of urgent cases and radiologists reading outside their specialty may increase the yield of discrepant cases. PMID:27013638

  1. The role of radiation therapy in childhood acute leukemia. A review from the viewpoint of basic and clinical radiation oncology

    Radiation therapy has been playing important roles in the treatment of childhood acute leukemia since the 1970s. The first is the preventive cranial irradiation for central nervous system therapy in acute lymphoblastic leukemia. The second is the total body irradiation as conditioning before bone marrow transplantation for children with acute myeloid leukemia in first remission and with acute lymphoblastic leukemia in second remission. Although some late effects have been reported, a part of them could be overcome by technical improvement in radiation and salvage therapy. Radiation therapy for children might have a successful outcome on a delicate balance between efficiencies and potential late toxicities. The role of radiation therapy for childhood acute leukemia was reviewed from the standpoint of basic and clinical radiation oncology in this paper. (author)

  2. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for testicular germ cell tumors

    Mohammed Alotaibi

    2016-01-01

    Full Text Available This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with testicular germ cell tumors. It is categorized according to the stage of the disease using the tumor-node-metastasis staging system 7th edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with testicular germ cell tumors.

  3. Saudi oncology society and Saudi urology association combined clinical management guidelines for prostate cancer

    Ashraf Abusamra

    2016-01-01

    Full Text Available This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with prostate cancer. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors who were selected by the Saudi oncology society and Saudi urological association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with adenocarcinoma of the prostate to.

  4. Non-surgical management of early breast cancer in the United Kingdom: follow-up. Clinical Audit Sub-committee of the Faculty of Clinical Oncology, Royal College of Radiologists, and the Joint Council for Clinical Oncology.

    Maher, E J

    1995-01-01

    Follow-up of operable breast cancer patients takes up a significant proportion of British oncologists' time, with 90% seeing 5-50 patients each week. Procedures vary greatly, but, in patients treated by surgery and radiotherapy, care is usually shared, with alternating visits to see each team. Currently, the general practitioner has sole responsibility for follow-up in less than 3% of patients. They tend to be followed up in general, rather than specialist, clinics. There is almost universal agreement that routine blood tests, radiographs and scans are not indicated as part of routine follow-up, but the role of mammography in evaluating an irradiated breast remains a source of debate. Just over a half of the oncologists surveyed order baseline mammography of both treated and contralateral breasts, usually between 6 and 12 months after local excision and radiotherapy, with further follow-up 1-3-yearly thereafter. Ten per cent of the participating oncologists never suggest follow-up mammography. Patients tend to be followed in oncology clinics at 3-4-monthly intervals for the first 2 years, 6-monthly in the third and fourth years and, thereafter, yearly. Fifteen per cent of oncologists discharge patients at 5 years, with the discharge rate rising to 43% at 10 years; around one-third modify follow-up according to the age of the patient. The aims of follow-up were seen to include detection of curable disease, but other goals were perceived as equally important (e.g. detection of iatrogenic problems, audit, counselling, education and the provision of early palliation of incurable and metastatic disease. Breast cancer is no longer seen as an absolute contraindication to either pregnancy or the use of hormone replacement therapy (HRT); however, oncologists are uncertain about the appropriate use of HRT, either alone or with tamoxifen. This audit highlights a number of research areas: the identification of the appropriate site and skill-mix for follow-up of patients

  5. Routine administration of standardized questionnaires that assess aspects of patients quality of life in medical oncology clinics: A systematic review

    Purpose: Increasing interest in the Quality of Life outcomes in cancer patients led to increase implementation of their use in routine clinical practice. The aim of this systemic review is to review the scientific evidence behind recommending the use of quality of life (QoL) scales routinely in outpatient evaluation. Methods: Systematic review for all published randomized controlled trials in English language between January 1, 1990 till December 31, 2012. Out of 487 articles (476 identified by electronic search + 11 articles identified by manual search), six trials satisfied the eligibility criteria: (1) the study was a randomized controlled trial (RCT) with randomization of patients or health care providers; (2) the findings of the administered questionnaire or scale (the intervention) were given to health care provider, and compared to standard care with no questionnaire administered (the control); (3) study was conducted in outpatient oncology clinics; and (4) an outcome was measured that related to (i) QoL improvement, (ii) reduction in morbidity, (iii) reduction in stress for the patients, (iv) improvement in communication between patients and health care provider, or (v) improved patient satisfaction. Assessment for the quality of the study was done using the GRADE methodology. Results: Serious methodological issues were affecting most of the trials. Overall the evaluation of the quality of the evidence from these identified trials suggests that there is a weak recommendation to use QoL scales in routine oncology practice to improve communication between physicians and patients. Conclusion: The routine use of such tools in the outpatient settings at improving the patient outcome or satisfaction cannot be recommended based on the available evidence. The potential harm with the excess use of resources needed to implement, collect, store, analyse, and present such data to health care providers should be also considered. Further research and better designed

  6. Attitudes of Oncologists, Oncology Nurses, and Patients from a Women's Clinic Regarding Medical Decision Making for Older and Younger Breast Cancer Patients.

    Beisecker, Analee E.; And Others

    1994-01-01

    Administered Beisecker Locus of Authority in Decision Making: Breast Cancer survey to 67 oncologists, 94 oncology nurses, and 288 patients from women's clinic. All groups believed that physicians should have dominant role in decision making. Nurses felt that patients should have more input than patients or physicians felt they should. Physicians…

  7. Heterogeneous Optimization Framework: Reproducible Preprocessing of Multi-Spectral Clinical MRI for Neuro-Oncology Imaging Research.

    Milchenko, Mikhail; Snyder, Abraham Z; LaMontagne, Pamela; Shimony, Joshua S; Benzinger, Tammie L; Fouke, Sarah Jost; Marcus, Daniel S

    2016-07-01

    Neuroimaging research often relies on clinically acquired magnetic resonance imaging (MRI) datasets that can originate from multiple institutions. Such datasets are characterized by high heterogeneity of modalities and variability of sequence parameters. This heterogeneity complicates the automation of image processing tasks such as spatial co-registration and physiological or functional image analysis. Given this heterogeneity, conventional processing workflows developed for research purposes are not optimal for clinical data. In this work, we describe an approach called Heterogeneous Optimization Framework (HOF) for developing image analysis pipelines that can handle the high degree of clinical data non-uniformity. HOF provides a set of guidelines for configuration, algorithm development, deployment, interpretation of results and quality control for such pipelines. At each step, we illustrate the HOF approach using the implementation of an automated pipeline for Multimodal Glioma Analysis (MGA) as an example. The MGA pipeline computes tissue diffusion characteristics of diffusion tensor imaging (DTI) acquisitions, hemodynamic characteristics using a perfusion model of susceptibility contrast (DSC) MRI, and spatial cross-modal co-registration of available anatomical, physiological and derived patient images. Developing MGA within HOF enabled the processing of neuro-oncology MR imaging studies to be fully automated. MGA has been successfully used to analyze over 160 clinical tumor studies to date within several research projects. Introduction of the MGA pipeline improved image processing throughput and, most importantly, effectively produced co-registered datasets that were suitable for advanced analysis despite high heterogeneity in acquisition protocols. PMID:26910516

  8. Nanotechnology in Radiation Oncology

    Wang, Andrew Z.; Tepper, Joel E.

    2014-01-01

    Nanotechnology, the manipulation of matter on atomic and molecular scales, is a relatively new branch of science. It has already made a significant impact on clinical medicine, especially in oncology. Nanomaterial has several characteristics that are ideal for oncology applications, including preferential accumulation in tumors, low distribution in normal tissues, biodistribution, pharmacokinetics, and clearance, that differ from those of small molecules. Because these properties are also wel...

  9. Multi-slice abdominal CT in oncological patients. Influence of table feed and detector configuration on image quality and radiation exposure

    Purpose: To evaluate the image quality and radiation exposure of different spiral CT scanning parameters for routine staging examination of the abdomen in oncologic patients using a multi-slice CT scanner. Methods/Materials: Examination of 40 patients in 4 groups on a multislice CT scanner (Somatom VolumeZoom, Siemens AG, Forchheim). Functional detector width (4x2.5, 4x5 mm) and pitch (table feed in relation to collimated slice width) were varied (3 and 5). Tube voltage (120 kV), effective tube current (160 mAs), slice-thickness (6 mm), increment (4 mm), kernel (B 30), and contrast injection parameters were dept constant. Axial images were assessed by three radiologists regarding delineation of anatomic structures, artifacts, and overall image quality. Results: Significantly reduced image quality especially due to artifacts was observed using a 5 mm detector configuration with a pitch of 5 (scan time 9 sec). Image quality was rated best for a 2.5 mm detector configuration with a pitch of 3 and a scan time of 28 sec. The effective dose was independent of the pitch. However, the mean effective dose was 9% higher using the smaller detector configuration (9.9 mSv vs 10.9 mSv). Conclusions: For routine staging CT of the abdomen use of a 4x2.5 mm detector configuration with a pitch between 3 and 5 is recommended. A 4x5 mm detector configuration using overlapping data acquisition can also be recommended, but additional thin slice reformations are not possible. (orig.)

  10. Randomized clinical trial comparing blunt tapered and standard needles in closing abdominal fascia.

    Nordkam, R.A.; Bluyssen, S.J.; Goor, H. van

    2005-01-01

    Glove perforation frequently occurs during the course of surgical procedures, introducing risks for both surgeons and patients. The aim of this study was to compare the use of blunt tapered and "sharp" needles during abdominal wall closure with respect to the incidence of glove perforation and the c

  11. Stereotactic body radiation therapy for abdominal oligometastases: a biological and clinical review

    Advances in imaging and biological targeting have led to the development of stereotactic body radiation therapy (SBRT) as an alternative treatment of extracranial oligometastases. New radiobiological concepts, such as ceramide-induced endothelial apoptosis after hypofractionated high-dose SBRT, and the identification of patients with oligometastatic disease by microRNA expression may yet lead to further developments. Key factors in SBRT are delivery of a high dose per fraction, proper patient positioning, target localisation, and management of breathing–related motion. Our review addresses the radiation doses and schedules used to treat liver, abdominal lymph node (LN) and adrenal gland oligometastases and treatment outcomes. Reported local control (LC) rates for liver and abdominal LN oligometastases are high (median 2-year actuarial LC: 61 -100% for liver oligometastases; 4-year actuarial LC: 68% in a study of abdominal LN oligometastases). Early toxicity is low-to-moderate; late adverse effects are rare. SBRT of adrenal gland oligometastases shows promising results in the case of isolated lesions. In conclusion, properly conducted SBRT procedures are a safe and effective treatment option for abdominal oligometastases

  12. CLINICAL OBSERVATION ON 36 CASES OF SCAPULOHUMERAL PERIARTHRITIS TREATED BY ABDOMINAL ACUPUNCTURE AND BODY-ACUPUNCTURE

    睢明河

    2001-01-01

    Objective: To compare the therapeutic effect of abdominal acupuncture plus body acupuncture and simple body acupuncture in treatment of scapulohumeral periarthritis. Methods: 68 cases of scapulohumeral periarthritis patients were randomly divided into abdominal acupuncture plus body acupuncture (AABA) group (n= 36) and simple body acupuncture (BA) group (n=32). In AABA group, abdominal acupuncture points used were Zhongwan(CV 12), Shangqu (KI 17) (on the healthy side) and Huaroumen-sanjiao (on the affected side); and body acupoints employed were Jianyu (LI 15), Jianliao(TE 14), Binao (LI 14), Quchi (LI 11), Waiguan (TE 5) and Hegu (LI 4) on the affected side. In BA group, the body acupoints used were the same to those mentioned above. The acupuncture needles were retained for 20 min. Acupuncture treatment was given once daily, with 10 sessions being a therapeutic course and the interval between two courses being one week. 2 courses of treatment were conducted altogether. Results: Following 2 courses of treatment, in AABA and BA groups, 6 (16.7%) and 1 (3.1%) cases were cured, 19 (52.8%) and 12 (37.5%) had remarkable improvement, 11 (30.6%) and 17 (53.1%) had improvement, 0 and 2 (6.25%) had no effect respectively. There was a significant difference between two groups in the therapeutic effect (P<0.05) .Conclusion: The therapeutic effect of abdominal acupuncture plus body acupuncture is superior to that of simple body acupuncture in treatment of scapulohumeral periarthritis.

  13. Instruction in medical ethics during clinical training for medical students. Report on experience in radio-oncology

    The article gives a review of the current state of education in medical ethics in Germany. The issue is considered from the viewpoint of radio-oncology. Both the pertinent literature and our own experience in teaching medical ethics are presented. In October 2003, medical ethics was integrated into the curriculum of medicine. The aim was to train competence in the field of personal attitudes and to intensify skills of moral reasoning. Our own experiences are positive, which is in accordance with the reports of other working groups. Most of the students were interested in education in medical ethics and looked upon ethical training as being an important part of their studies. Medical students are interested in ethical education during the clinical period of their studies, which has been taken into account since the actual change of the curriculum. Radio-oncologists as specialists in other clinical fields can offer important contributions when they discuss clinical cases from the viewpoint of medical ethics. The long-term effect of such an education will become the subject of future research. (orig.)

  14. Selected clinically established and scientific techniques of diffusion-weighted MRI. In the context of imaging in oncology

    Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) technique that was established in the clinical routine primarily for the detection of brain ischemia. In the past 15 years its clinical use has been extended to oncological radiology, as tumor and metastases can be depicted in DWI due to their hypercellular nature. The basis of DWI is the Stejskal-Tanner experiment. The diffusion properties of tissue can be visualized after acquisition of at least two diffusion-weighted series using echo planar imaging and a specific sequence of gradient pulses. The use of DWI in prostate MRI was reported to be one of the first established applications that found its way into internationally recognized clinical guidelines of the European Society of Urological Radiology (ESUR) and the prostate imaging reporting and data system (PI-RADS) scale. Due to recently reported high specificity and negative predictive values of 94 % and 92 %, respectively, its regular use for breast MRI is expected in the near future. Furthermore, DWI can also reliably be used for whole-body imaging in patients with multiple myeloma or for measuring the extent of bone metastases. New techniques in DWI, such as intravoxel incoherent motion imaging, diffusion kurtosis imaging and histogram-based analyses represent promising approaches to achieve a more quantitative evaluation for tumor detection and therapy response. (orig.)

  15. Dosimetric comparison of the linear accelerators at the University Clinic of Radiotherapy and Oncology in Skopje, Macedonia

    In radiotherapy practice, for various practical reasons it is important to know whether two or more linear accelerators (linacs) are dosimetric matched and whether the patient’s treatment can be shifted from one linac to another without reducing the treatment quality. This work presents the data from the dosimetric comparison of the two Varian Clinacs 23EX and one Varian Clinac iX at the University Clinic of Radiotherapy and Oncology in Skopje. Both Percentage Depth Dose (PDD) and Beam Profile (BP) curves were compared for the photon energies (6MV, 15MV) in use at the clinic. The comparison was performed using the IBA OmniPro Accept 7.4™ software. The results from the comparison of the PDD curves showed that in the clinically significant region the dose differences were smaller than 1%. The results from the comparison of the in line and cross line BP curves showed that in the flattened area the dose differences were smaller than 2.5%, while in the penumbra region they were usually between 2% and 8%, but sometimes up to 21%. This suggests that for treatments where the influence of the penumbra region is small, the three linacs may be considered to be dosimetric matched. For treatments where the influence of the penumbra region is greater, the patient can be switched to another machine only after recalculation of the treatment plan. (Author)

  16. Abdominal CT scan: A comparative study of patient exposure in clinical routine on devices with and without iterative reconstruction

    Objective: compare the dose delivered to patients and image quality in clinical routine to perform an abdominal CT scan with no iterative reconstruction techniques (IR) relative to an examination conducted on a scanner with IR. Materials and methods: this is a retrospective study of 30 patients who underwent two abdominal examinations: one on a 40-slice scanner (TDM40) without IR and another one on a 256-slice scanner with IR (TDM256). The patients, on medical follow-up for a chronic abdominal disease, had an exam on each scanner using the same protocol comprising an abdomino-pelvic time portal phase. The length of acquisition, the effective dose and the dose length product (DLP) as well as quantitative and qualitative assessments of the image were compared. Results: the average effective dose per examination was 17.3 mSv with the TDM40 (PDL: 1019 mGy.cm) against 11.1 mSv with the TDM256 (PDL: 654 mGy.cm), hence a reduction of 35.8% (p < 0.001). The length of acquisition and quantification were comparable in both groups. The qualitative assessment was slightly higher on the TDM40 but no examination was considered suboptimal. Conclusion: using a scanner equipped with IR significantly reduces the effective dose while maintaining image quality. (authors)

  17. Longitudinal clinical and serological survey of abdominal angiostrongyliasis in Guaporé, southern Brazil, from 1995 to 1999

    Graeff-Teixeira Carlos

    2005-01-01

    Full Text Available Abdominal angiostrongyliasis is a zoonotic infection caused by Angiostrongylus costaricensis, a nematode with an intra-vascular location in the mesentery. Our objective was to address several aspects of the natural history of this parasitosis, in a longitudinal clinical and seroepidemiological study. A total of 179 individuals living in a rural area with active transmission in southern Brazil were followed for five years (1995-1999 resulting in yearly prevalence of 28.2%, 4.2%, 10%, 20.2% and 2.8% and incidences of 0%, 5.9%, 8% and 1.5%, respectively. Both men and woman were affected with higher frequencies at age 30-49 years. In 32 individuals serum samples were collected at all time points and IgG antibody reactivity detected by ELISA was variable and usually persisting not longer than one year. Some individual antibody patterns were suggestive of re-infection. There was no association with occurrence of abdominal pain or of other enteroparasites and there was no individual with a confirmed (histopathologic diagnosis. Mollusks were found with infective third-stage larvae in some houses with an overall prevalence of 16% and a low parasitic burden. In conclusion, abdominal angiostrongyliasis in southern Brazil may be a frequent infection with low morbidity and a gradually decreasing serological reactivity.

  18. A Bayesian Dose-finding Design for Oncology Clinical Trials of Combinational Biological Agents.

    Cai, Chunyan; Yuan, Ying; Ji, Yuan

    2014-01-01

    Treating patients with novel biological agents is becoming a leading trend in oncology. Unlike cytotoxic agents, for which efficacy and toxicity monotonically increase with dose, biological agents may exhibit non-monotonic patterns in their dose-response relationships. Using a trial with two biological agents as an example, we propose a dose-finding design to identify the biologically optimal dose combination (BODC), which is defined as the dose combination of the two agents with the highest efficacy and tolerable toxicity. A change-point model is used to reflect the fact that the dose-toxicity surface of the combinational agents may plateau at higher dose levels, and a flexible logistic model is proposed to accommodate the possible non-monotonic pattern for the dose-efficacy relationship. During the trial, we continuously update the posterior estimates of toxicity and efficacy and assign patients to the most appropriate dose combination. We propose a novel dose-finding algorithm to encourage sufficient exploration of untried dose combinations in the two-dimensional space. Extensive simulation studies show that the proposed design has desirable operating characteristics in identifying the BODC under various patterns of dose-toxicity and dose-efficacy relationships. PMID:24511160

  19. Review of a large clinical series: Predicting death for patients with abdominal septic shock.

    Hanisch, Ernst; Brause, Rüdiger; Paetz, Jürgen; Arlt, Björn

    2011-01-01

    This paper reports the result of the MEDAN project that analyzes a multicenter septic shock patient data collection. The mortality prognosis based on 4 scores that are often used is compared with the prognosis of a trained neural network. We built an alarm system using the network classification results. Method. We analyzed the data of 382 patients with abdominal septic shock who were admitted to the intensive care unit (ICU) from 1998 to 2002. The analysis includes the calculation of daily sepsis-related organ failure assessment (SOFA), Acute Physiological and Chronic Health Evaluation (APACHE) II, simplified acute physiology score (SAPS) II, multiple-organ dysfunction score (MODS) scores for each patient and the training and testing of an appropriate neural network. Results. For our patients with abdominal septic shock, the analysis shows that it is not possible to predict their individual fate correctly on the day of admission to the ICU on the basis of any current score. However, when the trained network computes a score value below the threshold during the ICU stay, there is a high probability that the patient will die within 3 days. The trained neural network obtains the same outcome prediction performance as the best score, the SOFA score, using narrower confidence intervals and considering three variables only: systolic blood pressure, diastolic blood pressure and the number of thrombocytes. We conclude that the currently best available score for abdominal septic shock may be replaced by the output of a trained neural network with only 3 input variables. PMID:21262751

  20. Approval procedures for clinical trials in the field of radiation oncology; Genehmigungsverfahren klinischer Studien im Bereich der Radioonkologie

    Simon, Monique; Buettner, Daniel [Deutsches Konsortium fuer Translationale Krebsforschung (DKTK), Dresden (Germany); Deutsches Krebsforschungszentrum (DKFZ), Heidelberg (Germany); Medizinische Fakultaet und Universitaetsklinikum Carl Gustav Carus, Technische Universitaet Dresden, Klinik fuer Strahlentherapie und Radioonkologie und OncoRay - Nationales Zentrum fuer Strahlenforschung in der Onkologie, Dresden (Germany); Habeck, Matthias; Habeck, Uta; Brix, Gunnar [Bundesamt fuer Strahlenschutz (BfS), Fachbereich Strahlenschutz und Gesundheit, Neuherberg (Germany); Krause, Mechthild; Baumann, Michael [Deutsches Konsortium fuer Translationale Krebsforschung (DKTK), Dresden (Germany); Deutsches Krebsforschungszentrum (DKFZ), Heidelberg (Germany); Medizinische Fakultaet und Universitaetsklinikum Carl Gustav Carus, Technische Universitaet Dresden, Klinik fuer Strahlentherapie und Radioonkologie und OncoRay - Nationales Zentrum fuer Strahlenforschung in der Onkologie, Dresden (Germany); Helmholtz-Zentrum Dresden - Rossendorf, Institut fuer Radioonkologie und OncoRay - Nationales Zentrum fuer Strahlenforschung in der Onkologie, Dresden (Germany); Willich, Normann [Universitaetsklinikum Muenster, Klinik fuer Strahlentherapie - Radioonkologie, Muenster (Germany); Wenz, Frederik [Universitaetsmedizin Mannheim, Medizinische Fakultaet Mannheim, Universitaet Heidelberg, Klinik fuer Strahlentherapie und Radioonkologie, Mannheim (Germany); Schmidberger, Heinz [Universitaetsmedizin Mainz, Klinik fuer Radioonkologie und Strahlentherapie, Mainz (Germany); Debus, Juergen [Universitaetsklinikum Heidelberg, Klinik fuer Radioonkologie und Strahlentherapie, Heidelberg (Germany); Noelling, Torsten

    2015-12-15

    Application of ionizing radiation for the purpose of medical research in Germany needs to be approved by the national authority for radiation protection (Bundesamt fuer Strahlenschutz, BfS). For studies in the field of radiation oncology, differentiation between use of radiation for ''medical care (Heilkunde)'' versus ''medical research'' frequently leads to contradictions. The aim of this article is to provide principle investigators, individuals, and institutions involved in the process, as well as institutional review or ethics committees, with the necessary information for this assessment. Information on the legal frame and the approval procedures are also provided. A workshop was co-organized by the German Society for Radiation Oncology (DEGRO), the Working Party for Radiation Oncology (ARO) of the German Cancer Society (DKG), the German Society for Medical Physics (DGMP), and the German Cancer Consortium (DKTK) in October 2013. This paper summarizes the results of the workshop and the follow-up discussions between the organizers and the BfS. Differentiating between ''Heilkunde'' which does not need to be approved by the BfS and ''medical research'' is whether the specific application of radiation (beam quality, dose, schedule, target volume, etc.) is a clinically established and recognized procedure. This must be answered by the qualified physician(s) (''fachkundiger Arzt'' according to German radiation protection law) in charge of the study and the treatments of the patients within the study, taking into consideration of the best available evidence from clinical studies, guidelines and consensus papers. Among the important parameters for assessment are indication, total dose, and fractionation. Radiation treatments applied outside clinical trials do not require approval by the BfS, even if they are applied within a randomized or nonrandomized clinical trial

  1. Intravenous fluid restriction after major abdominal surgery: a randomized blinded clinical trial

    Legemate Dink A

    2009-07-01

    Full Text Available Abstract Background Intravenous (IV fluid administration is an essential part of postoperative care. Some studies suggest that a restricted post-operative fluid regime reduces complications and postoperative hospital stay after surgery. We investigated the effects of postoperative fluid restriction in surgical patients undergoing major abdominal surgery. Methods In a blinded randomized trial, 62 patients (ASA I-III undergoing elective major abdominal surgical procedures in a university hospital were allocated either to a restricted (1.5 L/24 h or a standard postoperative IV fluid regime (2.5 L/24 h. Primary endpoint was length of postoperative hospital stay (PHS. Secondary endpoints included postoperative complications and time to restore gastric functions. Results After a 1-year inclusion period, an unplanned interim analysis was made because of many protocol violations due to patient deterioration. In the group with the restricted regime we found a significantly increased PHS (12.3 vs. 8.3 days; p = 0.049 and significantly more major complications: 12 in 30 (40% vs. 5 in 32 (16% patients (Absolute Risk Increase: 0.24 [95%CI: 0.03 to 0.46], i.e. a number needed to harm of 4 [95%CI: 2–33]. Therefore, the trial was stopped prematurely. Intention to treat analysis showed no differences in time to restore gastric functions between the groups. Conclusion Restricted postoperative IV fluid management, as performed in this trial, in patients undergoing major abdominal surgery appears harmful as it is accompanied by an increased risk of major postoperative complications and a prolonged postoperative hospital stay. Trial registration Current Controlled Trials ISRCTN16719551

  2. Patient satisfaction at haematology and oncology clinics in the Free State & Northern Cape

    W.R. Davies

    2002-09-01

    Full Text Available The Free State and Northern Cape make up some 40% of the land area of South Africa, while being home to only 10% of the total population. Haematology and Oncotherapy outreach clinics were established in Kimberley, Bethlehem and Welkom to provide a more accessible service to the thinly spread population. A previous study showed these clinics to be cost-effective, but we had no idea how the patients experience them. Our aim was to obtain information about the demographics of the patients, the logistical support of the clinics, the medical needs of the patients and how they experience the clinics. This can help us to improve the service. A questionnaire was tested in a pilot study. The demographic questions covered age, sex and ethnicity. The logistical questions dealt with distance travelled to the clinic, mode of transport, length of time as a patient and cost. The medical need questions dealt with type of disease, treatment received, type of doctor seen and origin of referral. The questions about experience covered satisfaction with the service, staff, waiting times and involvement of non-governmental organizations. Of the 95 patients interviewed 42% were from the haematology clinics. The mean age was 59.5 and the male: female ratio was 0.6:1. Forty-six percent of the patients spoke Afrikaans and 31 % spoke South Sotho. The black:white ratio was 1:1. Twenty-eight percent used the government ambulances (of whom 80% were satisfied and 56% used their own cars. The median payment at a clinic was R20 (R0 to R200. Only 19% of patients were paying privately. Ninety-five percent of the patients were follow-ups, with the median length of follow-up being 24 months (1 to 468. The patients were mainly referred by local hospitals. Twentytwo percent of the patients had chronic haematological malignancies, while 68% had solid tumours. Thirty-seven percent of the patients received drugs to take home and only 6% got intravenous chemotherapy. Consultants saw 44

  3. [Communication in the context of phase I clinical trials in oncology: implementation and evaluation of training programs].

    Rouby, Pascal; Hollebecque, Antoine; Bahleda, Ratislav; Deutsch, Eric; Gomez-Rocca, Carlos; Angevin, Eric; de La Motte Rouge, Thibault; Soria, Jean-Charles; Dauchy, Sarah

    2015-02-01

    Communication training programs in oncology have demonstrated some efficacy to improve doctors' communication skills. The goal of our study was to evaluate the impact of such training in the particular context of phase I clinical trials. Self-satisfaction and self-efficacy scales evaluating doctor-patient communication was completed by 6 medical oncologists (3 juniors and 3 seniors) before and after their communication training for a total of sixty visits. Two types of visit have been distinguished: the visits between the oncologist and the patient alone (a dual situation) and those with a third party (a trilateral situation). For all the doctors in dual and trialateral situations, self-efficacy scores improved significantly after training. This improvement was more pronounced for juniors oncologists in trilateral situations. Before training, satisfactory scores were worst in duel versus trilateral situations (P=0.01). This was particularly pronounced for junior compared to senior doctors (P=0.035). After training, in trilateral situations, the satisfaction scores of junior doctors matched that of the senior doctors. The communication training programs appear to benefit junior oncologists to a greater extent in trilateral situations. PMID:25609484

  4. ASCO 2007: “Translating Research into Practice”. Report from the 34th Annual Meeting of the American Society of Clinical Oncology

    Camillo Porta

    2011-12-01

    Full Text Available This year, for the 34th time in its history, the mastodontic machinery of the American Society of Clinical Oncology (ASCO once again welcomed thousand of members and participants from all over the world to the Society’s annual meeting, which, this year, took place in the ample and well-appointed, McCormick’s Convention Center in Chicago, Illinois...

  5. Imaging in abdominal trauma

    Imaging in abdominal trauma with special regard to the value of abdominal X-ray, ultrasound and computed tomography is described. The introduction to each organ focusses on the clinical situation, special mechanism of trauma, symptoms and the pathological staging of trauma. (orig.)

  6. American society of clinical oncology update on the role of bisphosphonates and bone health issues in women with breast cancer Part II. Bisphosphonates in the adjuvant therapy of breast cancer

    I. V. Vysotskaya

    2014-09-01

    Full Text Available American society of clinical oncology update on the roleof bisphosphonates and bone health issues in women with breast cancer Part II. Bisphosphonates in the adjuvant therapy of breast cancer

  7. Phase III clinical evaluation of gadoteridol injection: Experience in pediatric neuro-oncologic MR imaging

    Twenty-two pediatric patients with known CNS neoplasms underwent magnetic resonance (MR) imaging before and after intravenous injection of 0.1 mmol/kg gadoteridol injection as part of a Phase IIIB open label multicenter clinical trial. Intravenous adminstration of this neutral, nonionic contrast agent was found to be safe in children. No clinically relevant changes in vital signs or laboratory values were attributed to the administration of gadoteridol injection. There were no systemic complaints. The imaging characteristics of gadoteridol in pediatric CNS disease appeared similar to those of gadopentetate dimeglumine. The very low toxicity, inherent to this nonionic low osmolal paramagnetic contrast formulation may allow administration of increased doses at increased infusion rates for an increased number of indications with improved sensitivity. (orig.)

  8. Next-generation mTOR inhibitors in clinical oncology: how pathway complexity informs therapeutic strategy.

    Wander, Seth A

    2011-04-01

    Mammalian target of rapamycin (mTOR) is a PI3K-related kinase that regulates cell growth, proliferation, and survival via mTOR complex 1 (mTORC1) and mTORC2. The mTOR pathway is often aberrantly activated in cancers. While hypoxia, nutrient deprivation, and DNA damage restrain mTORC1 activity, multiple genetic events constitutively activate mTOR in cancers. Here we provide a brief overview of the signaling pathways up- and downstream of mTORC1 and -2, and discuss the insights into therapeutic anticancer targets - both those that have been tried in the clinic with limited success and those currently under clinical development - that knowledge of these pathways gives us.

  9. Clinical trial designs for evaluating the medical utility of prognostic and predictive biomarkers in oncology

    Simon, Richard

    2010-01-01

    Physicians need improved tools for selecting treatments for individual patients. Many diagnostic entities hat were traditionally viewed as individual diseases are heterogeneous in their molecular pathogenesis and treatment responsiveness. This results in the treatment of many patients with ineffective drugs, incursion of substantial medical costs for the treatment of patients who do not benefit and the conducting of large clinical trials to identify small, average treatment benefits for heter...

  10. Implementation of Remote 3-Dimensional Image Guided Radiation Therapy Quality Assurance for Radiation Therapy Oncology Group Clinical Trials

    Purpose: To report the process and initial experience of remote credentialing of three-dimensional (3D) image guided radiation therapy (IGRT) as part of the quality assurance (QA) of submitted data for Radiation Therapy Oncology Group (RTOG) clinical trials; and to identify major issues resulting from this process and analyze the review results on patient positioning shifts. Methods and Materials: Image guided radiation therapy datasets including in-room positioning CT scans and daily shifts applied were submitted through the Image Guided Therapy QA Center from institutions for the IGRT credentialing process, as required by various RTOG trials. A centralized virtual environment is established at the RTOG Core Laboratory, containing analysis tools and database infrastructure for remote review by the Physics Principal Investigators of each protocol. The appropriateness of IGRT technique and volumetric image registration accuracy were evaluated. Registration accuracy was verified by repeat registration with a third-party registration software system. With the accumulated review results, registration differences between those obtained by the Physics Principal Investigators and from the institutions were analyzed for different imaging sites, shift directions, and imaging modalities. Results: The remote review process was successfully carried out for 87 3D cases (out of 137 total cases, including 2-dimensional and 3D) during 2010. Frequent errors in submitted IGRT data and challenges in the review of image registration for some special cases were identified. Workarounds for these issues were developed. The average differences of registration results between reviewers and institutions ranged between 2 mm and 3 mm. Large discrepancies in the superior-inferior direction were found for megavoltage CT cases, owing to low spatial resolution in this direction for most megavoltage CT cases. Conclusion: This first experience indicated that remote review for 3D IGRT as part of QA

  11. Abdominal and pelvic CT in cases of suspected abuse: can clinical and laboratory findings guide its use?

    Incomplete history and concern for occult injury in suspected child abuse occasionally results in CT screenings of the abdomen and pelvis. At our institution, we noted that these exams were infrequently positive. To identify clinical or laboratory criteria that may predict intra-abdominal injury and guide the use of abdominal and pelvic CT in this population. This retrospective review involved 68 children older than 36 months who had a CT of the abdomen/pelvis for suspected abuse. CT results and patient charts were reviewed for physical exam and historical and laboratory variables. CTs were positive in 16% of patients (11/68). Hypoactive/absent bowel sounds (P = 0.01, specificity = 94.7%) and AST and ALT values greater than twice normal (P = 0.004 and P = 0.003 respectively, NPV = 93.6%) were significantly associated with positive CTs. Multiple abnormal physical exam or laboratory findings were also significantly associated with positive CTs (P = 0.03 and P = 0.002 respectively, specificity = 91.3% and NPV = 93.6% respectively). CTs of the abdomen and pelvis are infrequently positive in cases of suspected abuse. To reduce radiation exposure, CTs should only be ordered if there are findings indicating that they may be positive. In our population, these findings include absent/hypoactive bowel sounds, LFTs greater than twice normal and ≥2 abnormal labs or physical exam findings. (orig.)

  12. Abdominal and pelvic CT in cases of suspected abuse: can clinical and laboratory findings guide its use?

    Trout, Andrew T.; Strouse, Peter J. [University of Michigan Health System, C.S. Mott Children' s Hospital, Department of Radiology, Ann Arbor, MI (United States); Mohr, Bethany A. [University of Michigan Health System, C.S. Mott Children' s Hospital, Department of Pediatrics, Ann Arbor, MI (United States); Khalatbari, S.; Myles, Jamie D. [University of Michigan, Michigan Institute for Clinical and Health Research, Ann Arbor, MI (United States)

    2011-01-15

    Incomplete history and concern for occult injury in suspected child abuse occasionally results in CT screenings of the abdomen and pelvis. At our institution, we noted that these exams were infrequently positive. To identify clinical or laboratory criteria that may predict intra-abdominal injury and guide the use of abdominal and pelvic CT in this population. This retrospective review involved 68 children older than 36 months who had a CT of the abdomen/pelvis for suspected abuse. CT results and patient charts were reviewed for physical exam and historical and laboratory variables. CTs were positive in 16% of patients (11/68). Hypoactive/absent bowel sounds (P = 0.01, specificity = 94.7%) and AST and ALT values greater than twice normal (P = 0.004 and P = 0.003 respectively, NPV = 93.6%) were significantly associated with positive CTs. Multiple abnormal physical exam or laboratory findings were also significantly associated with positive CTs (P = 0.03 and P = 0.002 respectively, specificity = 91.3% and NPV = 93.6% respectively). CTs of the abdomen and pelvis are infrequently positive in cases of suspected abuse. To reduce radiation exposure, CTs should only be ordered if there are findings indicating that they may be positive. In our population, these findings include absent/hypoactive bowel sounds, LFTs greater than twice normal and {>=}2 abnormal labs or physical exam findings. (orig.)

  13. The opinion of clinical staff regarding painfulness of procedures in pediatric hematology-oncology: an Italian survey

    Cesaro Simone; Frigo Anna C; Sainati Laura; Benini Franca; Po' Chiara; Farina Maria I; Agosto Caterina

    2011-01-01

    Abstract Background Beliefs of caregivers about patient's pain have been shown to influence assessment and treatment of children's pain, now considered an essential part of cancer treatment. Painful procedures in hematology-oncology are frequently referred by children as the most painful experiences during illness. Aim of this study was to evaluate professionals' beliefs about painfulness of invasive procedures repeatedly performed in Pediatric Hemato-Oncology Units. Methods Physicians, nurse...

  14. Breast-conserving therapy as a model for creating new knowledge in clinical oncology

    New knowledge can be derived from various kinds of studies. Studies of innovative approaches are the basis for progress. Some advances in treatment are so obvious that they do not need formal testing; e.g., penicillin for pneumococcal infection. For comparing interventions with small differences in efficacy or in groups without predictable outcome, prospective randomized trials are the 'gold standard'. However, randomized trials are cumbersome, expensive, and potentially difficult for both patients and physicians. Retrospective studies are less valid scientifically because they are more likely to suffer from bias, misclassification, confounding variables, and the use of multiple comparisons. Retrospective studies can be made more valid by first specifying the study design and analysis, but are generally most useful to generate hypotheses to be tested more formally. Retrospective studies can be particularly useful in improving outcome by identifying 'problems' and their causes. An important issue for radiation oncologists in doing retrospective studies is the difficulty of assessing an effect on local tumor control in diseases in which there are competing risks of local and distant failure. Many of these points will be illustrated in studies from the Joint Center for Radiation Therapy. Studies of innovative approaches, retrospective reviews and prospective randomized clinical trials have all been useful in establishing breast-conserving therapy as a safe and effective treatment for patients with early-stage breast cancer. Several studies of innovative breast-conserving therapy beginning in the 1960's showed favorable results. Based on this experience, a series of randomized clinical trials were initiated, beginning in the early 1970's, formally comparing mastectomy and breast-conserving therapy. These trials firmly established that the two forms of local treatment provide equivalent survival. Additional retrospective studies have also been useful in establishing

  15. A risk management approach for imaging biomarker-driven clinical trials in oncology.

    Liu, Yan; deSouza, Nandita M; Shankar, Lalitha K; Kauczor, Hans-Ulrich; Trattnig, Siegfried; Collette, Sandra; Chiti, Arturo

    2015-12-01

    Imaging has steadily evolved in clinical cancer research as a result of improved conventional imaging methods and the innovation of new functional and molecular imaging techniques. Despite this evolution, the design and data quality derived from imaging within clinical trials are not ideal and gaps exist with paucity of optimised methods, constraints of trial operational support, and scarce resources. Difficulties associated with integrating imaging biomarkers into trials have been neglected compared with inclusion of tissue and blood biomarkers, largely because of inherent challenges in the complexity of imaging technologies, safety issues related to new imaging contrast media, standardisation of image acquisition across multivendor platforms, and various postprocessing options available with advanced software. Ignorance of these pitfalls directly affects the quality of the imaging read-out, leading to trial failure, particularly when imaging is a primary endpoint. Therefore, we propose a practical risk-based framework and recommendations for trials driven by imaging biomarkers, which allow identification of risks at trial initiation to better allocate resources and prioritise key tasks. PMID:26678215

  16. Associations between clinical and sociodemographic data and patterns of communication in pediatric oncology

    Marina Kohlsdorf

    2016-01-01

    Full Text Available Abstract Pediatric communication directly contributes to treatment adherence, fewer symptoms, better clinical responses, healthier treatment adaptation and management of psychosocial issues. This study aimed to evaluate associations between the clinical and sociodemographic data of caregivers and children and the communicative patterns of pediatricians. Three oncohematology physicians and 44 child-caregiver dyads took part, with audio recording of 146 medical consultations. The physicians interacted more often with older children, offering more guidance, clarifying doubts, and asking for information. The number of questions from children and caregivers was positively correlated with the physician’s communicative behaviors. However, there was no association between the age of the children and the number of doubts of the patients. The diagnosis, treatment time, family income, marital status and caregiver’s level of education were associated with the amount of interaction provided by physicians to the children and caregivers. This study offers subsides relevant to psychosocial interventions that may improve communication in pediatric oncohematology settings.

  17. Clinical pilot study for the automatic segmentation and recognition of abdominal adipose tissue compartments from MRI data

    Purpose: In the diagnosis and risk assessment of obesity, both the amount and distribution of adipose tissue compartments are critical factors. We present a hybrid method for the quantitative measurement of human body fat compartments. Materials and Methods: MRI imaging was performed on a 1.5 T scanner. In a pre-processing step, the images were corrected for bias field inhomogeneity. For segmentation and recognition a hybrid algorithm was developed to automatically differentiate between different adipose tissue compartments. The presented algorithm is designed with a combination of shape and intensity-based techniques. To incorporate the presented algorithm into the clinical routine, we developed a graphical user interface. Results from our methods were compared with the known volume of an adipose tissue phantom. To evaluate our method, we analyzed 40 clinical MRI scans of the abdominal region. Results: Relatively low segmentation errors were found for subcutaneous adipose tissue (3.56 %) and visceral adipose tissue (0.29 %) in phantom studies. The clinical results indicated high correlations between the distribution of adipose tissue compartments and obesity. Conclusion: We present an approach that rapidly identifies and quantifies adipose tissue depots of interest. With this method examination and analysis can be performed in a clinically feasible timeframe. (orig.)

  18. Brief Introduction of NCCN Clinical Practice Guidelines for Adolescent and Young Adult Oncology

    HUANG Xin-en

    2014-09-01

    Full Text Available Cancer is always a main factor threatening human’s health and life, and its incidence and mortality are gradually increasing in recent years. However, some advances have been made with the unremitting efforts and exploration human made and the improvement is mainly made in cancer treatment of young children and older adults, while little in adolescent and young adult (AYA patients, who are generally defined as individuals of 15 to 39 years old at the time of initial cancer diagnosis due to many factors. To highlight the issues of this unique population, National Comprehensive Cancer Network (NCCN absorbs a large amount of information and previous researches and develops a set of clinical practice guidelines. Though the guidelines are more supportive care guidelines than treatment guidelines, they give us the opportunity to learn the latest international developments in AYA treatment and more survival chance for the treatment of AYA patients.

  19. Molecular imaging in oncology

    Schober, Otmar; Riemann, Burkhard (eds.) [Universitaetsklinikum Muenster (Germany). Klinik fuer Nuklearmedizin

    2013-02-01

    Considers in detail all aspects of molecular imaging in oncology, ranging from basic research to clinical applications in the era of evidence-based medicine. Examines technological issues and probe design. Discusses preclinical studies in detail, with particular attention to multimodality imaging. Presents current clinical use of PET/CT, SPECT/CT, and optical imagingWritten by acknowledged experts. The impact of molecular imaging on diagnostics, therapy, and follow-up in oncology is increasing significantly. The process of molecular imaging includes key biotarget identification, design of specific molecular imaging probes, and their preclinical evaluation, e.g., in vivo using small animal studies. A multitude of such innovative molecular imaging probes have already entered clinical diagnostics in oncology. There is no doubt that in future the emphasis will be on multimodality imaging in which morphological, functional, and molecular imaging techniques are combined in a single clinical investigation that will optimize diagnostic processes. This handbook addresses all aspects of molecular imaging in oncology, ranging from basic research to clinical applications in the era of evidence-based medicine. The first section is devoted to technology and probe design, and examines a variety of PET and SPECT tracers as well as multimodality probes. Preclinical studies are then discussed in detail, with particular attention to multimodality imaging. In the third section, diverse clinical applications are presented, and the book closes by looking at future challenges. This handbook will be of value to all who are interested in the revolution in diagnostic oncology that is being brought about by molecular imaging.

  20. ANALYSIS OF CLINICAL OUTCOME OF EFFECT OF CHEWING GUM ON BOWEL MOTILITY IN POST - OPERATIVE PATIENTS FOLLOWING ABDOMINAL SURGERY

    Vicky

    2015-04-01

    Full Text Available INTRODUCTION : One very important complication of abdominal surgeries is postoperative ileus which results in severe patient discomfort, prolonged hospitalization, and enhanced treatment cost. This study was conducted with an aim to analyze the clinical outcome of effe ct of chewing gum mainly to avoid post - operative paralytic ileus in post - operative patients of abdominal surgeries . MATERIAL AND METHODS : In this study total 200 patients were included, 100 were cases and remaining were controls. The cases were given chewing gum to chew after the surgery while the controls were allowed to heal without chewing gums in conventional style and both were observed hourly for clinical outcome. RESULTS : Among cases the mean duration of first sound heard was 26.3 hours while am ong controls this was 38.8 hours [p<0.001], the mean duration of first flatus passed among cases was 50.7 hours while that among controls was 68.5 hours, the mean duration of first Bowel passed among cases was 92.4 hours while that among controls was 128.3 hours [p<0.001]. On comparing cases of routine with emergency surgeries, gastric with small bowel surgeries, and traumatic with pathological bowel surgeries it was observed that the first bowel sound, first flatus and first bowel passed appears significan tly earlier in routine surgeries, gastric surgeries and traumatic surgeries respectively. CONCLUSIONS: It was observed that chewing gum has significant effect over bowel motility as bowel sounds appeared significantly earlier in cases than control and tim e for first flatus passed and first bowel passed were also noted significantly earlier in cases than controls. Hospital stay of cases were found significantly lesser than control hence simple intervention like chewing can decrease the burden of disease of paralytic ileus from community.

  1. The clinical management of abdominal ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: a review of current guidelines and recommendations.

    Pericleous, Marinos; Sarnowski, Alexander; Moore, Alice; Fijten, Rik; Zaman, Murtaza

    2016-03-01

    Several pathogenic processes have been implicated in the development of abdominal ascites. Portal hypertension, most usually in the context of liver cirrhosis, can explain about 75% of the cases, whereas infective, inflammatory and infiltrative aetiologies can account for the rest. In this article, we discuss the consensus best practice as published by three professional bodies for the management of ascites, spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). The aim of this study was to compare available clinical guidelines and identify areas of agreement and conflict. We carried out a review of the guidance documentation published by three expert bodies including the British Society of Gastroenterology, the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD), as well as a wider literature search for ascites, SBP and HRS. Abdominal ultrasonography, diagnostic paracentesis and ascitic fluid cultures are recommended by all three guidelines, especially when there is strong clinical suspicion for infection. EASL and AASLD advocate the use of ascitic amylase and mycobacterial cultures/PCR when there is strong suspicion for tuberculosis and pancreatitis, respectively. Ascitic cytology can be useful when cancer is suspected and has a good diagnostic yield if performed correctly. EASL supports the use of urinary electrolytes for all patients; however, the British Society of Gastroenterology and AASLD only recommend their use for therapy monitoring. All three societies recommend cefotaxime as the antibiotic of choice for SBP and large-volume paracentesis for the management of ascites greater than 5 l in volume. For HRS, cautious diuresis, volume expansion with albumin and the use of vasoactive drugs are recommended. There appears to be good concordance between recommendations by the European, American and British guidelines for the management of ascites and the possible

  2. The clinical significance of incidental intra-abdominal findings on positron emission tomography performed to investigate pulmonary nodules

    Gill Richdeep S

    2012-01-01

    Full Text Available Abstract Background Lung cancer is a common cause of cancer-related death. Staging typically includes positron emission tomography (PET scanning, in which18F-fluoro-2-dexoy-D-glucose (FDG is taken up by cells proportional to metabolic activity, thus aiding in differentiating benign and malignant pulmonary nodules. Uptake of FDG can also occur in the abdomen. The clinical significance of incidental intraabdominal FDG uptake in the setting of pulmonary nodules is not well established. Our objective was to report on the clinical significance of incidental intra-abdominal FDG activity in the setting of lung cancer. Methods Fifteen hundred FDG-PET reports for studies performed for lung cancer were retrospectively reviewed for the presence of incidental FDG-positive intraabdominal findings. Patient charts with positive findings were then reviewed and information extracted. Results Twenty-five patients (25/1500 demonstrated incidental intraabdominal FDG uptake thought to be significant (1.7% with a mean patient age of 71 years. Colonic uptake was most common (n = 17 with 9 (52% being investigated further. Of these 9 cases, a diagnosis of malignancy was made in 3 patients, pre-malignant adenomas in 2 patients, a benign lipoma in 1 patient and no abnormal findings in the remaining patients. 8 patients were not investigated further (3 diagnosed with metastatic lung cancer and 2 were of advanced age secondary to poor prognosis. Conclusion Incidental abdominal findings in the colon on FDG-PET scan for work-up of pulmonary nodules need to be further investigated by colonoscopy.

  3. Clinical usefulness of 99mTc-EDDA/HYNIC-TOC scintigraphy in oncological diagnostics: a preliminary communication

    This study assessed the clinical usefulness of a new technetium-99m labelled somatostatin analogue from the standpoint of oncological diagnostics. The study group comprised 40 patients in whom malignant neoplasms (32 primary and 8 metastatic) had been diagnosed. Among the primary tumours there were 21 cases of lung cancer (2 small cell and 19 non-small cell), seven pituitary adenomas (five hormonally active and two inactive), one liposarcoma, two carcinoids and one breast carcinoma. The metastatic tumours consisted of three malignant melanomas, one phaeochromocytoma, one prostatic cancer, one leiomyosarcoma, one pancreatic carcinoma ectopically secreting ACTH and one carcinoid of the thymus. The radiopharmaceutical 99mTc-EDDA/HYNIC-Tyr3-octreotide was administered i.v. at an activity of 740-925 MBq. The imaging comprised a whole-body scan and a single-photon emission tomography acquisition. Positive scintigrams were obtained in all cases of small cell and non-small cell lung cancer, four out of five hormonally active pituitary adenomas, one out of two cases of carcinoid, the liposarcoma and the breast cancer. Neoplastic metastases were visualised in two out of three patients with melanoma and in patients with phaeochromocytoma, ACTH-secreting pancreatic carcinoma and thymic carcinoid. Scintigrams were negative in both hormonally inactive pituitary adenomas, in one case of metastatic malignant melanoma, in the leiomyosarcoma and in the case of metastasis from prostatic carcinoma. The results of this pilot study indicate that 99mTc-EDDA/HYNIC-TOC is a potentially useful radiopharmaceutical for imaging of a wide range of primary and metastatic tumours. Special attention should be paid to the successful imaging of all cases of non-small cell lung cancer. (orig.)

  4. Clinical cancer advances 2007: major research advances in cancer treatment, prevention, and screening--a report from the American Society of Clinical Oncology.

    Gralow, Julie; Ozols, Robert F; Bajorin, Dean F; Cheson, Bruce D; Sandler, Howard M; Winer, Eric P; Bonner, James; Demetri, George D; Curran, Walter; Ganz, Patricia A; Kramer, Barnett S; Kris, Mark G; Markman, Maurie; Mayer, Robert J; Raghavan, Derek; Ramsey, Scott; Reaman, Gregory H; Sawaya, Raymond; Schuchter, Lynn M; Sweetenham, John W; Vahdat, Linda T; Davidson, Nancy E; Schilsky, Richard L; Lichter, Allen S

    2008-01-10

    A MESSAGE FROM ASCO'S PRESIDENT: For the third year, the American Society of Clinical Oncology (ASCO) is publishing Clinical Cancer Advances: Major Research Advances in Cancer Treatment, Prevention, and Screening, an annual review of the most significant cancer research presented or published over the past year. ASCO publishes this report to demonstrate the important progress being made on the front lines of clinical cancer research today. The report is intended to give all those with an interest in cancer care-the general public, cancer patients and organizations, policymakers, oncologists, and other medical professionals-an accessible summary of the year's most important cancer research advances. These pages report on the use of magnetic resonance imaging for breast cancer screening, the association between hormone replacement therapy and breast cancer incidence, the link between human papillomavirus and head and neck cancers, and the use of radiation therapy to prevent lung cancer from spreading. They also report on effective new targeted therapies for cancers that have been historically difficult to treat, such as liver cancer and kidney cancer, among many others. A total of 24 advances are featured in this year's report. These advances and many more over the past several years show that the nation's long-term investment in cancer research is paying off. But there are disturbing signs that progress could slow. We are now in the midst of the longest sustained period of flat government funding for cancer research in history. The budgets for the National Institutes of Health and the National Cancer Institute (NCI) have been unchanged for four years. When adjusted for inflation, cancer research funding has actually declined 12% since 2004. These budget constraints limit the NCI's ability to fund promising cancer research. In the past several years the number of grants that the NCI has been able to fund has significantly decreased; this year, in response to just the

  5. Initial clinical experience with a radiation oncology dedicated open 1.0T MR-simulation.

    Glide-Hurst, Carri K; Wen, Ning; Hearshen, David; Kim, Joshua; Pantelic, Milan; Zhao, Bo; Mancell, Tina; Levin, Kenneth; Movsas, Benjamin; Chetty, Indrin J; Siddiqui, M Salim

    2015-01-01

    The purpose of this study was to describe our experience with 1.0T MR-SIM including characterization, quality assurance (QA) program, and features necessary for treatment planning. Staffing, safety, and patient screening procedures were developed. Utilization of an external laser positioning system (ELPS) and MR-compatible couchtop were illustrated. Spatial and volumetric analyses were conducted between CT-SIM and MR-SIM using a stereotactic QA phantom with known landmarks and volumes. Magnetic field inhomogeneity was determined using phase difference analysis. System-related, in-plane distortion was evaluated and temporal changes were assessed. 3D distortion was characterized for regions of interest (ROIs) 5-20 cm away from isocenter. American College of Radiology (ACR) recommended tests and impact of ELPS on image quality were analyzed. Combined ultrashort echotime Dixon (UTE/Dixon) sequence was evaluated. Amplitude-triggered 4D MRI was implemented using a motion phantom (2-10 phases, ~ 2 cm excursion, 3-5 s periods) and a liver cancer patient. Duty cycle, acquisition time, and excursion were evaluated between maximum intensity projection (MIP) datasets. Less than 2% difference from expected was obtained between CT-SIM and MR-SIM volumes, with a mean distance of Dixon sequences yielded detectability between bone and air. For 4D MRI, faster breathing periods had higher duty cycles than slow (50.4% (3 s) and 39.4% (5 s), p MRI for a patient demonstrated acceptable image quality in ~ 7 min. MR-SIM was integrated into our workflow and QA procedures were developed. Clinical applicability was demonstrated for 4D MRI and UTE imaging to support MR-SIM for single modality treatment planning. PMID:26103190

  6. Performance in quasi-firms: an example from the Community Clinical Oncology Program.

    Lacey, L M; Hynes, D M; Kaluzny, A D

    1992-01-01

    In this analysis, the authors examined the effects of different sets of process, structure, and environmental variables on the performance of the CCOP as a quasi-firm. Specifically, they distinguished between internal organizational processes, structural, and size characteristics of the CCOP and the organizational environment created by prior NCI program experience and the relationship within the quasi-firm. The analysis revealed that these sets of organizational and environmental characteristics have differential effects on treatment accrual. The strongest predictors are those associated with the quasi-firm relationship between the CCOP and its chosen research bases. Any definitive policy implications for the design of organizational network relationships--especially the CCOPs--will require further analysis. Particular attention needs to be given to the longitudinal nature of the relationships and the ability of these organizational and environmental factors to affect other aspects of performance. Several points have been made within this initial assessment. First, the structural character of the CCOP and its relationship to its organizational environment are important factors affecting accrual performance. The subtleties of this multivariate model are not as important as simply demonstrating that the various internal and external characteristics of these organizations as quasi-firms simultaneously affect their ability to accrue patients to clinical trials. Secondly, the importance of research base relations, and particularly the significant role of nurses, needs to be emphasized. While CCOPs were originally designed as a network of physicians and hospitals, it appears that an infrastructure of professionally active nurses working within a larger organizational environment is critical to success--at least as defined by accrual to treatment protocols. Finally, the failure of prior experience with other NCI community programs to affect CCOP accrual performance

  7. Results of the 2005-2008 Association of Residents in Radiation Oncology Survey of Chief Residents in the United States: Clinical Training and Resident Working Conditions

    Purpose: To document clinical training and resident working conditions reported by chief residents during their residency. Methods and Materials: During the academic years 2005 to 2006, 2006 to 2007, and 2007 to 2008, the Association of Residents in Radiation Oncology conducted a nationwide survey of all radiation oncology chief residents in the United States. Chi-square statistics were used to assess changes in clinical training and resident working conditions over time. Results: Surveys were completed by representatives from 55 programs (response rate, 71.4%) in 2005 to 2006, 60 programs (75.9%) in 2006 to 2007, and 74 programs (93.7%) in 2007 to 2008. Nearly all chief residents reported receiving adequate clinical experience in commonly treated disease sites, such as breast and genitourinary malignancies; and commonly performed procedures, such as three-dimensional conformal radiotherapy and intensity-modulated radiotherapy. Clinical experience in extracranial stereotactic radiotherapy increased over time (p < 0.001), whereas clinical experience in endovascular brachytherapy (p <0.001) decreased over time. The distribution of gynecologic and prostate brachytherapy cases remained stable, while clinical case load in breast brachytherapy increased (p = 0.006). A small but significant percentage of residents reported receiving inadequate clinical experience in pediatrics, seeing 10 or fewer pediatric cases during the course of residency. Procedures involving higher capital costs, such as particle beam therapy and intraoperative radiotherapy, and infrequent clinical use, such as head and neck brachytherapy, were limited to a minority of institutions. Most residency programs associated with at least one satellite facility have incorporated resident rotations into their clinical training, and the majority of residents at these programs find them valuable experiences. The majority of residents reported working 60 or fewer hours per week on required clinical duties

  8. Abdominal Adhesions

    ... adhesions? Abdominal adhesions can cause intestinal obstruction and female infertility—the inability to become pregnant after a year of trying. Abdominal adhesions can lead to female infertility by preventing fertilized eggs from reaching the uterus, ...

  9. Abdominal Ultrasound

    ... It is used to help diagnose pain or distention and evaluate the kidneys, liver, gallbladder, pancreas, spleen ... variety of conditions, such as: abdominal pain or distention. abnormal liver function. enlarged abdominal organ. stones in ...

  10. Clinical approach to a child with abdominal pain who might have appendicitis

    Appendicitis can usually be diagnosed on completion of a history and physical examination (abdominal pain, vomiting, right lower quadrant tenderness and guarding), although laboratory evaluation with a urinalysis and white blood cell count can be of assistance. In the few cases where doubt remains, plain films of the chest and abdomen can be helpful. Whether and when further imaging is indicated remains controversial. We reviewed reports of studies published since 2003 in which the sensitivity and specificity of CT and sonography for diagnosing appendicitis were determined. Sonography had an average sensitivity of 87.1% and an average specificity of 89.2% in the nine studies reported during that period. The average sensitivity of CT was 90.8% in 11 studies during that period, and there was an average specificity of 94.2% in 10 studies. We also looked at data from 299 patients who underwent appendectomies at our hospital. Of the appendices removed, only 10.7% did not have appendicitis. In many cases, CT or US imaging data were available in the form of reports or images or both from outside institutions. CT and US images were also available from our institution when the diagnosis was in question. This is how patients present in the real world - with studies that might not be the best, might not have been indicated, and might not have images available for another interpretation. Among patients operated on with neither CT nor US images, 10.9% did not have appendicitis. Among those in whom US imaging had been performed, 11.1% were negative for appendicitis, and among those in whom CT had been performed, 9.7% were negative. Although these studies were necessary because they were performed in patients whose diagnosis was the most difficult, it is in every patient's best interest to have a thorough examination by a surgeon prior to having a CT scan. (orig.)

  11. Blueberry juice used per os in upper abdominal MR imaging: composition and initial clinical data

    The aim of this study was to evaluate the use of a commercially available blueberry juice (BJ) both as a positive and negative oral contrast agent and to present the exact contents of paramagnetic ions. The concentration of Mn and Fe were determined in tinned myrtilles in syrup (atomic absorption). Nine healthy volunteers and 12 patients (age range 20-65 years) were examined using a 1-T MR scanner before and after per os administration of 430 ml of BJ. A qualitative analysis of signal alterations in the stomach, duodenum, and proximal small intestine was performed. In addition, a quantitative analysis was assessed in terms of signal-to-noise ratio calculation. The mean concentration (x ± SD) of the ions found in the content of the three cans were 3.3 ± 0.4 μg/g for iron and 20.6 ± 2.6 μg/g for manganese. Based on the qualitative evaluation, signal alteration on T1-weighted images after administration of BJ was statistically significant in the stomach and duodenum, but not in the proximal small bowel. Signal alteration on T2-weighted images was not statistically significant in any part of the gastrointestinal tract. The quantitative analysis of the T1- and T2 shortening showed that BJ is efficient with only T1-weighted sequences, and this applied to the stomach, duodenum, and proximal small bowel. Blueberry juice can be used as an oral contrast agent in upper abdominal MR for T1-weighted imaging. (orig.)

  12. Systemic Therapy in Men With Metastatic Castration-Resistant Prostate Cancer: American Society of Clinical Oncology and Cancer Care Ontario Clinical Practice Guideline

    Basch, Ethan; Loblaw, D. Andrew; Oliver, Thomas K.; Carducci, Michael; Chen, Ronald C.; Frame, James N.; Garrels, Kristina; Hotte, Sebastien; Kattan, Michael W.; Raghavan, Derek; Saad, Fred; Taplin, Mary-Ellen; Walker-Dilks, Cindy; Williams, James; Winquist, Eric; Bennett, Charles L.; Wootton, Ted; Rumble, R. Bryan; Dusetzina, Stacie B.; Virgo, Katherine S.

    2014-01-01

    Purpose To provide treatment recommendations for men with metastatic castration-resistant prostate cancer (CRPC). Methods The American Society of Clinical Oncology and Cancer Care Ontario convened an expert panel to develop evidence-based recommendations informed by a systematic review of the literature. Results When added to androgen deprivation, therapies demonstrating improved survival, improved quality of life (QOL), and favorable benefit-harm balance include abiraterone acetate/prednisone, enzalutamide, and radium-223 (223Ra; for men with predominantly bone metastases). Improved survival and QOL with moderate toxicity risk are associated with docetaxel/prednisone. For asymptomatic/minimally symptomatic men, improved survival with unclear QOL impact and low toxicity are associated with sipuleucel-T. For men who previously received docetaxel, improved survival, unclear QOL impact, and moderate to high toxicity risk are associated with cabazitaxel/prednisone. Modest QOL benefit (without survival benefit) and high toxicity risk are associated with mitoxantrone/prednisone after docetaxel. No benefit and excess toxicity are observed with bevacizumab, estramustine, and sunitinib. Recommendations Continue androgen deprivation (pharmaceutical or surgical) indefinitely. Abiraterone acetate/prednisone, enzalutamide, or 223Ra should be offered; docetaxel/prednisone should also be offered, accompanied by discussion of toxicity risk. Sipuleucel-T may be offered to asymptomatic/minimally symptomatic men. For men who have experienced progression with docetaxel, cabazitaxel may be offered, accompanied by discussion of toxicity risk. Mitoxantrone may be offered, accompanied by discussion of limited clinical benefit and toxicity risk. Ketoconazole or antiandrogens (eg, bicalutamide, flutamide, nilutamide) may be offered, accompanied by discussion of limited known clinical benefit. Bevacizumab, estramustine, and sunitinib should not be offered. There is insufficient evidence to

  13. Professional practice assessment. Pertinence of positron emission tomography clinical indications in oncology; Evaluation des pratiques professionnelles. Pertinence des indications de la tomographie a emission de positons en cancerologie

    Le Stanc, E.; Tainturier, C. [Hopital Foch, Service de Medecine Nucleaire, 92 - Suresnes (France); Swaenepoel, J. [Hopital Foch, Cellule Qualite, 92 - Suresnes (France)

    2009-09-15

    Introduction As part of the health care quality and safety policy in France, Professional Practice Assessment (P.P.A.) are mandatory in the health services 'certification' process. We present our study regarding the pertinence of Positron Emission Tomography (PET) indications in oncology. Materials and methods A multidisciplinary task group used the Quick Audit method with two rounds of 100 request forms each. The assessment list of criteria comprised four items of decreasing relevance grading the PET scans clinical indications, which were derived from the three French published guidelines (S.O.R. [F.N.C.L.C.C]., 'Guide du bon usage des examens d'imagerie medicale' [S.F.R.-S.F.M.N.], 'Guide pour la redaction de protocoles pour la TEP au F.D.G. en cancerologie' [S.F.M.N.]) and five additional items: clinical information, patient's body weight, previous treatments dates, diabetes, claustrophobia. Results The first round showed that 68% of the requested scans corresponded to the two most relevant groups of indications (S.O.R. Standards and Options). The request forms were correctly filled in regarding the clinical information, but this was not the case for the other items we tested. Several actions were conducted: dedicated PET request form, availability of the S.O.R. on the hospital intranet, boost of the referring physicians awareness during the multidisciplinary oncology meetings (Reunions de Concertation Pluridisciplinaires RCP). The second round showed a better pertinence of the PET scans indications (75% versus 68%); the patient's body weight was more frequently mentioned on the request form. Discussion This study is an example of P.P.A. in our discipline. It led to an improvement of the oncologic PET scans clinical indications in our hospital. This work is pursued in everyday discussion with the referring clinicians, especially during the RCP. (authors)

  14. Methodological background and strategy for the 2012-2013 updated consensus definitions and clinical practice guidelines from the abdominal compartment society.

    Kirkpatrick, Andrew W; Roberts, Derek J; Jaeschke, Roman; De Waele, Jan J; De Keulenaer, Bart L; Duchesne, Juan; Bjorck, Martin; Leppäniemi, Ari; Ejike, Janeth C; Sugrue, Michael; Cheatham, Michael L; Ivatury, Rao; Ball, Chad G; Reintam Blaser, Annika; Regli, Adrian; Balogh, Zsolt; D'Amours, Scott; De Laet, Inneke; Malbrain, Manu L N G

    2015-01-01

    The Abdominal Compartment Society (www.wsacs.org) previously created highly cited Consensus Definitions/Management Guidelines related to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Implicit in this previous work, was a commitment to regularly reassess and update in relation to evolving research. Two years preceding the Fifth World Congress on Abdominal Compartment Syndrome, an International Guidelines committee began preparation. An oversight/steering committee formulated key clinical questions regarding IAH/ /ACS based on polling of the Executive to redundancy, structured according to the Patient, Intervention, Comparator, and Outcome (PICO) format. Scientific consultations were obtained from Methodological GRADE experts and a series of educational teleconferences were conducted to educate scientific review teams from among the wscacs. org membership. Each team conducted systematic or structured reviews to identify relevant studies and prepared evidence summaries and draft Grades of Recommendation Assessment, Development and Evaluation (GRADE) recommendations. The evidence and draft recommendations were presented and debated in person over four days. Updated consensus definitions and management statements were derived using a modified Delphi method. A writingcommittee subsequently compiled the results utilizing frequent Internet discussion and Delphi voting methods to compile a robust online Master Report and a concise peer-reviewed summarizing publication. A dedicated Paediatric Guidelines Subcommittee reviewed all recommendations and either accepted or revised them for appropriateness in children. Of the original 12 IAH/ACS definitions proposed in 2006, three (25%) were accepted unanimously, with four (33%) accepted by > 80%, and four (33%) accepted by > 50%, but required discussion to produce revised definitions. One (8%) was rejected by > 50%. In addition to previous 2006 definitions, the panel also defined the open abdomen

  15. Entrance surface dose and image quality: Comparison of adult chest and abdominal X-ray examinations in general practitioner clinics, public and private hospitals in Malaysia

    This study was undertaken to compare the entrance surface dose (ESD) and image quality of adult chest and abdominal X-ray examinations conducted at general practitioner (GP) clinics, and public and private hospitals in Malaysia. The surveyed facilities were randomly selected within a given category (28 GP clinics, 20 public hospitals and 15 private hospitals). Only departmental X-ray units were involved in the survey. Chest examinations were done at all facilities, while only hospitals performed abdominal examinations. This study used the x-ray attenuation phantoms and protocols developed for the Nationwide Evaluation of X-ray Trends (NEXT) survey program in the United States. The ESD was calculated from measurements of exposure and clinical geometry. An image quality test tool was used to evaluate the low-contrast detectability and high-contrast detail performance under typical clinical conditions. The median ESD value for the adult chest X-ray examination was the highest (0.25 mGy) at GP clinics, followed by private hospitals (0.22 mGy) and public hospitals (0.17 mGy). The median ESD for the adult abdominal X-ray examination at public hospitals (3.35 mGy) was higher than that for private hospitals (2.81 mGy). Results of image quality assessment for the chest X-ray examination show that all facility types have a similar median spatial resolution and low-contrast detectability. For the abdominal X-ray examination, public hospitals have a similar median spatial resolution but larger low-contrast detectability compared with private hospitals. The results of this survey clearly show that there is room for further improvement in performing chest and abdominal X-ray examinations in Malaysia. (authors)

  16. Implementing and Integrating a Clinically-Driven Electronic Medical Record (EMR for Radiation Oncology in a Large Medical Enterprise

    John Paxton Kirkpatrick

    2013-04-01

    Full Text Available Purpose/Objective: While our department is heavily invested in computer-based treatment planning, we historically relied on paper-based charts for management of Radiation Oncology patients. In early 2009, we initiated the process of conversion to an electronic medical record (EMR eliminating the need for paper charts. Key goals included the ability to readily access information wherever and whenever needed, without compromising safety, treatment quality, confidentiality or productivity.Methodology: In February, 2009, we formed a multi-disciplinary team of Radiation Oncology physicians, nurses, therapists, administrators, physicists/dosimetrists, and information technology (IT specialists, along with staff from the Duke Health System IT department. The team identified all existing processes and associated information/reports, established the framework for the EMR system and generated, tested and implemented specific EMR processes.Results: Two broad classes of information were identified: information which must be readily accessed by anyone in the health system versus that used solely within the Radiation Oncology department. Examples of the former are consultation reports, weekly treatment check notes and treatment summaries; the latter includes treatment plans, daily therapy records and quality assurance reports. To manage the former, we utilized the enterprise-wide system , which required an intensive effort to design and implement procedures to export information from Radiation Oncology into that system. To manage "Radiation Oncology" data, we used our existing system (ARIA, Varian Medical Systems. The ability to access both systems simultaneously from a single workstation (WS was essential, requiring new WS and modified software. As of January, 2010, all new treatments were managed solely with an EMR. We find that an EMR makes information more widely accessible and does not compromise patient safety, treatment quality or confidentiality

  17. The opinion of clinical staff regarding painfulness of procedures in pediatric hematology-oncology: an Italian survey

    Cesaro Simone

    2011-06-01

    Full Text Available Abstract Background Beliefs of caregivers about patient's pain have been shown to influence assessment and treatment of children's pain, now considered an essential part of cancer treatment. Painful procedures in hematology-oncology are frequently referred by children as the most painful experiences during illness. Aim of this study was to evaluate professionals' beliefs about painfulness of invasive procedures repeatedly performed in Pediatric Hemato-Oncology Units. Methods Physicians, nurses, psychologists and directors working in Hemato-Oncology Units of the Italian Association of Pediatric Hematology-Oncology (AIEOP were involved in a wide-nation survey. The survey was based on an anonymous questionnaire investigating beliefs of operators about painfulness of invasive procedures (lumbar puncture, bone marrow aspirate and bone marrow biopsy and level of pain management. Results Twenty-four directors, 120 physicians, 248 nurses and 22 psychologists responded to the questionnaire. The score assigned to the procedural pain on a 0-10 scale was higher than 5 in 77% of the operators for lumbar puncture, 97.5% for bone marrow aspiration, and 99.5% for bone marrow biopsy. The scores assigned by nurses differed statistically from those of the physicians and directors for the pain caused by lumbar puncture and bone marrow aspiration. Measures adopted for procedural pain control were generally considered good. Conclusions Invasive diagnostic-therapeutic procedures performed in Italian Pediatric Hemato-Oncology Units are considered painful by all the caregivers involved. Pain management is generally considered good. Aprioristically opinions about pain depend on invasiveness of the procedure and on the professional role.

  18. Tracers in oncology. Preclinical and clinical evaluation; Innovative Tracer in der onkologischen Diagnostik. Praeklinische und klinische Evaluierung

    Krause, B.J.; Schwarzenboeck, S.; Schwaiger, M. [Technische Univ. Muenchen, Klinikum rechts der Isar (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    2010-07-01

    In oncology, PET and PET/CT with tracers beyond FDG target more specific biological processes, such as proliferation ({sup 18}F-3'-fluoro-3'-deoxy-L-thymidine; {sup 18}F-FLT), tumour hypoxia ({sup 18}F-fluoromisonidazol; {sup 18}F-FMISO) and phospholipid metabolism (radioactively labelled choline derivates). FLT is a thymidine analogue which can be labelled with {sup 18}F. PET with {sup 18}F-FLT enables to non-invasively image and to quantify the proliferation fraction of tumours. Proliferation dependent accumulation of FLT has been demonstrated for a variety of solid and haematologic neoplasms including lung cancer, breast cancer, gastric cancer, colorectal cancer and malignant lymphoma. Furthermore, FLT has been suggested as surrogate marker for the assessment of response to treatment, especially when targeted drugs are utilized. PET imaging in particular has emerged as a promising non-invasive tool to accurately characterize tumour oxygenation. The great promise of PET/CT is its potential as a single imaging modality for whole body staging that provides anatomical and biological information on the disease as a whole. It allows a more precise estimation of the hypoxic tumour volume as well as comparisons on a voxel-by-voxel basis (parametric mapping). PET and PET/CT with hypoxia tracers thus offer the potential to optimize and individualize therapy for patients suffering from cancer. PET- and PET/CT-studies using {sup 11}C- or {sup 18}F-labeled choline derivates recently have shown promising results for re-staging prostate cancer in patients with biochemical recurrence and advanced prostate cancer. In patients with biochemical recurrence of prostate cancer after primary therapy the detection rate of {sup 11}C-choline- PET/CT shows a positive relationship with serum PSA-levels. In these patients {sup 11}C-choline PET/CT allows not only to diagnose but also to localize recurrent disease with implications on disease management (localised vs. systemic

  19. American Society of Clinical Oncology policy statement update: tobacco control--reducing cancer incidence and saving lives. 2003.

    2003-07-15

    As an international medical society dedicated to cancer prevention, the American Society of Clinical Oncology (ASCO) advocates a fundamental reform of United States and international policy toward addictive tobacco products. ASCO's goal is the immediate reduction of tobacco use and ultimate achievement of a tobacco-free world. The centerpiece of ASCO's policy is the recommendation for an independent commission to study the tobacco problem in all of its dimensions: social, medical, legal, and economic (both domestically and globally). The commission membership should include broad-based representation and expertise on tobacco issues. In ASCO's view, tobacco control efforts to date have been less than successful because they are too fragmented and incremental, leaving many important issues unaddressed. A more comprehensive solution could flow from this study, including input from a variety of government agencies involved with public health, agriculture, First Amendment and other legal considerations, and international trade. The study, within defined time limits, should culminate in a report that outlines a strategy for achieving immediate reduction of tobacco use and ultimate achievement of a tobacco-free world, including explicit plans and a timetable for implementation. Although this comprehensive approach to tobacco control will take many years to implement even under the best of circumstances, there are certain measures that could be undertaken immediately with meaningful impact on tobacco usage. These include: Increasing efforts to discourage tobacco use, particularly among the young Raising federal excise taxes by at least $2 per pack and encouraging states to consider tobacco taxes as a first resort in revenue enhancement Ensuring that tobacco settlement funds be devoted only to health-related projects, including medical treatment, biomedical research, and tobacco prevention efforts Requiring disclosure of all ingredients in tobacco products Comprehensively

  20. [Abdominal pregnancy, institutional experience].

    Bonfante Ramírez, E; Bolaños Ancona, R; Simón Pereyra, L; Juárez García, L; García-Benitez, C Q

    1998-07-01

    Abdominal pregnancy is a rare entity, which has been classified as primary or secondary by Studiford criteria. A retrospective study, between January 1989 and December 1994, realized at Instituto Nacional de Perinatología, found 35,080 pregnancies, from which 149 happened to be ectopic, and 6 of them were abdominal. All patients belonged to a low income society class, age between 24 and 35 years, and average of gestations in 2.6. Gestational age varied from 15 weeks to 32.2 weeks having only one delivery at term with satisfactory postnatal evolution. One patient had a recurrent abdominal pregnancy, with genital Tb as a conditional factor. Time of hospitalization varied from 4 to 5 days, and no further patient complications were reported. Fetal loss was estimated in 83.4%. Abdominal pregnancy is often the sequence of a tubarian ectopic pregnancy an when present, it has a very high maternal mortality reported in world literature, not found in this study. The stated frequency of abdominal pregnancy is from 1 of each 3372, up to 1 in every 10,200 deliveries, reporting in the study 1 abdominal pregnancy in 5846 deliveries. The study had two characteristic entities one, the recurrence and two, the delivery at term of one newborn. Abdominal pregnancy accounts for 4% of all ectopic pregnancies. Clinical findings in abdominal pregnancies are pain, transvaginal bleeding and amenorrea, being the cardinal signs of ectopic pregnancy. PMID:9737070

  1. Analysis of NF-B Pathway Proteins in Pediatric Hodgkin Lymphoma: Correlations with EBV Status and Clinical Outcome—A Children's Oncology Group Study

    Horton, Terzah M.; Sheehan, Andrea M.; Dolores López-Terrada; Hutchison, Robert E.; Sonia Narendra; Meng-Fen Wu; Hao Liu

    2012-01-01

    Constitutively active nuclear factor-κB (NF-κB) is integral to the survival of Hodgkin/Reed-Sternberg cells (H/RS) in Hodgkin lymphoma (HL). To investigate NF-κB pathway proteins in pediatric HL, we utilized a tissue microarray compiled from 102 children enrolled in the Children's Oncology Group intermediate-risk clinical trial AHOD0031 (56 male, 78 Caucasian, median age 15 years (range 1–20 years), 85 nodular sclerosing subtype, 23 Epstein-Barr virus (EBV) positive, and 24 refractory/relapse...

  2. Imaging Opportunities in Radiation Oncology

    Interdisciplinary efforts may significantly affect the way that clinical knowledge and scientific research related to imaging impact the field of Radiation Oncology. This report summarizes the findings of an intersociety workshop held in October 2008, with the express purpose of exploring 'Imaging Opportunities in Radiation Oncology.' Participants from the American Society for Radiation Oncology (ASTRO), National Institutes of Health (NIH), Radiological Society of North America (RSNA), American Association of physicists in Medicine (AAPM), American Board of Radiology (ABR), Radiation Therapy Oncology Group (RTOG), European Society for Therapeutic Radiology and Oncology (ESTRO), and Society of Nuclear Medicine (SNM) discussed areas of education, clinical practice, and research that bridge disciplines and potentially would lead to improved clinical practice. Findings from this workshop include recommendations for cross-training opportunities within the allowed structured of Radiology and Radiation Oncology residency programs, expanded representation of ASTRO in imaging related multidisciplinary groups (and reciprocal representation within ASTRO committees), increased attention to imaging validation and credentialing for clinical trials (e.g., through the American College of Radiology Imaging Network (ACRIN)), and building ties through collaborative research as well as smaller joint workshops and symposia.

  3. The role of computed tomography in evaluating body composition and the influence of reduced muscle mass on clinical outcome in abdominal malignancy: a systematic review.

    Gibson, D J; Burden, S T; Strauss, B J; Todd, C; Lal, S

    2015-10-01

    It is estimated that there were 3.45 million new cases and 1.75 million deaths from cancer in Europe in 2012. Colorectal cancer was one of the most common cancers, accounting for 13% of new cases and 12.2% of all deaths. Conditions causing reduced muscle mass, such as sarcopenia, can increase the morbidity and mortality of people with cancer. Computed tomography (CT) scans can provide accurate, high-quality information on body composition, including muscle mass. To date, there has been no systematic review on the role of CT scans in identifying sarcopenia in abdominal cancer. This review aimed to examine the role of CT scans in determining the influence of reduced muscle mass on clinical outcome in abdominal cancer. A systematic review of English-language articles published in 2000 or later was conducted. Articles included cohort, randomised controlled trials and validation studies. Participants were people diagnosed with abdominal cancer who had undergone a CT scan. Data extraction and critical appraisal were undertaken. Ten cohort studies met the inclusion criteria. Seven studies demonstrated that low muscle mass was significantly associated with poor clinical outcome, with six specifically demonstrating reduced survival rates. Eight studies demonstrated that a greater number of patients (27.3-66.7%) were identified as sarcopenic using CT scans compared with numbers identified as malnourished using body mass index. CT scans can identify reduced muscle mass and predict negative cancer outcomes in people with abdominal malignancies, where traditional methods of assessment are less effective. PMID:25782424

  4. Imaging in Tuberculosis abdominal

    In this article we illustrate and discuss imaging features resulting from Tuberculosis abdominal affectation. We present patients evaluated with several imaging modalities who had abdominal symptoms and findings suggestive of granulomatous disease. Diagnosis was confirm including hystopatology and clinical outgoing. Cases involved presented many affected organs such as lymphatic system, peritoneum, liver, spleen, pancreas, kidneys, ureters, adrenal glands and pelvic organs Tuberculosis, Tuberculosis renal, Tuberculosis hepatic, Tuberculosis splenic Tomography, x-ray, computed

  5. The Effect of Honey Gel on Abdominal Wound Healing in Cesarean Section: A Triple Blind Randomized Clinical Trial

    Maryam Nikpour

    2014-07-01

    Full Text Available Objective: To assess whether honey can accelerate the wound healing in women undergoing cesarean section. Methods: This was a triple blinded randomized prospective clinical trial. Women with cesarean section were randomly designated as drug (37 cases and placebo (38 cases groups. The drug group received local honey gel 25% while the placebo group received similar free-honey gel on abdominal cesarean incision twice a day for 14 days. REEDA scale (Redness, Edema, Ecchymosis, Discharge and Approximation of wound edges was used to assess wound healing. Results: The mean REEDA was 2.27 ± 2.46 and 3.91 ± 2.74 (p=0.008 on the 7th day and 0.47 ± 0.84 and 1.59± 1.95 (p=0.002 on the 14th day for the drug and placebo groups, respectively. Redness, edema and hematoma in the drug group were significantly lower on the 7th and 14th days. Conclusion: Honey was effective in healing the cesarean section incision. Using topical honey is suggested as a natural product with rare side effects in order to reduce the complications of cesarean wounds.

  6. Abdominal Assessment.

    Fritz, Deborah; Weilitz, Pamela Becker

    2016-03-01

    Abdominal pain is one of the most common complaints by patients, and assessment of abdominal pain and associated symptoms can be challenging for home healthcare providers. Reasons for abdominal pain are related to inflammation, organ distention, and ischemia. The history and physical examination are important to narrow the source of acute or chronic problems, identify immediate interventions, and when necessary, facilitate emergency department care. PMID:26925941

  7. Reliable clinical and sonographic findings in the diagnosis of abdominal wall endometriosis near cesarean section scar

    Giampiero Francica

    2012-01-01

    Full Text Available AIM: To highlight sonographic and clinical characteristics of scar endometrioma with special emphasis on size-related features. METHODS: Thirty women (mean age 30.6 years, range 20-42 years with 33 scar endometriomas (mean diameter 27.1 mm, range 7-60 mm were consecutively studied by Sonography and Color Doppler examination prior to surgery. Pathological examination was available in all cases. RESULTS: The most frequent (24 of 33 nodules, 74% sonographic B-mode aspect of endometrioma was that of an inhomogenously hypoechoic roundish nodule with fibrotic changes (in the form of hyperechoic spots or strands, a peripheral inflammatory hyperechoic ring, spiculated margins and a single vascular pedicle entering the mass at the periphery. On average, 1.6 cesarean sections were recorded per patient (range 1-3. The median interval between the last cesarean section and admission to hospital was 36 mo (range 12-120 mo and the median duration of symptoms before admission was 25.7 mo (range 0.5-80 mo. 13 patients had 13 large endometriomas (≥ 30 mm with a mean lesion diameter of 41.3 ± 9.02 mm (range 30-60 mm. Seventeen women had 20 small endometriomas with a mean lesion size of 18.2 ± 5.17 mm (range 7-26 mm. The mean interval between the last cesarean section and admission to hospital (66.0 mo vs 39.6 mo, P < 0.01 and the mean duration of symptoms before admission (43.0 mo vs 17.4 mo, P < 0.01 were significantly longer in patients with large endometriomas; in addition, a statistically significant higher percentage of patients with large implants had undergone previous inconclusive diagnostic examinations, including either computed tomography/magnetic resonance imaging/fine needle biopsy/laparoscopy (38.4% vs 0%, P < 0.05. On sonography, large endometriomas showed frequent cystic portions and fistulous tracts (P < 0.02, loss of round/oval shape (P < 0.04 along with increased vascularity (P < 0.04. CONCLUSION: Endometrioma near cesarean section scar is

  8. Clinical Studies of Sweet Bee Venom to the Effect of Abdominal Fat Accumulation

    Chung San, Lim

    2008-06-01

    Full Text Available Objective : Sweet bee venom is made by removing allergen from the bee venom through gel filtration chromatography and propionic acid/urea polyacrylamide gel electrophoresis. The aim of this study was to verify allergy inhibitory action in Sweet Bee Venom(SBV and New Sweet Bee Venom(NSBV removed enzymes and compounds of low molecular weight. Methods : 84 healthy adult men and women were selected through a survey whom had never received the bee venom therapy in the past. The concentration of Normal Saline, SBV and NSBV pharmacopuncture was equally at 0.1mg/mL and the experiment was conducted as the double blind test. Results : Participants of the study was comprised of 63 men and 21 women with the average age of 28.3 years. According to results of pain sense, SBV group showed significant higher score compared with NS group and NSBV group using VAS in treating time. And SBV and NSBV group showed significant higher score compared with NS group after 30 minutes. Other allergic responses were insignificant between the groups. Conclusions : As a result of removed allergen and compounds of low molecular weight, NSBV significantly inhibits pain sense in treating time compared with SBV. This indicates wider and easier application of NSBV for the useful application in clinical treatment. Further comparative studies should be conducted to yield more objective verification.

  9. Comparison of clinical curative effect between open surgery and endovascular repair of abdominal aortic aneurysm in China

    WANG Si-wen; LIN Ying; YAO Chen; LIN Pei-liang; WANG Shen-ming

    2012-01-01

    Objective To compare clinical curative effects of open surgery (OS) or endovascular repair (EVAR) for patients with abdominal aortic aneurysm (AAA) in China.Data sources We performed a comprehensive search of both English and Chinese literatures involving case studies on retrograde OS or EVAR of AAA in China from January 1976 to December 2010.Study selection According to the inclusion criteria,76 articles were finally analyzed to compare patient characteristics,clinical success,complications,and prognosis.Results We analyzed a total of 2862 patients with 1757 undergoing OS (OS group) and 1105 undergoing EVAR (EVAR group).There was no significant difference in the success rate of the procedures.Operative time,length of ICU stay,fasting time,duration of total postoperative stay,blood loss,and blood transfusion requirements during the procedure were significantly lower in the EVAR group.A 30-day follow up revealed more cardiac,renal,pulmonary,and visceral complications in the OS group (P<0.01).Low-limb ischemia,however,was more common in the EVAR group (P<0.05).The 30-day mortality rate,including aorta-related and non-aorta related mortality,was significantly lower in the EVAR group (P<0.01).In the follow-up period,there were more patients with occlusions of artificial vessel and late endoleak in the EVAR group (P<0.01).The overall late mortality rate was higher in the OS group (P <0.01),especially non-aorta-related late mortality and mortality during the fourth to the sixth year (P<0.01).Conclusions EVAR was safer and less invasive for AAA patients.Patients suffered fewer complications and recovered sooner.However,complications such as artificial vessel occlusion,low-limb ischemia,and endoleak were common in EVAR.Clinicians should carry out further research to solve these complications and improve the efficacy of EVAR.

  10. Pediatric oncologic emergencies

    Oncologic emergencies arise in three ways: disease or therapy induced cytopenias; a space occupying lesion causing pressure on or obstruction of surrounding tissues; or leukemia or tumors creating life-threatening metabolic or hormonal problems. Knowledge of presenting signs and symptoms of these emergencies are essential in pediatric oncologic nursing. Neutropenia opens the door for all manner of infections, but the most life threatening is septicemia progressing to shock. A variety of organisms can cause septic shock in the neutropenic patient, but episodes are most often due to gram-negative organisms and the endotoxins they release. Shock, while still compensated, may present with a elevated or subnormal temperature, flushed, warm, dry skin, widening pulse pressure, tachycardia, tachypnoea and irritability, but without medical intervention will progress to hypo tension, cool, clammy extremities, decreased urinary out- put, and eventually to bradycardia and cardiogenic shock. Another emergency in the cytopenia category is bleeding as a result of thrombocytopenia. Of greatest concern is intracranial hemorrhage that may occur at platelet counts of less than 5,000/mm3. Space-occupying lesions of the chest may produce superior vena cava syndrome (SVGS), pleural and pericardial effusions, and cardiac tamponade. SVGS is most often caused by non-Hodgkin's lymphoma (NHL) and presents as cough, hoarseness, dyspnea, orthopnea and chest pain. Signs include swelling, plethora, cyanosis, edema of conjunctiva and wheezing. Pleural and pericardial effusions present with respiratory or cardiac distress as does cardiac tamponade. Abdominal emergencies arise because of inflammation, mechanical obstruction, hemorrhage (often from steroid induced ulcers), and perforation. Pain is the most common presenting symptom, although vital sign alterations, fever, blood in vomitus or stool, abdominal distension and cessation of flatus are also important components of the acute abdomen

  11. Neurologic complications in oncology

    Andrea Pace

    2010-06-01

    Full Text Available Neurologic side effects related to cancer therapy are a common problem in oncology practice. These complications can negatively affect the management of the patient, because they can inhibit treatment and diminish quality of life. Therefore specific skills are required to recognise symptoms and clinical manifestations. This review focuses on the most common neurologic complications to improve physician’s familiarity in determining the aetiology of these symptoms.

  12. Clinical application of preoperative embolization of tumor feeding artery combined with intraoperative balloon occlusion of the abdominal aorta in the resection of sacral tumors

    Objective: To investigate the clinical application of preoperative embolization of tumor feeding artery combined with intraoperative balloon occlusion of the abdominal aorta in performing the surgical resection of sacral tumors. Methods: Conventional surgical excision of sacral tumors was employed in 24 patients with sacral tumors (control group), while preoperative embolization of tumor feeding artery combined with intraoperative balloon occlusion of the abdominal aorta was carried out in 32 patients with sacral tumors (study group). The operation time, blood loss during the surgery and the one-year recurrence rate of both groups were documented, and the results were statistically analyzed. Results: Angiography showed that in the study group the sacral tumors were supplied by several vessels, and these feeding arteries were occluded separately. The tumors were successfully removed in all patients with the help of intraoperative balloon occlusion of the abdominal aorta. During the surgery, the surgical area was clearly exposed and the blood loss wa remarkably reduced. After the surgery, no ectopic vascular embolization, renal ischemia, limb ischemia or other complications occurred. Statistically significant difference in the operation time, blood loss during the surgery and the one-year recurrence rate existed between the two groups (P<0.05). Conclusion: Preoperative embolization of tumor feeding artery combined with intraoperative balloon occlusion of the abdominal aorta can effectively shorten the operation time, reduce the blood loss during the surgery and provide a clear surgical field, and thus the surgical safety can be significantly ensured. (authors)

  13. External audit of clinical practice and medical decision making in a new Asian oncology center: Results and implications for both developing and developed nations

    Purpose: The external audit of oncologist clinical practice is increasingly important because of the incorporation of audits into national maintenance of certification (MOC) programs. However, there are few reports of external audits of oncology practice or decision making. Our institution (The Cancer Institute, Singapore) was asked to externally audit an oncology department in a developing Asian nation, providing a unique opportunity to explore the feasibility of such a process. Methods and Materials: We audited 100 randomly selected patients simulated for radiotherapy in 2003, using a previously reported audit instrument assessing clinical documentation/quality assurance and medical decision making. Results: Clinical documentation/quality assurance, decision making, and overall performance criteria were adequate 74.4%, 88.3%, and 80.2% of the time, respectively. Overall 52.0% of cases received suboptimal management. Multivariate analysis revealed palliative intent was associated with improved documentation/clinical quality assurance (p = 0.07), decision making (p 0.007), overall performance (p = 0.003), and optimal treatment rates (p 0.07); non-small-cell lung cancer or central nervous system primary sites were associated with better decision making (p = 0.001), overall performance (p = 0.03), and optimal treatment rates (p = 0.002). Conclusions: Despite the poor results, the external audit had several benefits. It identified learning needs for future targeting, and the auditor provided facilitating feedback to address systematic errors identified. Our experience was also helpful in refining our national revalidation audit instrument. The feasibility of the external audit supports the consideration of including audit in national MOC programs

  14. Red Blood Cell Antibodies in Hematology/Oncology Patients: Interpretation of Immunohematologic Tests and Clinical Significance of Detected Antibodies.

    Hendrickson, Jeanne E; Tormey, Christopher A

    2016-06-01

    Red blood cell (RBC) transfusion is a cornerstone of the management of patients with hematology/oncology disorders. However, a potentially deleterious consequence of transfusion is the development of alloantibodies against blood group antigens present on RBCs. Such alloantibodies can be an obstacle in providing compatible units for transfusion. Providers in this arena must fully understand the testing performed by blood banks, as well as the consequences of detected antibodies. This article reviews immunohematologic tests, describes how autoimmune hemolytic anemia is classified by autoantibodies; outlines RBC alloimmunization rates, and presents strategies to prevent/mitigate the impact of RBC alloimmunization. PMID:27113001

  15. Abdominal trauma

    Radiologic evaluation of abdominal trauma must provide a quick and accurate assessment of the lesions in order to improve the management of the patient. The technique used varies depending on the mechanism of the trauma (blunt trauma or stab wounds) and the hemodynamic status. Radiologic evaluation is usually performed in blunt trauma whereas stab wound trauma is usually explored surgically. The various techniques available are standard radiographs, ultrasonography, computed tomography and arteriography. The role of magnetic resonance imaging in the immediate evaluation is still not well defined. It appears to be useful method in the delayed evaluation of diaphragmatic trauma. Computed tomography is the method most commonly performed in trauma patients. This technique is accurate and allows correct assessment of the lesions. The disadvantages are the radiation induced and the need for a hemo-dynamically stable patient. The aim of the radiologic evaluation is to provide the clinicians with an accurate description of the lesions. It can help in the management of the patient usually in association with clinical and laboratory data. It can also guide interventional procedures (drainage, embolization...). Finally, it allows radiographic follow-up when conservative treatment is performed. (authors). 26 refs., 11 figs., 1 tab

  16. [Differential diagnosis of abdominal pain].

    Frei, Pascal

    2015-09-01

    Despite the frequency of functional abdominal pain, potentially dangerous causes of abdominal pain need to be excluded. Medical history and clinical examination must focus on red flags and signs for imflammatory or malignant diseases. See the patient twice in the case of severe and acute abdominal pain if lab parameters or radiological examinations are normal. Avoid repeated and useless X-ray exposure whenever possible. In the case of subacute or chronic abdominal pain, lab tests such as fecal calprotectin, helicobacter stool antigen and serological tests for celiac disease are very useful. Elderly patients may show atypical or missing clinical signs. Take care of red herrings and be skeptical whether your initial diagnosis is really correct. Abdominal pain can frequently be an abdominal wall pain. PMID:26331201

  17. Non-surgical management of early breast cancer in the United Kingdom: the role and practice of radiotherapy. Clinical Audit Sub-committee of the Faculty of Clinical Oncology, Royal College of Radiologists, and the Joint Council for Clinical Oncology.

    Price, P; Yarnold, J R

    1995-01-01

    This paper reports on the delivery of radiotherapy to the primary site and lymphatic pathways in the management of early stage breast cancer. Radiotherapists were clear that their aim of locoregional radiotherapy was to reduce local recurrence. However, variation in policies for delivery were seen: 80% of radiotherapists did not always give radiotherapy routinely following wide local excision as part of breast conserving management; instead they withheld it selectively for a number of reasons. Only 66% routinely used breast boosts. There was a range of indications for giving radiotherapy to the lymphatic pathways; there was also variation in the management of incompletely or marginally excised primary tumours. Most sources of variation in the practice of radiotherapy in the management of women with early stage breast cancer appeared to arise from scientific uncertainty. However, organizational issues influenced many decisions. These scientific uncertainties and organizational issues are best addressed in the context of multidisciplinary breast clinics. PMID:8845315

  18. Ethical issues at the interface of clinical care and research practice in pediatric oncology: a narrative review of parents' and physicians' experiences

    de Vries Martine C

    2011-09-01

    Full Text Available Abstract Background Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians. Methodology An empirical ethical approach, combining (1 a narrative review of (primarily qualitative studies on parents' and physicians' experiences of the pediatric oncology research practice, and (2 comparison of these experiences with existing theoretical ethical concepts about (pediatric research. The use of empirical evidence enriches these concepts by taking into account the peculiarities that ethical challenges pose in practice. Results Analysis of the 22 studies reviewed revealed that the integration of research and care has consequences for the informed consent process, the promotion of the child's best interests, and the role of the physician (doctor vs. scientist. True consent to research is difficult to achieve due to the complexity of research protocols, emotional stress and parents' dependency on their child's physician. Parents' role is to promote their child's best interests, also when they are asked to consider enrolling their child in a trial. Parents are almost never in equipoise on trial participation, which leaves them with the agonizing situation of wanting to do what is best for their child, while being fearful of making the wrong decision. Furthermore, a therapeutic misconception endangers correct assessment of participation, making parents inaccurately attribute therapeutic intent to research procedures. Physicians prefer the perspective of a therapist over a researcher. Consequently they may truly believe that in the research setting they promote the child's best interests, which maintains the

  19. Abdominal shotgun trauma: A case report

    Toutouzas, Konstantinos G; Larentzakis, Andreas; Drimousis, Panagiotis; Riga, Maria; Theodorou, Dimitrios; Katsaragakis, Stylianos

    2008-01-01

    Introduction One of the most lethal mechanisms of injury is shotgun wound and particularly the abdominal one. Case presentation We report a case of a 45 years old male suffering abdominal shotgun trauma, who survived his injuries. Conclusion The management of the abdominal shotgun wounds is mainly dependent on clinical examination and clinical judgment, while requires advanced surgical skills.

  20. Abdominal trauma

    Abdominal injury is an important cause of morbidity and mortality in childhood. Ten percent of trauma-related deaths are due to abdominal injury. Thousands of children are involved in auto accidents annually; many suffer severe internal injury. Child abuse is a second less frequent but equally serious cause of internal abdominal injury. The descriptions of McCort and Eisenstein and their associates in the 1960s first brought to attention the frequency and severity of visceral injury as important manifestations of the child abuse syndrome. Blunt abdominal trauma often causes multiple injuries; in the past, many children have been subjected to exploratory surgery to evaluate the extent of possible hidden injury. Since the advent of noninvasive radiologic imaging techniques including radionuclide scans and ultrasound and, especially, computed tomography (CT), the radiologist has been better able to assess (accurately) the extent of abdominal injury and thus allow conservative therapy in many cases. Penetrating abdominal trauma occurs following gunshot wounds, stabbing, and other similar injury. This is fortunately, a relatively uncommon occurrence in most pediatric centers and will not be discussed specifically here, although many principles of blunt trauma diagnosis are valid for evaluation of penetrating abdominal trauma. If there is any question that a wound has extended intraperitonelly, a sinogram with water-soluble contrast material allows quick, accurate diagnosis. The presence of large amounts of free intraperitoneal gas suggests penetrating injury to the colon or other gas-containing viscus and is generally considered an indication for surgery

  1. 腹针疗法治疗慢性结肠炎的临床观察%Clinical observation on treating chronic colitis with abdominal acupuncture

    陈杰

    2013-01-01

    目的:观察腹针疗法治疗慢性结肠炎的临床疗效。方法:选择62例慢性结肠炎患者,随机分为两组,分别与腹针治疗、药物治疗,观察患者的临床症状改善情况以及临床疗效。结果:腹针治疗组与药物治疗组经治疗后评分差值比较,差异有统计学意义(P<0.01),提示治疗组在改善患者症状方面优于对照组。腹针治疗组与药物治疗组间疗效比较差异有统计学意义(P<0.05),提示治疗组疗效优于对照组。结论:腹针疗法能够有效的改善患者的临床症状,有较好的临床疗效,值得临床推广。%Objective:To observe the abdominal acupuncture treatment of chronic colitis clinical efficacy. Methods:62 cases of chronic colitis patients were randomly divided into two groups, respectively, with abdominal acupuncture therapy, medicine therapy, observed in patients with clinical symptoms and clinical efficacy. Results:Abdominal acupuncture group and the medicine group compared score difference after treatment, the difference was statistically significant (P<0.01). In improving symptoms, the treated group was better than the control group. The difference between the efficacy of abdominal acupuncture group and medicine group was statistically significant (P<0.05), the efficacy of treated group was better than the control group. Conclusion:Abdominal acupuncture can effectively improve the patient’s clinical symptoms, has better clinical efficacy, is worthy of promotion.

  2. Abdominal sounds

    ... during sleep. They also occur normally for a short time after the use of certain medicines and after abdominal surgery. Decreased or absent bowel sounds often indicate constipation. Increased ( hyperactive ) bowel sounds ...

  3. American Society of Clinical Oncology policy statement: opportunities in the patient protection and affordable care act to reduce cancer care disparities.

    Moy, Beverly; Polite, Blase N; Halpern, Michael T; Stranne, Steven K; Winer, Eric P; Wollins, Dana S; Newman, Lisa A

    2011-10-01

    Patients in specific vulnerable population groups suffer disproportionately from cancer. The elimination of cancer disparities is critically important for lessening the burden of cancer. The Patient Protection and Affordable Care Act provides both opportunities and challenges for addressing cancer care disparities and access to care. The American Society of Clinical Oncology (ASCO) advocates for policies that ensure access to cancer care for the underserved. Such policies include insurance reform and the reduction of economic barriers to quality health care. Building on ASCO's prior statement on disparities in cancer care (2009), this article summarizes elements of the health care law that are relevant to cancer disparities and provides recommendations for addressing major provisions in the law. It outlines specific strategies to address insurance reform, access to care, quality of care, prevention and wellness, research on health care disparities, and diversity in the health care workforce. ASCO is committed to leading efforts toward the improvement of cancer care among the most vulnerable patients. PMID:21810680

  4. Bioimpedance-based respiratory gating method for oncologic positron emission tomography (PET) imaging with first clinical results

    Respiratory motion may cause significant image artefacts in positron emission tomography/computed tomography (PET/CT) imaging. This study introduces a new bioimpedance-based gating method for minimizing respiratory artefacts. The method was studied in 12 oncologic patients by evaluating the following three parameters: maximum metabolic activity of radiopharmaceutical accumulations, the size of these targets as well as their target-to-background ratio. The bioimpedance-gated images were compared with non-gated images and images that were gated with a reference method, chest wall motion monitoring by infrared camera. The bioimpedance method showed clear improvement as increased metabolic activity and decreased target volume compared to non-gated images and produced consistent results with the reference method. Thus, the method may have great potential in the future of respiratory gating in nuclear medicine imaging.

  5. Bioimpedance-based respiratory gating method for oncologic positron emission tomography (PET) imaging with first clinical results

    Koivumäki, T.; Vauhkonen, M.; Teuho, J.; Teräs, M.; Hakulinen, M. A.

    2013-04-01

    Respiratory motion may cause significant image artefacts in positron emission tomography/computed tomography (PET/CT) imaging. This study introduces a new bioimpedance-based gating method for minimizing respiratory artefacts. The method was studied in 12 oncologic patients by evaluating the following three parameters: maximum metabolic activity of radiopharmaceutical accumulations, the size of these targets as well as their target-to-background ratio. The bioimpedance-gated images were compared with non-gated images and images that were gated with a reference method, chest wall motion monitoring by infrared camera. The bioimpedance method showed clear improvement as increased metabolic activity and decreased target volume compared to non-gated images and produced consistent results with the reference method. Thus, the method may have great potential in the future of respiratory gating in nuclear medicine imaging.

  6. Towards secondary use of heterogeneous radio-oncological data for retrospective clinical trials: service-oriented connection of a central research database with image analysis tools

    Bougatf, Nina; Bendl, Rolf; Debus, Jürgen

    2015-03-01

    Our overall objective is the utilization of heterogeneous and distributed radio-oncological data in retrospective clinical trials. Previously, we have successfully introduced a central research database for collection of heterogeneous data from distributed systems. The next step is the integration of image analysis tools in the standard retrieval process. Hence, analyses for complex medical questions can be processed automatically and facilitated immensely. In radiation oncology recurrence analysis is a central approach for the evaluation of therapeutic concepts. However, various analysis steps have to be performed like image registration, dose transformation and dose statistics. In this paper we show the integration of image analysis tools in the standard retrieval process by connecting them with our central research database using a service-oriented approach. A concrete problem from recurrence analysis has been selected to prove our concept exemplarily. We implemented service-oriented data collection and analysis tools to use them in a central analysis platform, which is based on a work flow management system. An analysis work flow has been designed that, at first, identifies patients in the research database fulfilling the inclusion criteria. Then the relevant imaging data is collected. Finally the imaging data is analyzed automatically. After the successful work flow execution, the results are available for further evaluation by a physician. As a result, the central research database has been connected successfully with automatic data collection and image analysis tools and the feasibility of our service-oriented approach has been demonstrated. In conclusion, our approach will simplify retrospective clinical trials in our department in future.

  7. Hypnosis for functional abdominal pain.

    Gottsegen, David

    2011-07-01

    Chronic abdominal pain is a common pediatric condition affecting 20% of the pediatric population worldwide. Most children with this disorder are found to have no specific organic etiology and are given the diagnosis of functional abdominal pain. Well-designed clinical trials have found hypnotherapy and guided imagery to be the most efficacious treatments for this condition. Hypnotic techniques used for other somatic symptoms are easily adaptable for use with functional abdominal pain. The author discusses 2 contrasting hypnotic approaches to functional abdominal pain and provides implications for further research. These approaches may provide new insights into this common and complex disorder. PMID:21922712

  8. Childhood abdominal cystic lymphangioma

    Konen, Osnat; Rathaus, Valeria; Shapiro, Myra [Department of Diagnostic Imaging, Meir General Hospital, Sapir Medical Centre, Kfar Saba (Israel); Dlugy, Elena [Department of Paediatric Surgery, Schneider Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Freud, Enrique [Department of Paediatric Surgery, Sapir Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Kessler, Ada [Department of Diagnostic Imaging, Sourasky Medical Centre, Tel-Aviv (Israel); Horev, Gadi [Department of Diagnostic Imaging, Schneider Medical Centre, Tel-Aviv (Israel)

    2002-02-01

    Background: Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics. Clinical presentation is variable and may be misleading; therefore, complex imaging studies are necessary in the evaluation of this condition. US and CT have a major role in the correct preoperative diagnosis and provide important information regarding location, size, adjacent organ involvement, and expected complications. Objective: To evaluate the clinical and imaging findings of seven children with proven abdominal cystic lymphangioma. Materials and methods: Clinical and imaging files of seven children with pathologically proven abdominal lymphangioma, from three university hospitals, were retrospectively evaluated. Patient's ages ranged from 1 day to 6 years (mean, 2.2 years). Symptoms and signs included evidence of inflammation, abnormal prenatal US findings, chronic abdominal pain, haemorrhage following trauma, clinical signs of intestinal obstruction, and abdominal distension with lower extremities lymphoedema. Plain films of five patients, US of six patients and CT of five patients were reviewed. Sequential imaging examinations were available in two cases. Results: Abdominal plain films showed displacement of bowel loops by a soft tissue mass in five of six patients, two of them with dilatation of small bowel loops. US revealed an abdominal multiloculated septated cystic mass in five of six cases and a single pelvic cyst in one which changed in appearance over 2 months. Ascites was present in three cases. CT demonstrated a septated cystic mass of variable sizes in all available five cases. Sequential US and CT examinations in two patients showed progressive enlargement of the masses, increase of fluid echogenicity, and thickening of walls or septa in both cases, with multiplication of septa in one case. At surgery, mesenteric lymphangioma was found in five patients and retroperitoneal lymphangioma in the other two

  9. Childhood abdominal cystic lymphangioma

    Background: Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics. Clinical presentation is variable and may be misleading; therefore, complex imaging studies are necessary in the evaluation of this condition. US and CT have a major role in the correct preoperative diagnosis and provide important information regarding location, size, adjacent organ involvement, and expected complications. Objective: To evaluate the clinical and imaging findings of seven children with proven abdominal cystic lymphangioma. Materials and methods: Clinical and imaging files of seven children with pathologically proven abdominal lymphangioma, from three university hospitals, were retrospectively evaluated. Patient's ages ranged from 1 day to 6 years (mean, 2.2 years). Symptoms and signs included evidence of inflammation, abnormal prenatal US findings, chronic abdominal pain, haemorrhage following trauma, clinical signs of intestinal obstruction, and abdominal distension with lower extremities lymphoedema. Plain films of five patients, US of six patients and CT of five patients were reviewed. Sequential imaging examinations were available in two cases. Results: Abdominal plain films showed displacement of bowel loops by a soft tissue mass in five of six patients, two of them with dilatation of small bowel loops. US revealed an abdominal multiloculated septated cystic mass in five of six cases and a single pelvic cyst in one which changed in appearance over 2 months. Ascites was present in three cases. CT demonstrated a septated cystic mass of variable sizes in all available five cases. Sequential US and CT examinations in two patients showed progressive enlargement of the masses, increase of fluid echogenicity, and thickening of walls or septa in both cases, with multiplication of septa in one case. At surgery, mesenteric lymphangioma was found in five patients and retroperitoneal lymphangioma in the other two. Conclusions: US

  10. Evaluation of Preemptive Use of Analgesia of The Skin, Before and After Lower Abdominal Surgery: A Prospective, Double-Blind, Randomized Clinical Trial

    P Kashefi

    2005-03-01

    Full Text Available Background: Perioperative pain is prevalent and poorly treated. Apart from that it makes the recovery from surgery unpleasent, pain often remains as a residual side effect of surgery, even though the tissue healing is complete. An essential observation is that tissue injury and the resulting nociceptor barrage initiates a cascade of events that can indelibly alter pain perception. Preemptive analgesia is the concept of initiating analgesic therapy before the onset of the noxious stimulus so as to prevent the nociceptor barrage and its consequences. However, anticipated clinical potency of preemptive analgesia, though has firmly grounded in the neurobiology of pain, has not been yet realized. As data accumulates, it has become clear that clinical studies emulating those from the laboratory and designed around a relatively narrow definition of preemptive analgesia have been largely unsupportive of its use. Nevertheless, preemptive analgesic interventions that recognize the intensity, duration, and somatotopic extent of major surgery can help reduce perioperative pain and its longer-term sequelae. surgeons spend a lot of time treating the pain of lower abdominal surgery. Methods: A total number of 48 consecutive patients who were going to undergo elective lower abdominal surgery. Were randomly assigned in two groups of 24 each. In one group the patients received an injection of 0.5 % bupivacaine in the planned skin for incision just before lower abdominal surgery, and in the other group, they received an equal amount of 0.5% bupivacaine after the surgery had been done. Pain was objectified by a numerical visual pain score, in the 24 hours following the lower abdominal surgery. Results: There were no differences in postoperative pain scores on the visual analog scale (VAS: In groups 1and 2, VAS at hour 4 were 6.37±1.13 versus 6.29±1.19; At hour 8 were 5.54 ± 1.17 versus 5.37±1.09; and at hour 12 were 4.5 ± 1.31 versus 4.45 ± 1

  11. Abdominal Sepsis.

    De Waele, Jan J

    2016-08-01

    Abdominal infections are an important challenge for the intensive care physician. In an era of increasing antimicrobial resistance, selecting the appropriate regimen is important and, with new drugs coming to the market, correct use is important more than ever before and abdominal infections are an excellent target for antimicrobial stewardship programs. Biomarkers may be helpful, but their exact role in managing abdominal infections remains incompletely understood. Source control also remains an ongoing conundrum, and evidence is increasing that its importance supersedes the impact of antibiotic therapy. New strategies such as open abdomen management may offer added benefit in severely ill patients, but more data are needed to identify its exact role. The role of fungi and the need for antifungal coverage, on the other hand, have been investigated extensively in recent years, but at this point, it remains unclear who requires empirical as well as directed therapy. PMID:27363829

  12. Stereotactic body radiation therapy for abdominal targets using volumetric intensity modulated arc therapy with RapidArc: Feasibility and clinical preliminary results

    Purpose. To report early clinical experience in stereotactic body radiation therapy (SBRT) delivered using volumetric intensity modulated arc therapy with RapidArc (RA) in patients with primary or metastatic tumours at abdominal sites. Material and methods. Thirty-seven consecutive patients were treated using RA. Of these, 16 had primary or metastatic liver tumours, nine had pancreatic cancer and 12 a nodal metastasis in the retro-peritoneum. Dose prescription varied from 45 to 75 Gy to the Clinical Target Volume in 3 to 6 fractions. The median follow-up was 12 months (6-22). Early local control and toxicity were investigated and reported. Results. Planning objectives on target volumes and organs at risk were met in most cases. Delivery time ranged from 2.8 ± 0.3 to 9.2 ± 2.4 minutes and pre-treatment plan verification resulted in a Gamma Agreement Index from 95.3 ± 3.8 to 98.3 ± 1.7%. At the time of analysis, local control (freedom from progression) at six months, was assessable in 24 of 37 patients and was achieved in 19 patients with a crude rate of 79.2%. Seven patients experienced treatment-related toxicity. Three patients experienced a mild and transient G1 enteritis and two showed a transient G1 liver damage. Two had late toxicity: one developed chronic enteritis causing G1 diarrhoea and G1 abdominal pain and one suffered at three months a G3 gastric bleeding. No patients experienced G4 acute toxicity. Conclusions. SBRT for abdominal targets delivered by means of RA resulted to be feasible with good early clinical results in terms of local control rate and acute toxicity profile. RA allowed to achieve required target coverage as well as to keep within normal tissue dose/volume constraints

  13. Stereotactic body radiation therapy for abdominal targets using volumetric intensity modulated arc therapy with RapidArc: Feasibility and clinical preliminary results

    Scorsetti, Marta; Bignardi, Mario; Alongi, Filippo; Mancosu, Pietro; Navarria, Piera; Castiglioni, Simona; Pentimalli, Sara; Tozzi, Angelo (IRCCS Istituto Clinico Humanitas, Rozzano (Italy)), e-mail: pietro.mancosu@humanitas.it; Fogliata, Antonella; Cozzi, Luca (Oncology Inst. of Southern Switzerland, Bellinzona (Switzerland))

    2011-05-15

    Purpose. To report early clinical experience in stereotactic body radiation therapy (SBRT) delivered using volumetric intensity modulated arc therapy with RapidArc (RA) in patients with primary or metastatic tumours at abdominal sites. Material and methods. Thirty-seven consecutive patients were treated using RA. Of these, 16 had primary or metastatic liver tumours, nine had pancreatic cancer and 12 a nodal metastasis in the retro-peritoneum. Dose prescription varied from 45 to 75 Gy to the Clinical Target Volume in 3 to 6 fractions. The median follow-up was 12 months (6-22). Early local control and toxicity were investigated and reported. Results. Planning objectives on target volumes and organs at risk were met in most cases. Delivery time ranged from 2.8 +- 0.3 to 9.2 +- 2.4 minutes and pre-treatment plan verification resulted in a Gamma Agreement Index from 95.3 +- 3.8 to 98.3 +- 1.7%. At the time of analysis, local control (freedom from progression) at six months, was assessable in 24 of 37 patients and was achieved in 19 patients with a crude rate of 79.2%. Seven patients experienced treatment-related toxicity. Three patients experienced a mild and transient G1 enteritis and two showed a transient G1 liver damage. Two had late toxicity: one developed chronic enteritis causing G1 diarrhoea and G1 abdominal pain and one suffered at three months a G3 gastric bleeding. No patients experienced G4 acute toxicity. Conclusions. SBRT for abdominal targets delivered by means of RA resulted to be feasible with good early clinical results in terms of local control rate and acute toxicity profile. RA allowed to achieve required target coverage as well as to keep within normal tissue dose/volume constraints

  14. Summary of clinical anesthesia abdominal liposuction swelling%肿胀麻醉腹部吸脂术临床总结

    周晓毛; 谢广诚

    2013-01-01

    目的:探讨肿胀麻醉腹部吸脂术的手术方法及临床效果。方法:总结我院行肿胀麻醉腹部吸脂术的38例患者临床资料。结果:38例患者手术过程均较顺利,术中、术后未出现相关并发症。术后患者均可自行下地回家。术后随访1-3个月,患者均满意腹部形态的改善。结论:肿胀麻醉腹部吸脂术是恢复形体美立竿见影的美体塑身手术,效果满意,值得临床推广。%the operation methods and the clinical results of tumescent anesthesia abdominal liposuction. The clinical data of 38 cases of patients underwent tumescent anesthesia methods abdominal liposuction. Results of the 38 patients had successful operation procedure, postoperative, no related complication. Patients can be self to go home. The patients were fol owed up for 1-3 months, patients were satisfied with the improvement of the shape of the abdomen. Conclusion tumescent anesthesia abdominal liposuction is to restore the beauty of body shaping operation to get instant results, with satisfactory effect, is worth the clinical promotion.

  15. Antimicrobial Treatmdent of "Complicated" Intra-Abdominal Infections and The New IDSA Guidelines - A Commentary and an Alternative European Approach According to Clinical Definitions

    Eckmann C

    2011-03-01

    Full Text Available Abstract Recently, an update of the IDSA guidelines for the treatment of complicated intraabdominal infections has been published. No guideline can cater for all variations in ecology, antimicrobial resistance patterns, patient characteristics and presentation, health care and reimbursement systems in many different countries. In the short time the IDSA guidelines have been available, a number of practical clinical issues have been raised by physicians regarding interpretation of the guidelines. The main debatable issues of the new IDSA guidelines are described as follows: The authors of the IDSA guidelines present recommendations for the following subgroups of "complicated" IAI: community-acquired intra-abdominal infections of mild-to-moderate and high severity and health care-associated intra-abdominal infections (no general treatment recommendations, only information about antimicrobial therapy of specific resistant bacterial isolates. From a clinical point of view, "complicated" IAI are better differentiated into primary, secondary (community-acquired and postoperative and tertiary peritonitis. Those are the clinical presentations of IAI as seen in the emergency room, the general ward and on ICU. Future antibiotic treatment studies of IAI would be more clinically relevant if they included patients in studies for the efficacy and safety of antibiotics for the treatment of the above mentioned forms of IAI, rather than conducting studies based on the vague term "complicated" intra-abdominal infections. The new IDSA guidelines for the treatment of resistant bacteria fail to mention many of new available drugs, although clinical data for the treatment of "complicated IAI" with new substances exist. Further-more, treatment recommendations for cIAI caused by VRE are not included. This group of diseases comprises enough patients (i.e. the entire group of postoperative and tertiary peritonitis, recurrent interventions in bile duct surgery or

  16. Different Clinical Utility of Oropharyngeal Bacterial Screening prior to Percutaneous Endoscopic Gastrostomy in Oncological and Neurological Patients

    Radek Kroupa

    2014-01-01

    Full Text Available Background. The aim of this study was to monitor oropharyngeal bacterial colonization in patients indicated for percutaneous endoscopic gastronomy (PEG. Methods. Oropharyngeal swabs were obtained from patients prior to PEG placement. A development of peristomal infection was evaluated. The analysis of oropharyngeal and peristomal site pathogens was done. Results. Consecutive 274 patients referred for PEG due to neurological disorder or cancer completed the study. Oropharyngeal colonization with pathogens was observed in 69% (190/274, dominantly in the neurologic subgroup of patients (P < 0.001. Peristomal infection occurred in 30 (10.9% of patients and in 57% of them the correlation between oropharyngeal and peristomal agents was present. The presence of oropharyngeal pathogens was assessed as an important risk factor for the development of peristomal infection only in oncological patients (OR = 8.33, 95% CI: 1.66–41.76. Despite a high prevalence of pathogens in neurological patients, it did not influence the risk of peristomal infection with the exception for methicillin resistant Staphylococcus aureus (MRSA carriers (OR 4.5, 95% CI: 1.08–18.76. Conclusion. During oropharyngeal microbial screening prior to the PEG insertion, the detection of pathogens may be a marker of the increased risk of peristomal infection in cancer patients only. In neurological patients the benefit of the screening is limited to the detection of MRSA carriers.

  17. Abdominal Pain

    ... relaxation. Guided imagery for abdominal pain About self-hypnosis and kids See YourChild : Pain and Your Child or Teen for more detail ... how to help your baby cope with the pain of medical procedures, circumcision, and teething. ... Helping Kids YourChild : A Look at Biofeedback YourChild : ...

  18. ADULT ABDOMINAL WALL HERNIA IN IBADAN

    Ayandipo, O.O; Afuwape, O.O.; Irabor, D. O.; Abdurrazzaaq, A.I.

    2015-01-01

    Background: Abdominal wall hernias are very common diseases encountered in surgical practice. Groin hernia is the commonest type of abdominal wall hernias. There are several methods of hernia repair but tension-free repair (usually with mesh) offers the least recurrent rate. Aim: To describe the clinical profile of anterior abdominal wall hernias and our experience in the surgical management of identified hernias Method: The project was a retrospective study of all patients with abdominal wal...

  19. Daily intake of rosehip extract decreases abdominal visceral fat in preobese subjects: a randomized, double-blind, placebo-controlled clinical trial

    Nagatomo A

    2015-03-01

    Full Text Available Akifumi Nagatomo,1 Norihisa Nishida,1 Ikuo Fukuhara,2 Akira Noro,3 Yoshimichi Kozai,3 Hisao Sato,3 Yoichi Matsuura1 1Research and Development Division, Morishita Jintan Co, Ltd, Osaka, Japan; 2Fukuhara Clinic, Hokkaido, Japan; 3New Drug Research Center, Inc., Hokkaido, Japan Background: Obesity has become a great problem all over the world. We repeatedly screened to find an effective food to treat obesity and discovered that rosehip extract shows potent antiobesity effects. Investigations in mice have demonstrated that rosehip extract inhibits body weight gain and decreases visceral fat. Thus, the present study examined the effect of rosehip extract on human body fat in preobese subjects. Methods: We conducted a 12-week, single-center, double-blind, randomized, placebo-controlled study of 32 subjects who had a body mass index of ≥25 but <30. The subjects were assigned to two random groups, and they received one tablet of placebo or rosehip that contained 100 mg of rosehip extract once each day for 12 weeks with no dietary intervention. Abdominal fat area and body fat percent were measured as primary outcomes. The other outcomes were body weight and body mass index. Results: Abdominal total fat area, abdominal visceral fat area, body weight, and body mass index decreased significantly in the rosehip group at week 12 compared with their baseline levels (P<0.01 after receiving the rosehip tablet intake, and the decreases in these parameters were significantly higher when compared with those in the placebo group. Additionally, body fat percent tended to decrease compared with the placebo group and their baseline level. Moreover, the abdominal subcutaneous fat area was significantly lower in the rosehip group than in the placebo group at week 12 after the initiation of intake (P<0.05. In addition, there were no abnormalities, subjective symptoms, and findings that may indicate clinical problems during the study period. Conclusion: These results

  20. Thirty years since foundation of the department of gynaecology at the Institute of Clinical Oncology in Bratislava

    In 1949, the department of gynaecology was set up. After a brief historical draft describing the development of the oncological center, we draw attention to the advantages of its multidisciplinary structure demonstrated in our cooperation with that of radiotherapy. The kinds of treatment and their results are reported with regard to the carcinomas of the cervix, corpus and vulva. Radiotherapy of the carcinoma of the cervix using a modified Stockholm method covers two sessions, with an interval of two to three weeks during which 60 mg radium (= 1600 mgh) intrauterine and twice 30 mg radium (= 1600 mgh) intravaginal are applied for 26.5 hours combined with a percutaneous irradiation of the parametries with 3500 to 4000 rad (gammatron, 60Co; betatron, 42 MeV). We prefer surgical therapy for the carcinoma of the cervix in the Ia, Ib and IIa stages up to the age of 65. We operated on 604 patients between 1957 and 1978, all of them receiving additional radiotherapy, a third preoperative irradiation. Carcinoma of the corpus has rarely been treated surgically in account of the negative selection of our patients. The radiotherapeutic procedure mostly applied is the tamponade of the uterine cavum whereby twelfe 10-mg radium tubes are applied in two sessions for 25 hours, 6000 mgh in all, plus a vaginal implant of 1500 mgh in stage-I cases, and in stage-II cases 3000 mgh intravaginally and a percutaneous telecobalt-dose of 3000 to 4000 rad. Carcinoma of the vulva is, if possible, primarily to be treated surgically by radical vulvectomy and lymphadenectomy of the inguinal and subinguinal lymphodes. Postoperative radiotherapy is carried out, when the lymphodes are positive. (orig.)

  1. Thirty years since foundation of the department of gynaecology at the Institute of Clinical Oncology in Bratislava

    Manka, I. (Komenskeho Univerzita, Bratislava (Czechoslovakia). Gynaecological Dept.)

    1980-09-01

    In 1949, the department of gynaecology was set up. After a brief historical draft describing the development of the oncological center, we draw attention to the advantages of its multidisciplinary structure demonstrated in our cooperation with that of radiotherapy. The kinds of treatment and their results are reported with regard to the carcinomas of the cervix, corpus and vulva. Radiotherapy of the carcinoma of the cervix using a modified Stockholm method covers two sessions, with an interval of two to three weeks during which 60 mg radium (= 1600 mgh) intrauterine and twice 30 mg radium (= 1600 mgh) intravaginal are applied for 26.5 hours combined with a percutaneous irradiation of the parametries with 3500 to 4000 rad (gammatron, /sup 60/Co; betatron, 42 MeV). We prefer surgical therapy for the carcinoma of the cervix in the Ia, Ib and IIa stages up to the age of 65. We operated on 604 patients between 1957 and 1978, all of them receiving additional radiotherapy, a third preoperative irradiation. Carcinoma of the corpus has rarely been treated surgically in account of the negative selection of our patients. The radiotherapeutic procedure mostly applied is the tamponade of the uterine cavum whereby twelfe 10-mg radium tubes are applied in two sessions for 25 hours, 6000 mgh in all, plus a vaginal implant of 1500 mgh in stage-I cases, and in stage-II cases 3000 mgh intravaginally and a percutaneous telecobalt-dose of 3000 to 4000 rad. Carcinoma of the vulva is, if possible, primarily to be treated surgically by radical vulvectomy and lymphadenectomy of the inguinal and subinguinal lymphodes. Postoperative radiotherapy is carried out, when the lymphodes are positive.

  2. Abdominal scintigraphy using {sup 99m}Tc-HMPAO-labelled leucocytes in patients with seronegative spondylarthropathies without clinical evidence of inflammatory bowel disease

    Alonso, J.C. [Department of Nuclear Medicine, Hospital Virgen de Alarcos, Ciudad Real (Spain); Lopez-Longo, F.J. [Department of Rheumatology, Hospital Universitario Gregorio Maranon, Madrid (Spain); Lampreave, J.L. [Department of Nuclear Medicine, Hospital Universitario Gregorio Maranon, Madrid (Spain); Gonzalez, C.M. [Department of Rheumatology, Hospital Universitario Gregorio Maranon, Madrid (Spain); Vegazo, O. [Department of Nuclear Medicine, Hospital Universitario Gregorio Maranon, Madrid (Spain); Carreno, L. [Department of Rheumatology, Hospital Universitario Gregorio Maranon, Madrid (Spain); Almoguera, I. [Department of Nuclear Medicine, Hospital Universitario Gregorio Maranon, Madrid (Spain)

    1996-03-01

    Abdominal scintigraphy with technetium-99m hexamethylpropylene amine oxime ({sup 99m}Tc-HMPAO)-labelled leucocytes is an excellent tool for evaluating disease extent and activity of intestinal lesions in patients with inflammatory bowel disease (IBD). In some cases of seronegative spondylarthropathies (SSp), IBD may remain subclinical. The aim of this study was to evaluate the presence of positive abdominal scintigraphy in patients with SSp and without clinical symptoms or signs of IBD. To this end we studied 32 patients with active SSp (European Spondylarthropathy Study Group 1991 criteria) without clinical evidence of IBD (eight had ankylosing spondylitis, four psoriatic arthritis, three reactive arthritis an 17 undifferentiated SSp) and 11 controls without SSp. All SSp and control patients received similar doses of non-steroidal anti-inflammatory drugs (NSAIDs). Abdominal scintigraphic images were obtained at 30 and 120 min after re-injection of {sup 99m}Tc-HMPAO-labelled leucocytes. The {sup 99m}Tc-HMPAO-labelled leucocyte scan was positive in 17 patients with SSp (53.1%) (six with ankylosing spondylitis, three with psoriatic arthritis, two with reactive arthritis and six with undifferentiated SSp). Fourteen patients scored from 2 to 4 on the intensity of uptake scale. The colon and terminal ileum were predominantly involved. Axial involvement was more frequent in patients with a positive scan than in patients with negative results (P<0.05) (64.7% vs 26.6%; odds ratio: 5). No control patient showed a positive scan. It is concluded that {sup 99m}Tc-HMPAO-labelled leucocyte scan shows increased uptake among patients with SSp without evidence of IBD. These findings provide new evidence linking SSp with intestinal inflammation and suggest that in some cases a bowel-related process could contribute to the development of SSp. Long-term follow-up studies with more patients are necessary to evaluate the diagnostic and therapeutic implications of these results.

  3. Abdominal scintigraphy using 99mTc-HMPAO-labelled leucocytes in patients with seronegative spondylarthropathies without clinical evidence of inflammatory bowel disease

    Abdominal scintigraphy with technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocytes is an excellent tool for evaluating disease extent and activity of intestinal lesions in patients with inflammatory bowel disease (IBD). In some cases of seronegative spondylarthropathies (SSp), IBD may remain subclinical. The aim of this study was to evaluate the presence of positive abdominal scintigraphy in patients with SSp and without clinical symptoms or signs of IBD. To this end we studied 32 patients with active SSp (European Spondylarthropathy Study Group 1991 criteria) without clinical evidence of IBD (eight had ankylosing spondylitis, four psoriatic arthritis, three reactive arthritis an 17 undifferentiated SSp) and 11 controls without SSp. All SSp and control patients received similar doses of non-steroidal anti-inflammatory drugs (NSAIDs). Abdominal scintigraphic images were obtained at 30 and 120 min after re-injection of 99mTc-HMPAO-labelled leucocytes. The 99mTc-HMPAO-labelled leucocyte scan was positive in 17 patients with SSp (53.1%) (six with ankylosing spondylitis, three with psoriatic arthritis, two with reactive arthritis and six with undifferentiated SSp). Fourteen patients scored from 2 to 4 on the intensity of uptake scale. The colon and terminal ileum were predominantly involved. Axial involvement was more frequent in patients with a positive scan than in patients with negative results (P99mTc-HMPAO-labelled leucocyte scan shows increased uptake among patients with SSp without evidence of IBD. These findings provide new evidence linking SSp with intestinal inflammation and suggest that in some cases a bowel-related process could contribute to the development of SSp. Long-term follow-up studies with more patients are necessary to evaluate the diagnostic and therapeutic implications of these results. (orig.). With 3 figs., 3 tabs

  4. Introduction of online adaptive radiotherapy for bladder cancer through a multicentre clinical trial (Trans-Tasman Radiation Oncology Group 10.01): lessons learned

    Online adaptive radiotherapy for bladder cancer is a novel radiotherapy technique that was found feasible in a pilot study at a single academic institution. In September 2010 this technique was opened as a multicenter study through the Trans-Tasman Radiation Oncology Group (TROG 10.01 bladder online adaptive radiotherapy treatment). Twelve centers across Australia and New-Zealand registered interest into the trial. A multidisciplinary team of radiation oncologists, radiation therapists and medical physicists represented the trial credentialing and technical support team. To provide timely activation and proper implementation of the adaptive technique the following key areas were addressed at each site: Staff education/training; Practical image guided radiotherapy assessment; provision of help desk and feedback. The trial credentialing process involved face-to-face training and technical problem solving via full day site visits. A dedicated 'help-desk' team was developed to provide support for the clinical trial. 26% of the workload occurred at the credentialing period while the remaining 74% came post-center activation. The workload was made up of the following key areas; protocol clarification (36%), technical problems (46%) while staff training was less than 10%. Clinical trial credentialing is important to minimizing trial deviations. It should not only focus on site activation quality assurance but also provide ongoing education and technical support. (author)

  5. Introduction of online adaptive radiotherapy for bladder cancer through a multicentre clinical trial (Trans-Tasman Radiation Oncology Group 10.01: Lessons learned

    Daniel Pham

    2013-01-01

    Full Text Available Online adaptive radiotherapy for bladder cancer is a novel radiotherapy technique that was found feasible in a pilot study at a single academic institution. In September 2010 this technique was opened as a multicenter study through the Trans-Tasman Radiation Oncology Group (TROG 10.01 bladder online adaptive radiotherapy treatment. Twelve centers across Australia and New-Zealand registered interest into the trial. A multidisciplinary team of radiation oncologists, radiation therapists and medical physicists represented the trial credentialing and technical support team. To provide timely activation and proper implementation of the adaptive technique the following key areas were addressed at each site: Staff education/training; Practical image guided radiotherapy assessment; provision of help desk and feedback. The trial credentialing process involved face-to-face training and technical problem solving via full day site visits. A dedicated "help-desk" team was developed to provide support for the clinical trial. 26% of the workload occurred at the credentialing period while the remaining 74% came post-center activation. The workload was made up of the following key areas; protocol clarification (36%, technical problems (46% while staff training was less than 10%. Clinical trial credentialing is important to minimizing trial deviations. It should not only focus on site activation quality assurance but also provide ongoing education and technical support.

  6. Oncology nurses awareness of drug interactions

    Azize Karahan; Sevcan Avcı Isik; Sultan Kav; Aysel Abbasoglu

    2015-01-01

    Objective: The aim of this study was to determine oncology nurses awareness of drug interactions. Methods: This descriptive study was conducted with nurses working in the oncology clinics who are a member of Oncology Nursing Association of Turkey. A total of 115 nurses (response rate %20) were responded to the online survey that consists of 28 questions. Results: The mean age of the nurses was 33 ± 6.8. The majority of nurses work in university hospital (60%) as a clinical nurse (62.6%) and h...

  7. A CLINICAL COMPARATIVE STUDY OF ANALGESIC EFFECT OF TRAMADOL AND PENTAZOCINE IN POST - OPERATIVE PATIENTS FOLLOWING UPPER ABDOMINAL SURGERY

    Jamuna

    2015-06-01

    Full Text Available The post - operative pain can be treated by various approaches. Aim of this randomised prospective study was to compare two drugs (Tramadol and Pentazocine . 100 adult patients of both sexes of ASA status 1 & 2 posted for elective upper abdominal surgery were randomly assigned into two groups of 50 each, where Group 1 received Tramadol intravenously and Group 2 received Pentazocine intravenously as post - opera tive pain management. The efficacy of the analgesic effect of intravenous Tramadol & Pentazocine was compared during post - operative pain management. It was observed that Tramadol has got more potent analgesic action compared to equianalgesic dose of Pentaz ocine.

  8. Randomized clinical trial of mast cell inhibition in patients with a medium-sized abdominal aortic aneurysm

    Sillesen, H; Eldrup, N; Hultgren, R;

    2015-01-01

    BACKGROUND: Abdominal aortic aneurysm (AAA) is thought to develop as a result of inflammatory processes in the aortic wall. In particular, mast cells are believed to play a central role. The AORTA trial was undertaken to investigate whether the mast cell inhibitor, pemirolast, could retard the...... surgery, diabetes mellitus, and severe concomitant disease with a life expectancy of less than 2 years. Included patients were treated with 10, 25 or 40 mg pemirolast, or matching placebo for 52 weeks. The primary endpoint was change in aortic diameter as measured from leading edge adventitia at the...

  9. Review and comparison of clinical evidence submitted to support European Medicines Agency market authorization of orphan-designated oncological treatments

    Winstone, Julie; Chadda, Shkun; Ralston, Stephen; Sajosi, Peter

    2015-01-01

    Background Clinical trials for treatments indicated for orphan diseases may be limited due to the low prevalence of such diseases; this can result in implications for both regulatory and health economic perspectives. This study assessed the pivotal clinical evidence packages submitted to support applications for European Medicines Agency (EMA) marketing authorizations for treatments for orphan conditions, in relation to the size of the eligible patient population. Methods Approved treatments ...

  10. Hyperthermia - its actual role in radiation oncology. Pt. 3. Clinical rationale and results in deep seated tumors

    Combined hyperthermia and radiation therapy has been reported to yield higher complete and durable responses than radiotherapy alone in superficial tumors. In deep seated tumors the effect of the combined treatment is still under research. The literature and own clinical data are reviewed with regard to biological and physical fundamentals and clinical results. Clinical phase I to II studies have applied regional hyperthermia in the abdomen, the pelvic region and the extremities. Usually primary advanced, persistent or local recurrent and metastatic tumors were selected for treatment either due to poor response to conventional therapy or for effective palliation. The clinical data are presented concerning the following topics: Invasive thermometry, temperature parameter in tumor and normal tissue, toxicity, tumor response, treatment planning, clinical trials and prognostic factors. Clinical results of thermoradiotherapy for advanced or recurrent rectal cancer, cervical cancer and soft tissue sarcomas are reviewed in detail. In addition, the prognostic relevance of temperature parameters and physiological conditions such as global tumor perfusion are discussed. (orig.)

  11. PET/CT Interpretation: Abdominal Anatomy

    Detail knowledge of abdominal anatomy is essential for accurate interpretation of oncologic PET/CT. The objective of this lecture is to provide the core knowledge and guidance about, peritoneal cavity, vessels, nodal, internal organ, especially liver segmental anatomy, and retroperitoneal spaces to nuclear medicine physicians in their interpretation of oncologic PET/CT. Peritoneal Cavity: The peritoneal spaces are easiest to recognize when there is ascites. The right subphrenic space communicates with anterior and posterior subhepatic (Morrison's) space. The left subphrenic space freely communicate with the left subhepatic space. The right and left subphrenic spaces are separated by falciform ligament and do not communicate directly. The lesser sac is the isolated peritoneal compartment between the stomach and pancreas. It communicates with the rest of the peritoneal cavity (greater sac) through the Foramen of Winslow. The right subphrenic and subhepatic spaces communicate freely with the pelvic peritoneal cavity thru the right paracolic gutter. The phrenicocolic ligament prevents free communication between the left subphrenic / subhepatic space and left paracolic gutter. Free fluid and peritoneal metastases commonly settles in pelvis as the most dependent portion of the peritoneal cavity. The small mesentery suspends the jejunum and ileum and extends obliquely from the left upper quadrant to right lower quadrant. Disease originating above the ligament is directed towards the right lower quadrant and below the ligament can spread to pelvis. The greater omentum hangs from the greater curvature of the stomach and descends in front of the abdominal viscera and serves as a fertile ground for peritoneal metastases. Vessels: The abdominal aorta descends anterior to the left side of the spine to its bifurcation at the level of the iliac crest. The normal aorta does not exceed 3 cm diameter and tapers progressively as it descends distally. The common iliac arteries

  12. Oncology Nursing Society

    ... Hill Days Monday, August 22, 2016 Oncology Nursing Society Announces Support for DAISY Foundation Monday, August 8, 2016 Oncology Nursing Society and Haymarket Media Inc. Announce Navigation Summit Collaboration ...

  13. A randomized clinical trial comparing the efficacy and safety of ramosetron versus ondansetron in patients undergoing abdominal surgery under general anesthesia

    Sriramamurthy Kaja

    2014-01-01

    Full Text Available Background: Post-operative nausea and vomiting is one of the most common and distressing complications after anesthesia and surgery. It may lead to serious post-operative complications. Ramosetron is a newer 5-HT3 receptor antagonist and has more potent and longer duration of antiemetic effects compared to first generation 5HT3 receptor antagonists. The purpose of this study was to compare the efficacy of Ramosetron for the prevention of post-operative nausea and vomiting with that of Ondansetron in patients undergoing abdominal surgeries under general anesthesia. Methods: In this randomized, double-blind study, 60 patients, 18-60 years of both genders falling under ASA I-II category scheduled for abdominal surgery were included. Group I received I.V ramosetron 0.3 mg while group II received I.V Ondansetron 4 mg at the time of extubation. The standard general anesthetic technique was used throughout. Postoperatively the incidences of nausea, vomiting, and safety assessments were performed at 1, 2, 6, and 24 h during the first 24 h after surgery. Results: There were no differences between groups with respect to patient demographics. The percentage of patients who had complete response (no PONV, and no need for another rescue antiemetic from 0 to 24 h after anesthesia was 56% with ramosetron and 33% with ondansetron. The corresponding rates at 1, 2, 6, and 24 h after anesthesia were 76% and 63%, 76% and 50%, 100 and 83%, 100 and 93%, respectively. Safety profiles of the two drugs were comparable, as no clinically serious adverse effects caused by study drugs were observed in either of the groups. Conclusion: Our study concludes that prophylactic therapy with ramosetron is highly efficacious than ondansetron in preventing PONV in patients undergoing abdominal surgery under general anesthesia.

  14. Intravenous acetaminophen is superior to ketamine for postoperative pain after abdominal hysterectomy: results of a prospective, randomized, double-blind, multicenter clinical trial

    Faiz HR

    2014-01-01

    Full Text Available Hamid Reza Faiz,1 Poupak Rahimzadeh,1 Ognjen Visnjevac,2 Behzad Behzadi,1 Mohammad Reza Ghodraty,1 Nader D Nader2 1Iran University of Medical Sciences, Tehran, Iran; 2VA Western NY Healthcare System, University at Buffalo, Buffalo, NY, USA Background: In recent years, intravenously (IV administered acetaminophen has become one of the most common perioperative analgesics. Despite its now-routine use, IV acetaminophen's analgesic comparative efficacy has never been compared with that of ketamine, a decades-old analgesic familiar to obstetricians, gynecologists, and anesthesiologists alike. This double-blind clinical trial aimed to evaluate the analgesic effects of ketamine and IV acetaminophen on postoperative pain after abdominal hysterectomy. Methods: Eighty women aged 25–70 years old and meeting inclusion and exclusion criteria were randomly allocated into two groups of 40 to receive either IV acetaminophen or ketamine intraoperatively. Postoperatively, each patient had patient-controlled analgesia. Pain and sedation (Ramsay Sedation Scale were documented based on the visual analog scale in the recovery room and at 4 hours, 6 hours, 12 hours, and 24 hours after the surgery. Hemodynamic changes, adverse medication effects, and the need for breakthrough meperidine were also recorded for both groups. Data were analyzed by repeated-measures analysis of variance. Results: Visual analog scale scores were significantly lower in the IV acetaminophen group at each time point (P<0.05, and this group required significantly fewer doses of breakthrough analgesics compared with the ketamine group (P=0.039. The two groups had no significant differences in terms of adverse effects. Conclusion: Compared with ketamine, IV acetaminophen significantly improved postoperative pain after abdominal hysterectomy. Keywords: intravenous acetaminophen, abdominal hysterectomy, ketamine, analgesia, postoperative pain

  15. Randomized clinical trial of bedside ultrasound among patients with abdominal pain in the emergency department: impact on patient satisfaction and health care consumption

    Nilsson Laila

    2009-11-01

    Full Text Available Abstract Background Previous research shows that surgeon-performed ultrasound for patients presenting with abdominal pain in the emergency department leads both to higher diagnostic accuracy and to other benefits. We have evaluated the level of patient satisfaction, health condition and further health care consumption after discharge from the emergency department. Methods A total of 800 patients who attended the emergency department for abdominal pain were randomized to surgeon-performed ultrasound or not as a complement to standard examination. All patients were interviewed by telephone six weeks after the visit to the emergency department using a structured questionnaire including information about health condition, satisfaction and medical examinations. A regional health register was used to check health care consumption over two years and mortality was checked for in the personal data register. Results We found a higher self-rated patient satisfaction in the ultrasound group when leaving the emergency department. After six weeks the figures were equal. There were fewer patients in the ultrasound group with completed or planned complementary examinations after six weeks (31.1% compared with the control group (41.4%, p = 0.004. There was no difference found in the two-year health care consumption or mortality between the groups. Conclusion For patients with acute abdominal pain, bedside ultrasound examination is related to higher satisfaction and decreased short-term health care consumption. No major effects were revealed when evaluating effects on a long-term basis, including mortality. The previously proven benefit together with the lack of adverse effects from the method makes ultrasound well worth considering for implementation in emergency departments. Trial registration The study has been registered in ClinicalTrials.gov ID NCT00550511.

  16. Abdominal angiostrongyliasis: report of two cases with different clinical presentations Angiostrongilíase abdominal: relato de dois casos com diferentes apresentações clínicas

    Rubens Rodriguez

    2008-12-01

    Full Text Available Abdominal angiostrongyliasis is a sporadic infectious disease caused by the nematode Angiostrongylus costaricensis. It usually presents as acute abdomen, secondary to mesenteric ischemia, and pronounced eosinophilia. In some cases its course is insidious and transient, and the diagnosis is suspicious. The disease is confirmed by the detection of A. costaricensis elements in surgical specimen. The treatment is supportive, with avoidance of antihelminthic administration due to a possible erratic migration followed by worsening of the disease. We report two cases, both with intense eosinophilia and serum IgG-ELISA positive to A. costaricensis. The first case presented ileal perforation and was surgically treated. The second one showed hepatic nodules at ultrasound and was only symptomatically treated, evolving to an apparent protracted resolution. These two cases exemplify different clinical forms of the disease, one of them with liver involvement.A angiostrongilíase abdominal é doença esporádica decorrente da infecção pelo nematódeo Angiostrongylus costaricensis. Costuma manifestar-se como abdome agudo secundário a isquemia mesentérica, além de marcada eosinofilia. Pode também apresentar-se de forma insidiosa e transitória, exigindo alta suspeita clínica para o diagnóstico. A doença é confirmada pela identificação de elementos do A. costaricensis em peças cirúrgicas. O tratamento é apenas de suporte, devendo-se evitar o uso de anti-helmínticos pela possibilidade de migração errática do verme com piora do quadro. Aqui foram apresentados dois casos, ambos com acentuada eosinofilia e ELISA-IgG sérico positivo para A. costaricencis. O primeiro caso cursou com perfuração ileal e foi tratado cirurgicamente. O segundo caso apresentou nódulos hepáticos ao ultrassom e foi tratado sintomaticamente, evoluindo para lenta resolução. Estes dois casos exemplificam diferentes formas de apresentação clínica da doença, uma delas

  17. [History of Oncology in Slovakia].

    Ondruš, D; Kaušitz, J

    2016-01-01

    The history of oncology in Slovakia is closely linked to the history of St. Elizabeth Hospital, which was set up in the mid-18th century by nuns of the St. Elizabeth Order in Bratislava. In the first half of the 20th century, a unit was set up in the hospital dedicated to diagnosis and treatment of cancer. Shortly after World War II, the unit was turned into the Institute for Cancer Research and Treatment. In 1950, St. Elizabeth Hospital was nationalized, and the Cancer Research Institute of the Slovak Academy of Science and the Institute of Clinical Oncology were located there as centers for oncological diagnosis and treatment. After the restitution of church property in the early 1990s, the hospital was returned to the Order of St. Elizabeth, which set up the St. Elisabeth Cancer Institute in the hospital premises in January of 1996. This year marks the 20th anniversary of this institute in its new premises and the 85th anniversary of the Institute of Radiumtherapy founded in Bratislava, and thus the establishment of institutional healthcare for cancer patients in Slovakia is the reason for balancing. We present a view of the consecutive changes in the organization, space and staff of the Institute and evaluate the impact of celebrities on medicine who developed oncology as a clinical, scientific and educational discipline in Bratislava and in other cities and regions of Slovakia. PMID:27296401

  18. Radiation Therapy Oncology Group Consensus Panel Guidelines for the Delineation of the Clinical Target Volume in the Postoperative Treatment of Pancreatic Head Cancer

    Purpose: To develop contouring guidelines to be used in the Radiation Therapy Oncology Group protocol 0848, a Phase III randomized trial evaluating the benefit of adjuvant chemoradiation in patients with resected head of pancreas cancer. Methods and Materials: A consensus committee of six radiation oncologists with expertise in gastrointestinal radiotherapy developed stepwise contouring guidelines and an atlas for the delineation of the clinical target volume (CTV) in the postoperative treatment of pancreas cancer, based on identifiable regions of interest and margin expansions. Areas at risk for subclinical disease to be included in the CTV were defined, including nodal regions, anastomoses, and the preoperative primary tumor location. Regions of interest that could be reproducibly contoured on postoperative imaging after a pancreaticoduodenectomy were identified. Standardized expansion margins to encompass areas at risk were developed after multiple iterations to determine the optimal margin expansions. Results: New contouring recommendations based on CT anatomy were established. Written guidelines for the delineation of the postoperative CTV and normal tissues, as well as a Web-based atlas, were developed. Conclusions: The postoperative abdomen has been a difficult area for effective radiotherapy. These new guidelines will help physicians create fields that better encompass areas at risk and minimize dose to normal tissues.

  19. Consensus of the Brazilian Society of Infectious Diseases and Brazilian Society of Clinical Oncology on the management and treatment of Kaposi's sarcoma

    Érico Arruda

    2014-06-01

    Full Text Available Kaposi's sarcoma is a multifocal vascular lesion of low-grade potential that is most often present in mucocutaneous sites and usually also affects lymph nodes and visceral organs. The condition may manifest through purplish lesions, flat or raised with an irregular shape, gastrointestinal bleeding due to lesions located in the digestive system, and dyspnea and hemoptysis associated with pulmonary lesions. In the early 1980s, the appearance of several cases of Kaposi's sarcoma in homosexual men was the first alarm about a newly identified epidemic, acquired immunodeficiency syndrome. In 1994, it was finally demonstrated that the presence of a herpes virus associated with Kaposi's sarcoma called HHV-8 or Kaposi's sarcoma herpes virus and its genetic sequence was rapidly deciphered. The prevalence of this virus is very high (about 50% in some African populations, but stands between 2% and 8% for the entire world population. Kaposi's sarcoma only develops when the immune system is depressed, as in acquired immunodeficiency syndrome, which appears to be associated with a specific variant of the Kaposi's sarcoma herpes virus. There are no treatment guidelines for Kaposi's sarcoma established in Brazil, and thus the Brazilian Society of Clinical Oncology and the Brazilian Society of Infectious Diseases developed the treatment consensus presented here.

  20. Intensity correction method customized for multi-animal abdominal MR imaging with 3 T clinical scanner and multi-array coil

    Simultaneous magnetic resonance (MR) imaging of multiple small animals in a single session increases throughput of preclinical imaging experiments. Such imaging using a 3-tesla clinical scanner with multi-array coil requires correction of intensity variation caused by the inhomogeneous sensitivity profile of the coil. We explored a method for correcting intensity that we customized for multi-animal MR imaging, especially abdominal imaging. Our institutional committee for animal experimentation approved the protocol. We acquired high resolution T1-, T2-, and T2*-weighted images and low resolution proton density-weighted images (PDWIs) of 4 rat abdomens simultaneously using a 3T clinical scanner and custom-made multi-array coil. For comparison, we also acquired T1-, T2-, and T2*-weighted volume coil images in the same rats in 4 separate sessions. We used software created in-house to correct intensity variation. We applied thresholding to the PDWIs to produce binary images that displayed only a signal-producing area, calculated multi-array coil sensitivity maps by dividing low-pass filtered PDWIs by low-pass filtered binary images pixel by pixel, and divided uncorrected T1-, T2-, or T2*-weighted images by those maps to obtain intensity-corrected images. We compared tissue contrast among the liver, spinal canal, and muscle between intensity-corrected multi-array coil images and volume coil images. Our intensity correction method performed well for all pulse sequences studied and corrected variation in original multi-array coil images without deteriorating the throughput of animal experiments. Tissue contrasts were comparable between intensity-corrected multi-array coil images and volume coil images. Our intensity correction method customized for multi-animal abdominal MR imaging using a 3T clinical scanner and dedicated multi-array coil could facilitate image interpretation. (author)

  1. A clinical retrospective study of the detectable ability of the advanced colorectal cancer by plain abdominal multislice CT

    We evaluated the efficacy of plain CT for diagnosis of advanced colorectal cancer retrospectively. During 2 years between December 1999 and November 2001, 26 patients with advanced colorectal cancer underwent abdominal CT scan (Toshiba ASTEIONMULTI). The patients had received no special preparation for CT scan except for avoiding breakfast. The sensitivity of CT scan in detecting tumors was 76.9%. Moreover, cancers originated in the cecum, ascending colon and descending colon were all detectable by CT. Ninety-two percent of cancers occupying more than 2/3 of circumference of the colonic wall were detectable. These evidences may indicate that plain CT is useful for detecting colorectal cancers with little patients' burden as well as providing information about their extension and metastasis, when colorectal cancer is suspected by patients' symptom. (author)

  2. Pregabalin and dexamethasone in combination with paracetamol for postoperative pain control after abdominal hysterectomy. A randomized clinical trial

    Rasmussen, M L; Dierking, G; Lech, K;

    2008-01-01

    BACKGROUND: Multimodal analgesia may be important for optimal postoperative pain treatment and facilitation of early mobilization and recovery. We investigated the analgesic effect of pregabalin and dexamethasone in combination with paracetamol after abdominal hysterectomy. METHODS: One hundred and...... sixteen patients were randomly assigned to either group A (paracetamol+placebo x 2), group B (paracetamol+pregabalin+placebo) or group C (paracetamol+pregabalin+dexamethasone). According to randomization and preoperatively, patients received paracetamol 1000 mg, pregabalin 300 mg, dexamethasone 8 mg or...... placebo. General anaesthesia was performed. Postoperative pain treatment was paracetamol 1000 mg x 4 and patient-controlled intravenous morphine, 2.5 mg bolus. Nausea was treated with ondansetron. Morphine consumption, pain score (visual analogue scale) at rest and during mobilization, nausea, sedation...

  3. Adult abdominal hernias.

    Murphy, Kevin P

    2014-06-01

    Educational Objectives and Key Points. 1. Given that abdominal hernias are a frequent imaging finding, radiologists not only are required to interpret the appearances of abdominal hernias but also should be comfortable with identifying associated complications and postrepair findings. 2. CT is the imaging modality of choice for the assessment of a known adult abdominal hernia in both elective and acute circumstances because of rapid acquisition, capability of multiplanar reconstruction, good spatial resolution, and anatomic depiction with excellent sensitivity for most complications. 3. Ultrasound is useful for adult groin assessment and is the imaging modality of choice for pediatric abdominal wall hernia assessment, whereas MRI is beneficial when there is reasonable concern that a patient\\'s symptoms could be attributable to a hernia or a musculoskeletal source. 4. Fluoroscopic herniography is a sensitive radiologic investigation for patients with groin pain in whom a hernia is suspected but in whom a hernia cannot be identified at physical examination. 5. The diagnosis of an internal hernia not only is a challenging clinical diagnosis but also can be difficult to diagnose with imaging: Closed-loop small-bowel obstruction and abnormally located bowel loops relative to normally located small bowel or colon should prompt assessment for an internal hernia.

  4. Clinical significance of the interaction between non-coding RNAs and the epigenetics machinery: Challenges and opportunities in oncology

    Maia, Beatriz M; Rocha, Rafael M; CALIN, GEORGE A.

    2013-01-01

    Non-coding RNAs and epigenetics are remarkable mechanisms of cellular control. In this review we underline the processes by which non-coding RNAs (ncRNAs), shown to be involved in various diseases, are capable of modifying and being modified by the epigenetic machinery, emphasizing the clinical importance of this network in cancer. Many ncRNAs have been described that play important roles in the establishment and maintenance of the epigenome. However, only a few studies deeply take into accou...

  5. Significance of chronic marked hyperglycemia on FDG-PET. Is it really problematic for clinical oncologic imaging?

    The purpose of this study was to evaluate the adverse effects of chronic marked hyperglycemia on clinical diagnostic performance of positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG). Fifty-seven scans of 54 patients, who received FDG-PET for the diagnosis of various cancer(s), and who showed high plasma glucose level of more than 200 mg/dl at the time of administration of FDG in spite of at least 4-h fasting, were retrospectively analyzed. In the clinical follow-up, this high plasma glucose was confirmed as chronic hyperglycemia derived from uncontrolled diabetes (n=32) and untreated diabetes (n=25). Based on the final diagnosis of malignancy obtained by histopathology or clinical follow-up for at least 6 months, the diagnostic performance of visual PET analysis was evaluated. Excluding nine scans of nine patients without sufficient follow-up, final diagnosis was obtained in 48 scans of 45 patients. In 36 scans of 36 patients, at least one malignant lesion was finally confirmed, and true-positive and false-negative results were obtained in 30 and six cases, respectively. Six cases showed false-negative results due to low FDG-avid pathological characteristics (hepatocellular carcinoma, etc.), chemotherapeutic effect or small tumor size. Overall, the patient-based sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 83, 83, 94, 63 and 83%, respectively. In lesion-based diagnosis, 56 of 75 lesions (74%) were depicted by PET, while 19 lesions were negative on PET, also due to low FDG-avid characteristics or small size (less than 15 mm). At the time of chronic hyperglycemia (not acute hyperglycemia), the adverse effect caused by high plasma glucose level was minimum. The FDG uptake of the tumor maintained a sufficiently high level for visual clinical diagnosis in most cases, except in the cases of low FDG-avid tumors or small lesions (15 mm in size). (author)

  6. African American Participation in Oncology Clinical Trials-Focus on Prostate Cancer: Implications, Barriers, and Potential Solutions.

    Ahaghotu, Chiledum; Tyler, Robert; Sartor, Oliver

    2016-04-01

    In the United States, the incidence and mortality rates of many cancers, especially prostate cancer, are disproportionately high among African American men compared with Caucasian men. Recently, mortality rates for prostate cancer have declined more rapidly in African American versus Caucasian men, but prostate cancer is still the most common cancer and the second leading cause of cancer deaths in African American men in the United States. Compared with Caucasian men, prostate cancer occurs at younger ages, has a higher stage at diagnosis, and is more likely to progress after definitive treatments in African American men. Reasons for racial discrepancies in cancer are multifactorial and potentially include socioeconomic, cultural, nutritional, and biologic elements. In addition to improving access to novel therapies, clinical trial participation is essential to adequately establish the risks and benefits of treatments in African American populations. Considering the disproportionately high mortality rates noted in these groups, our understanding of the natural history and responses to therapies is limited. This review will explore African American underrepresentation in clinical trials with a focus on prostate cancer, and potentially effective strategies to engage African American communities in prostate cancer research. Solutions targeting physicians, investigators, the community, and health care systems are identified. Improvement of African American participation in prostate cancer clinical trials will benefit all stakeholders. PMID:26786562

  7. Radiotherapy quality assurance review in a multi-center randomized trial of limited-disease small cell lung cancer: the Japan Clinical Oncology Group (JCOG) trial 0202

    The purpose of this study was to analyze the radiotherapy (RT) quality assurance (QA) assessment in Japan Clinical Oncology Group (JCOG) 0202, which was the first trial that required on-going RT QA review in the JCOG. JCOG 0202 was a multi-center phase III trial comparing two types of consolidation chemotherapy after concurrent chemoradiotherapy for limited-disease small cell lung cancer. RT requirements included a total dose of 45 Gy/30 fx (bis in die, BID/twice a day) without heterogeneity correction; elective nodal irradiation (ENI) of 30 Gy; at least 1 cm margin around the clinical target volume (CTV); and interfraction interval of 6 hours or longer. Dose constraints were defined in regards to the spinal cord and the lung. The QA assessment was classed as per protocol (PP), deviation acceptable (DA), violation unacceptable (VU), and incomplete/not evaluable (I/NE). A total of 283 cases were accrued, of which 204 were fully evaluable, excluding 79 I/NE cases. There were 18 VU in gross tumor volume (GTV) coverage (8% of 238 evaluated); 4 VU and 23 DA in elective nodal irradiation (ENI) (2% and 9% of 243 evaluated, respectively). Some VU were observed in organs at risk (1 VU in the lung and 5 VU in the spinal cord). Overall RT compliance (PP + DA) was 92% (187 of 204 fully evaluable). Comparison between the former and latter halves of the accrued cases revealed that the number of VU and DA had decreased. The results of the RT QA assessment in JCOG 0202 seemed to be acceptable, providing reliable results

  8. Clinical impact of [18F]FDG-PET in oncology evaluated by the referring physicians during year 2000

    Full text: The first study evaluating directly by the referring physician the clinical impact of [18F]-FDG PET on modification of patient's management was performed only recently in California by means of a questionnaire. We have used the same methodology to evaluate this clinical impact during the opening year of our PET center in France. A questionnaire was sent to the referring physician of each of the 476 patients who had at least one routine FDG-PET examination during the year 2000. Of 348 responses (response rate 73 %), the disease was upstaged in 26 % of the cases and downstaged in 9 %. Inter-modality management changes (change from a scheduled therapeutic modality for a different one) were reported in 37 % of the cases and intra-modality changes in 9 %. Those modification rates were respectively 38 % and 7 % in recurrence of colorectal cancer (153 patients), 47 % and 7 % in lung cancer (118 patients), 16 % and 23 % in lymphoma (43 patients), 25 % and 6 % in the staging of head and neck cancers (32 patients). When comparing with the corresponding studies performed in California using the same questionnaire, there were no significant differences between the rates of inter-modality management changes (43 % versus 37 %). In contrast, intra-modality management changes were less frequent in our survey (17 % versus 9 %), except for lymphoma (10 % versus 23 %). Globally, the clinical impact of FDG PET was similar, with a higher rate of response to the questionnaire in our study (73 % versus 35 %) which yields a better confidence in the values that are reported here. An extensive survey of literature (including data published as abstracts until 2000) was recently published by Gambhir et al., including more than 3000 patients in the clinical settings of our study. The mean value for the rate of changing patient's management was 31 %. That means that the clinical impact observed in our study (46 %) performed on the opening year of our dedicated-PET center reached the

  9. PET / MRI vs. PET / CT. Indications Oncology

    Hybrid techniques in Nuclear Medicine is currently a field in full development for diagnosis and treatment of various medical conditions. With the recent advent of PET / MRI much it speculated about whether or not it is superior to PET / CT especially in oncology. The Conference seeks to clarify this situation by dealing issues such as: State of the art technology PET / MRI; Indications Oncology; Some clinical cases. It concludes by explaining the oncological indications of both the real and current situation of the PET / MRI. (author)

  10. Updates on abdominal desmoid tumors

    2007-01-01

    Desmoid tumor is a monoclonal, fibroblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia infiltrates locally, recurs frequentiy after resection but does not metastasize. Abdominal desmoid occurs sporadically, in association with some familial syndromes and often represents a clinical dilemma for surgeons. The enigmatic biology and anatomical location of abdominal desmoids make treatment recommendations difficult. This distinct pathological entity is reviewed with a specific focus on aetiology and management.

  11. Effects of postimplantation systemic inflammatory response on long-term clinical outcomes after endovascular aneurysm repair of an abdominal aortic aneurysm.

    Kwon, Hyunwook; Ko, Gi-Young; Kim, Min-Ju; Han, Youngjin; Noh, Minsu; Kwon, Tae-Won; Cho, Yong-Pil

    2016-08-01

    The aim of this study was to determine the association between postimplantation syndrome (PIS) and long-term clinical outcomes after elective endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm.In this single-center, observational cohort study, a total of 204 consecutive patients undergoing EVAR were included. Primary outcome was long-term mortality from any cause; secondary outcomes included long-term mortality, systemic or implant-related complications, and secondary therapeutic procedures.The diagnosis of PIS was established in 64 patients (31.4%). PIS patients were more likely to receive woven polyester endografts and have a longer postoperative hospital stay and lower incidence of type II endoleaks. In multivariate analysis, PIS was significantly associated with a decreased risk of developing type II endoleaks (P = 0.044). During follow-up period of 44 months, clinical outcomes showed no significant differences in mortality (P = 0.876), systemic (P = 0.668), or implant-related complications (P = 0.847), although rates of secondary therapeutic procedure were significantly higher in non-PIS patients (P = 0.037). The groups had similar rates of overall survival (P = 0.761) and other clinical outcomes (P = 0.562).Patients with and without PIS had similar long-term overall survival rates and other clinical outcomes. PIS was beneficial in preventing type II endoleaks during postoperative period. PMID:27512875

  12. Personalized oncology

    Tuxen, Ida Viller; Jønson, Lars; Santoni-Rugiu, Eric;

    2014-01-01

    . Only a limited number of patients will benefit from the treatment. However, introducing genomic mapping to select patients for early clinical trials with targeted molecular therapy according to the genomic findings, may lead to a better outcome for the patient, an enrichment of phase 1 trials, and...... thereby accelerated drug development. The overall advantage is to determine which mutation profiles correlate with sensitivity or lack of resistance to specific targeted therapies. The utility and current limitations of genomic screening to guide selection to Phase 1 clinical trial will be discussed....... of genes simultaneously, personalized molecular medicine has become an option. New treatments are being investigated in phase 1 trials around the world. Traditionally, the goal of phase 1 studies was to determine the optimal dose and assess dose-limiting toxicity of a potential new experimental drug...

  13. Clinical effectiveness of posaconazole versus fluconazole as antifungal prophylaxis in hematology–oncology patients: a retrospective cohort study

    In preventing invasive fungal disease (IFD) in patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS), clinical trials demonstrated efficacy of posaconazole over fluconazole and itraconazole. However, effectiveness of posaconazole has not been investigated in the United States in real-world setting outside the environment of controlled clinical trial. We performed a single-center, retrospective cohort study of 130 evaluable patients ≥18 years of age admitted to Duke University Hospital between 2004 and 2010 who received either posaconazole or fluconazole as prophylaxis during first induction or first reinduction chemotherapy for AML or MDS. The primary endpoint was possible, probable, or definite breakthrough IFD. Baseline characteristics were well balanced between groups, except that posaconazole recipients received reinduction chemotherapy and cytarabine more frequently. IFD occurred in 17/65 (27.0%) in the fluconazole group and in 6/65 (9.2%) in the posaconazole group (P = 0.012). Definite/probable IFDs occurred in 7 (10.8%) and 0 patients (0%), respectively (P = 0.0013). In multivariate analysis, fluconazole prophylaxis and duration of neutropenia were predictors of IFD. Mortality was similar between groups. This study demonstrates superior effectiveness of posaconazole over fluconazole as prophylaxis of IFD in AML and MDS patients. Such superiority did not translate to reductions in 100-day all-cause mortality

  14. Case management in oncology rehabilitation (CAMON: The effect of case management on the quality of life in patients with cancer after one year of ambulant rehabilitation. A study protocol for a randomized controlled clinical trial in oncology rehabilitation

    Bardheci Katarina

    2011-04-01

    Full Text Available Abstract Background Cancer diseases and their therapies have negative effects on the quality of life. The aim of this study is to assess the effectiveness of case management in a sample of oncological outpatients with the intent of rehabilitation after cancer treatment. Case management wants to support the complex information needs of the patients in addition to the segmented structure of the health care system. Emphasis is put on support for self-management in order to enhance health - conscious behaviour, learning to deal with the burden of the illness and providing the opportunity for regular contacts with care providers. We present a study protocol to investigate the efficacy of a case management in patients following oncology rehabilitation after cancer treatment. Methods The trial is a multicentre, two-arm randomised controlled study. Patients are randomised parallel in either 'usual care' plus case management or 'usual care' alone. Patients with all types of cancer can be included in the study, if they have completed the therapy with chemo- and/or radiotherapy/surgery with curative intention and are expected to have a survival time >1 year. To determine the health-related quality of life the general questionnaire FACT G is used. The direct correlation between self-management and perceived self-efficacy is measured with the Jerusalem & Schwarzer questionnaire. Patients satisfaction with the care received is measured using the Patient Assessment of Chronic Illness Care 5 As (PACIC-5A. Data are collected at the beginning of the trial and after 3, 6 and 12 months. The power analysis revealed a sample size of 102 patients. The recruitment of the centres began in 2009. The inclusion of patients began in May 2010. Discussion Case management has proved to be effective regarding quality of life of patients with chronic diseases. When it comes to oncology, case management is mainly used in cancer treatment, but it is not yet common in the

  15. Clinical results of RF capacitive hyperthermia combined with radiation for abdominal and pelvic deep-seated tumors

    Thirty-one patients with deep-seated abdominal and pelvic tumors were treated with thermoradiotherapy. The patients were given 3 to 14 sessions of hyperthermia for 30 - 60 min once or twice a week within 30 min after irradiation. Irradiation was given in 5 fraction/week with a total dosage of 20 to 70 Gy. The temperature of 42 deg C or more could be achieved within the central part of tumor in 20 patients (65 %). Tumor regression was evaluated as 100 % in 4 patients (13 %), 80 -< 100 % in 5 (16 %), 50 -<80 % in 9 (29 %), and < 50 % in 13 (42 %). It was dependent on tumor size, radiation doses, and average minimum temperature for tumors. The possible factors for favorable prognosis were a tumor of less than 3 cm in diameter, a total dose of more than 60 Gy, and an average minimum temperature of more than 41 deg C for tumors. The appearance of low density areas on post-treatment CT scans was associated with higher temperature in the central part of tumor. Thermoradiotherapy-related atrophic cystitis or subcutaneous fibrosis was encountered in each one patient. (Namekawa, K.)

  16. MR-guided percutaneous drainage of abdominal fluid collections in combination with X-ray fluoroscopy: initial clinical experience

    The aim of this study was to examine the feasibility of a hybrid interventional MR system, which combines a closed bore magnet with a C-arm fluoroscopy unit for percutaneous drainage of abdominal fluid collections. During the past 2 years, we have performed four drainage procedures in four patients (mean age 47 years). Three patients had abscesses (psoas muscle, kidney, subphrenic location) and the fourth patient had a recurrent splenic cyst. All procedures were performed on an interventional MR system consisting of a 1.5-T ACS-NT scanner combined with a specially shielded C-arm. The drainages were guided by T1-weighted fast gradient-echo images, T2-weighted single-shot turbo spin-echo images or both. A standard 18 G (1.2 mm) nonferromagnetic stainless steel needle with a Teflon sheath was used for the punctures following which a 0.89 mm nitinol guidewire was inserted into the fluid collection. Thereafter, the patient was positioned in the immediate adjacent fluoroscopy unit and a drainage catheter was placed under fluoroscopic control. All drainage catheters were successfully placed into the fluid collections, as proven by fluid aspiration and resolution of the collection. The mean time needed for the entire drainage procedure (MR and fluoroscopy) was 110 min. No procedure-related complications occurred. It is feasible to perform drainage procedures on a closed-bore MR scanner. The multiplanar imaging capabilities of MR are particularly helpful for fluid collections in the subphrenic location. (orig.)

  17. Assessment of abdominal aortic aneurysms using a cone-beam CT system. An experimental phantom study and an initial clinical evaluation before and after stent-graft treatment in patients with an abdominal aortic aneurysm

    The aim of this study is to conduct a quantitative analysis of cone-beam CT (CBCT) images using a phantom, and then to evaluate the clinical usefulness of CBCT in the assessment of abdominal aortic aneurysms (AAA) before and after stent-grafting, both qualitatively as well as quantitatively. The phantom used in this study was a rectangular plate made of an acrylic resin, which contained eight through-holes to mimic blood vessels. Each columnar cavity was filled with contrast media and the diameter of each was then measured using a cone-beam multiplanar reformation/curved planar reformation (CB-MPR/CPR) technique, and the results were compared with the corresponding results obtained by actual measurement. In the clinical assessment, nine patients with AAA (consisting only of males with an average age of 68 years old: 56-80) were enrolled. The clinical qualitative analysis of CBCT consisted of: for the pre-operative state, the shape of the aortic aneurysm, the relationship between the aneurysm and the aortic branches, and for the post-operative state, the shape of the stent and any endoleakage present. The clinical quantitative analysis of CBCT included, for the aneurysm, its inflection angle, its maximum diameter, the diameter of the proximal and distal necks, and the distance of these two necks from specific reference points. The quantitative analysis using the phantom showed no significant differences between the results based on CB-MPR/CPR and those obtained by actual measurement. In the clinical qualitative analysis three-dimensional CBCT (3D-CBCT) depicted the anatomical relationship between the aneurysm and the aortic branches well, an accomplishment that was not possible by conventional angiography. Cone-beam maximum intensity projection (CB-MIP) was as good in tracing the migration and deformation of the stent following endovascular intervention as plain radiograms and conventional angiograms. CB-MPR/CPR enabled us to obtain any cross-sectional image of the

  18. Volumetric modulated arc therapy with flattening filter free beams for isolated abdominal/pelvic lymph nodes: report of dosimetric and early clinical results in oligometastatic patients

    SBRT is a safe and efficient strategy to locally control multiple metastatic sites. While research in the physics domain for Flattening Filter Free Beams (FFF) beams is increasing, there are few clinical data of FFF beams in clinical practice. Here we reported dosimentric and early clinical data of SBRT and FFF delivery in isolated lymph node oligometastatic patients. Between October 2010 and March 2012, 34 patients were treated with SBRT for oligometastatic lymph node metastasis on a Varian TrueBeamTM treatment machine using Volumetric Modulated Arc Therapy (RapidArc). We retrospectively evaluated a total of 25 patients for isolated lymph node metastases in abdomen and/or pelvis treated with SBRT and FFF (28 treatments). Acute toxicity was recorded. Local control evaluation was scored by means of CT scan and/or PET scan. All dosimetric results are in line with what published for the same type of stereotactic abdominal lymph node metastases treatments and fractionation, using RapidArc. All 25 FFF SBRT patients completed the treatment. Acute gastrointestinal toxicity was minimal: one patient showed Grade 1 gastrointestinal toxicity. Three other patients presented Grade 2 toxicity. No Grade 3 or higher was recorded. All toxicities were recovered within one week. The preliminary clinical results at the median follow up of 195 days are: complete response in 12 cases, partial response in 11, stable disease in 5, with an overall response rate of 82%; no local progression was recorded. Data of dosimetrical findings and acute toxicity are excellent for patients treated with SBRT with VMAT using FFF beams. Preliminary clinical results showed a high rate of local control in irradiated lesion. Further data and longer follow up are needed to assess late toxicity and definitive clinical outcomes

  19. Volumetric modulated arc therapy with flattening filter free beams for isolated abdominal/pelvic lymph nodes: report of dosimetric and early clinical results in oligometastatic patients

    Alongi Filippo

    2012-12-01

    Full Text Available Abstract Background SBRT is a safe and efficient strategy to locally control multiple metastatic sites. While research in the physics domain for Flattening Filter Free Beams (FFF beams is increasing, there are few clinical data of FFF beams in clinical practice. Here we reported dosimentric and early clinical data of SBRT and FFF delivery in isolated lymph node oligometastatic patients. Methods Between October 2010 and March 2012, 34 patients were treated with SBRT for oligometastatic lymph node metastasis on a Varian TrueBeamTM treatment machine using Volumetric Modulated Arc Therapy (RapidArc. We retrospectively evaluated a total of 25 patients for isolated lymph node metastases in abdomen and/or pelvis treated with SBRT and FFF (28 treatments. Acute toxicity was recorded. Local control evaluation was scored by means of CT scan and/or PET scan. Results All dosimetric results are in line with what published for the same type of stereotactic abdominal lymph node metastases treatments and fractionation, using RapidArc. All 25 FFF SBRT patients completed the treatment. Acute gastrointestinal toxicity was minimal: one patient showed Grade 1 gastrointestinal toxicity. Three other patients presented Grade 2 toxicity. No Grade 3 or higher was recorded. All toxicities were recovered within one week. The preliminary clinical results at the median follow up of 195 days are: complete response in 12 cases, partial response in 11, stable disease in 5, with an overall response rate of 82%; no local progression was recorded. Conclusions Data of dosimetrical findings and acute toxicity are excellent for patients treated with SBRT with VMAT using FFF beams. Preliminary clinical results showed a high rate of local control in irradiated lesion. Further data and longer follow up are needed to assess late toxicity and definitive clinical outcomes.

  20. CT of abdominal trauma

    Soon after it became available for clinical use, cranial CT became the method of choice for evaluating head trauma. Only relatively recently have newer generation full-body scanners been installed at major trauma centers, but experience is rapidly being gained in the utilization of CT for abdominal trauma. CT has proved highly accurate in diagnosing a wide variety of injuries to both intra- and retroperitoneal organs in pediatric and adult patient populations. The impact has been evident not only in decreasing utilization of other diagnostic tests, such as angiography, but also in practical management decisions, such as whether to perform exploratory laparotomy. This chapter details the authors' approach to evaluation of abdominal trauma by CT

  1. The blunt abdominal trauma

    Up to 1970 the number of patients suffering from blunt abdominal trauma showed a substantial increase. In more than 50% of all cases there are additional injuries. The most important factor influencing the prognosis of these patients is the early and correct indication for operation and the avoidance of unnecessary laparotomies. As a primary aim in diagnosis one should consider the recognition of an intraperitoneal bleeding without risk for the patient. Peritoneal lavage as an invasive method with low complication rates has proved good. First reports also show good results using the sonography of the abdomen. The recognition of the injured organ allows a carefully directed operation. Concerning the prognosis it is of minor importance. The diagnosis in patients with blunt abdominal trauma at the university clinic of Freiburg consists of: sonography, followed in positive cases by laparotomy or angiography and laparotomy. In cases with questionable results a lavage is done. (orig.)

  2. About the Community Oncology and Prevention Trials Research Group | Division of Cancer Prevention

    The Community Oncology and Prevention Trials Research Group supports clinical oncology trials in cancer prevention and control in community settings. The group also supports investigator-initiated research projects in supportive, palliative and end-of-life care, and coordinates clinical oncology research projects with other NCI programs to be done in the community setting. |

  3. Abdominal Aortic Aneurysms: Treatments

    ... access catheters Vertebroplasty Women and vascular disease Women's health Social Media Facebook Twitter ... Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists are vascular ...

  4. Respiratory motion reduction in PET/CT using abdominal compression for lung cancer patients.

    Tzung-Chi Huang

    Full Text Available PURPOSE: Respiratory motion causes substantial artifacts in reconstructed PET images when using helical CT as the attenuation map in PET/CT imaging. In this study, we aimed to reduce the respiratory artifacts in PET/CT images of patients with lung tumors using an abdominal compression device. METHODS: Twelve patients with lung cancer located in the middle or lower lobe of the lung were recruited. The patients were injected with 370 MBq of 18F-FDG. During PET, the patients assumed two bed positions for 1.5 min/bed. After conducting free-breathing imaging, we obtained images of the patients with abdominal compression by applying the same setup used in the free-breathing scan. The differences in the standardized uptake value (SUVmax, SUVmean, tumor volume, and the centroid of the tumors between PET and various CT schemes were measured. RESULTS: The SUVmax and SUVmean derived from PET/CT imaging using an abdominal compression device increased for all the lesions, compared with those obtained using the conventional approach. The percentage increases were 18.1% ±14% and 17% ±16.8% for SUVmax and SUVmean, respectively. PET/CT imaging combined with abdominal compression generally reduced the tumor mismatch between CT and the corresponding attenuation corrected PET images, with an average decrease of 1.9±1.7 mm over all the cases. CONCLUSIONS: PET/CT imaging combined with abdominal compression reduces respiratory artifacts and PET/CT misregistration, and enhances quantitative SUV in tumor. Abdominal compression is easy to set up and is an effective method used in PET/CT imaging for clinical oncology, especially in the thoracic region.

  5. Acute oncological emergencies.

    Gabriel, J

    2012-01-01

    The number of people receiving systemic anti-cancer treatment and presenting at emergency departments with treatment-related problems is rising. Nurses will be the first point of contact for most patients and need to be able to recognise oncological emergencies to initiate urgent assessment of patients and referral to the acute oncology team so that the most appropriate care can be delivered promptly. This article discusses the role of acute oncology services, and provides an overview of the most common acute oncological emergencies.

  6. Comparison of epidural butorphanol and fentanyl as adjuvants in the lower abdominal surgery: A randomized clinical study

    Jasleen Kaur

    2014-01-01

    Full Text Available Background: Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. The present study compared the efficacy and safety profile of epidurally administered butorphanol and fentanyl combined with bupivacaine (B. Materials and Methods: A total of 75 adult patients of either sex of American Society of Anesthesiologist physical status I and II, aged 20-60 years, undergoing lower abdominal under epidural anesthesia were enrolled into the study. Patients were randomly divided into three groups of 25 each: B, bupivacaine and butorphanol (BB and bupivacaine + fentanyl (BF. B (0.5% 20 ml was administered epidurally in all the three groups with the addition of 1 mg butorphanol in BB group and 100 μg fentanyl in the BF group. The hemodynamic parameters as well as various block characteristics including onset, completion, level and duration of sensory analgesia as well as onset, completion and regression of motor block were observed and compared. Adverse events and post-operative visual analgesia scale scores were also noted and compared. Data was analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher′s exact test. Value of P < 0.05 was considered significant and P < 0.001 as highly significant. Results: The demographic profile of patients was comparable in all the three groups. Onset and completion of sensory analgesia was earliest in BF group, followed by BB and B group. The duration of analgesia was significantly prolonged in BB group followed by BF as compared with group B. Addition of butorphanol and fentanyl to B had no effect on the time of onset, completion and regression of motor block. No serious cardio-respiratory side effects were observed in any group. Conclusions: Butorphanol and fentanyl as epidural adjuvants are equally safe and provide comparable stable hemodynamics, early onset and establishment of sensory

  7. Cell Line Derived Multi-Gene Predictor of Pathologic Response to Neoadjuvant Chemotherapy in Breast Cancer: A Validation Study on US Oncology 02-103 Clinical Trial

    Shen Kui

    2012-11-01

    Full Text Available Abstract Background The purpose of this study is to assess the predictive accuracy of a multi-gene predictor of response to docetaxel, 5-fluorouracil, epirubicin and cyclophosphamide combination chemotherapy on gene expression data from patients who received these drugs as neoadjuvant treatment. Methods Tumor samples were obtained from patients with stage II-III breast cancer before starting neoadjuvant chemotherapy with four cycles of 5-fluorouracil/epirubicin/cyclophosphamide (FEC followed by four cycles of docetaxel/capecitabine (TX on US Oncology clinical trial 02-103. Most patients with HER-2-positive cancer also received trastuzumab (H. The chemotherapy predictor (TFEC-MGP was developed from publicly available gene expression data of 42 breast cancer cell-lines with corresponding in vitro chemotherapy sensitivity results for the four chemotherapy drugs. No predictor was developed for treatment with trastuzumab. The predictive performance of TFEC-MGP in distinguishing cases with pathologic complete response from those with residual disease was evaluated for the FEC/TX and FEC/TX plus H group separately. The area under the receiver-operating characteristic curve (AU-ROC was used as the metric of predictive performance. Genomic predictions were performed blinded to clinical outcome. Results The AU-ROC was 0.70 (95% CI: 0.57-0.82 for the FEC/TX group (n=66 and 0.43 (95% CI: 0.20-0.66 for the FEC/TX plus H group (n=25. Among the patients treated with FEC/TX, the AU-ROC was 0.69 (95% CI: 0.52-0.86 for estrogen receptor (ER-negative (n=28 and it was 0.59 (95% CI: 0.36-0.82 for ER-positive cancers (n=37. ER status was not reported for one patient. Conclusions Our results indicate that the cell line derived 291-probeset genomic predictor of response to FEC/TX combination chemotherapy shows good performance in a blinded validation study, particularly in ER-negative patients.

  8. Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline

    Colorectal cancer (CRC) is a major cause of morbidity and mortality [1, 2]. CRC screening by fecal occult blood testing (FOBT) has been shown to reduce CRC mortality [3, 4], and is currently used in several European countries. Colonoscopy is highly effective for detecting advanced neoplasia, and endoscopic polypectomy reduces subsequent CRCspecific incidence and mortality [5]. In Europe, colonoscopy is mainly used to investigate FOBT-positive or symptomatic patients, or as a preventive strategy in those with increased CRC risk [6]. Computed tomographic colonography (CTC) is a minimally invasive imaging technique that is highly accurate for detecting colorectal cancer (CRC) and adenomatous polyps. The technique is standardized [7], and CTC is more easily performed than barium enema. Evidence-based data suggest that CTC is the natural replacement for barium enema and a complementary rather than an alternative examination to colonoscopy. However, the clinical scenarios for which CTC is indicated remain unclear. To address this uncertainty - 20 years after the first presentation of CTC at a radiological meeting [8] - the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) decided to produce a common guideline regarding indications for CTC in clinical practice. Technical and quality issues of CTC have been deliberately excluded from this work as these have already been discussed separately [7].

  9. Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline

    Spada, Cristiano; Barbaro, Federico; Petruzziello, Lucio [Catholic University, Digestive Endoscopy Unit, Rome (Italy); Stoker, Jaap; Haan, Margriet C. de [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Alarcon, Onofre [Universidad de La Laguna, Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, La Laguna, Tenerife (Spain); Bellini, Davide; Laghi, Andrea [Sapienza University of Rome, I.C.O.T. Hospital, Department of Radiological Sciences, Oncology and Pathology, Latina (Italy); Bretthauer, Michael [Oslo University Hospital, Department of Health Economy and Health Management, University of Oslo, and Department of Transplantation Medicine, Gastroenterology Unit, Oslo (Norway); Dumonceau, Jean-Marc [Gedyt Endoscopy Center, Buenos Aires (Argentina); Ferlitsch, Monika [Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna (Austria); Halligan, Steve; Helbren, Emma; Plumb, Andrew; Taylor, Stuart A. [University College London, Centre for Medical Imaging, London (United Kingdom); Hellstrom, Mikael [Sahlgrenska University Hospital and Sahlgrenska Academy at University of Gothenburg, Department of Radiology, Gothenburg (Sweden); Kuipers, Ernst J. [Erasmus MC University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam (Netherlands); Lefere, Philippe [Virtual Colonoscopy Teaching Centre, Hooglede (Belgium); AZ Delta, Roeselare (Belgium); Mang, Thomas [Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); Neri, Emanuele [University of Pisa, Diagnostic and Interventional Radiology, Pisa (Italy); Regge, Daniele [Institute for Cancer Research and Treatment, Candiolo-Torino (Italy); Hassan, Cesare [Catholic University, Digestive Endoscopy Unit, Rome (Italy); Ospedale Nuovo Regina Margherita, Department of Gastroenterology, Rome (Italy)

    2014-10-03

    Colorectal cancer (CRC) is a major cause of morbidity and mortality [1, 2]. CRC screening by fecal occult blood testing (FOBT) has been shown to reduce CRC mortality [3, 4], and is currently used in several European countries. Colonoscopy is highly effective for detecting advanced neoplasia, and endoscopic polypectomy reduces subsequent CRCspecific incidence and mortality [5]. In Europe, colonoscopy is mainly used to investigate FOBT-positive or symptomatic patients, or as a preventive strategy in those with increased CRC risk [6]. Computed tomographic colonography (CTC) is a minimally invasive imaging technique that is highly accurate for detecting colorectal cancer (CRC) and adenomatous polyps. The technique is standardized [7], and CTC is more easily performed than barium enema. Evidence-based data suggest that CTC is the natural replacement for barium enema and a complementary rather than an alternative examination to colonoscopy. However, the clinical scenarios for which CTC is indicated remain unclear. To address this uncertainty - 20 years after the first presentation of CTC at a radiological meeting [8] - the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) decided to produce a common guideline regarding indications for CTC in clinical practice. Technical and quality issues of CTC have been deliberately excluded from this work as these have already been discussed separately [7].

  10. American Society for Radiation Oncology

    ... PAC Become an Advocate Log In SNIPEND American Society for Radiation Oncology Plan your time at the ... oncology practices. RO-ILS The only medical specialty society-sponsored incident learning system for radiation oncology. RO ...

  11. Abdominal aspergillosis: CT findings

    Yeom, Suk Keu, E-mail: pagoda20@hanmail.net [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Hye Jin, E-mail: kimhyejin@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Byun, Jae Ho, E-mail: jhbyun@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Ah Young, E-mail: aykim@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Lee, Moon-Gyu, E-mail: mglee@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Ha, Hyun Kwon, E-mail: hkha@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of)

    2011-03-15

    Objective: In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients. Materials and methods: CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients (5 women, 1 man; mean age, 43.4 years; range, 23-59 years) with pathologically proved abdominal aspergillosis by two gastrointestinal radiologists in consensus. Medical records were also reviewed to determine each patient's clinical status and outcome. Results: All patients were immunocompromised state: 4 patients received immunosuppressive therapy for solid organ transplantation and 2 patients received chemotherapy for acute myeloid leukemia. Aspergillosis involved blood vessels (n = 3), liver (n = 2), spleen (n = 2), gastrointestinal tract (n = 2), native kidney (n = 1), transplanted kidney (n = 1), peritoneum (n = 1), and retroperitoneum (n = 1). CT demonstrated solid organ or bowel infarction or perforation secondary to vascular thrombosis or pseudoaneurysm, multiple low-attenuating lesions of solid organs presenting as abscesses, concentric bowel wall thickening mimicking typhlitis, or diffuse or nodular infiltration of the peritoneum and retroperitoneum. Conclusion: Familiarity with findings commonly presenting as angioinvasive features or abscesses on CT, may facilitate the diagnosis of rare and fatal abdominal aspergillosis.

  12. Abdominal aspergillosis: CT findings

    Objective: In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients. Materials and methods: CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients (5 women, 1 man; mean age, 43.4 years; range, 23-59 years) with pathologically proved abdominal aspergillosis by two gastrointestinal radiologists in consensus. Medical records were also reviewed to determine each patient's clinical status and outcome. Results: All patients were immunocompromised state: 4 patients received immunosuppressive therapy for solid organ transplantation and 2 patients received chemotherapy for acute myeloid leukemia. Aspergillosis involved blood vessels (n = 3), liver (n = 2), spleen (n = 2), gastrointestinal tract (n = 2), native kidney (n = 1), transplanted kidney (n = 1), peritoneum (n = 1), and retroperitoneum (n = 1). CT demonstrated solid organ or bowel infarction or perforation secondary to vascular thrombosis or pseudoaneurysm, multiple low-attenuating lesions of solid organs presenting as abscesses, concentric bowel wall thickening mimicking typhlitis, or diffuse or nodular infiltration of the peritoneum and retroperitoneum. Conclusion: Familiarity with findings commonly presenting as angioinvasive features or abscesses on CT, may facilitate the diagnosis of rare and fatal abdominal aspergillosis.

  13. Prediction tools in surgical oncology.

    Isariyawongse, Brandon K; Kattan, Michael W

    2012-07-01

    Artificial neural networks, prediction tables, and clinical nomograms allow physicians to transmit an immense amount of prognostic information in a format that exhibits comprehensibility and brevity. Current models demonstrate the feasibility to accurately predict many oncologic outcomes, including pathologic stage, recurrence-free survival, and response to adjuvant therapy. Although emphasis should be placed on the independent validation of existing prediction tools, there is a paucity of models in the literature that focus on quality of life outcomes. The unification of tools that predict oncologic and quality of life outcomes into a comparative effectiveness table will furnish patients with cancer with the information they need to make a highly informed and individualized treatment decision. PMID:22583992

  14. Synovial sarcoma of the abdominal wall

    A case report of synovial sarcoma arising in the abdominal wall is presented. A brief review of the clinical and radiological features of synovial sarcoma is made. Pre-operative diagnosis of an abdominal wall synovial sarcoma is virtually impossible, but should be considered when a soft tissue swelling is found to show amorphous stippled calcification X-ray. (author)

  15. Psycho-oncology: Searching for practical wisdom?

    Butlin, Helen

    2015-10-01

    The debate is vigorous in psycho-oncology about whether spiritual, existential, and psychosocial are the most comprehensive terms for academic research discourses investigating meaning and purpose. A call-to-action email from the International Society of Psycho-Oncology included the term soul. The current essay highlights the historical and contemporary uses of "soul" to suggest that the re-emergent soul signifies a tacit quest for an "intangible" that seems missing in current constructs of clinical domains reflected in the vigor of the debates. It is suggested that the re-emergence of the pre-Medieval meaning(s) of the notion of soul affirms a growing need for integrative paradigms on "being human" to guide psycho-oncology practitioners and their research. As a paradigmatic example, a clinical support group entitled Soul Medicine is described as employing the term soul to open up the more marginal discourses about experiences of illness arising from philosophical reflection, arts, humanities, and spirituality within a clinical oncology context. A link between soul and wisdom is suggested for further exploration with the view that phronesis ("the virtue of practical wisdom"), an emerging concept in health professional education research, is of ultimate value to the people psycho-oncology seeks to serve. This group holds that garnering wisdom from the expertise of those living with cancer should be a central aim of our field. PMID:26399749

  16. Oncology Advanced Practitioners Bring Advanced Community Oncology Care.

    Vogel, Wendy H

    2016-01-01

    Oncology care is becoming increasingly complex. The interprofessional team concept of care is necessary to meet projected oncology professional shortages, as well as to provide superior oncology care. The oncology advanced practitioner (AP) is a licensed health care professional who has completed advanced training in nursing or pharmacy or has completed training as a physician assistant. Oncology APs increase practice productivity and efficiency. Proven to be cost effective, APs may perform varied roles in an oncology practice. Integrating an AP into an oncology practice requires forethought given to the type of collaborative model desired, role expectations, scheduling, training, and mentoring. PMID:27249776

  17. Application of a Static Fluorescence-based Cytometer (the CellScan in Basic Cytometric Studies, Clinical Pharmacology, Oncology and Clinical Immunology

    Yehuda Shoenfeld

    2005-01-01

    Full Text Available The CellScan apparatus is a laser scanning cytometer enabling repetitive fluorescence intensity (FI and polarization (FP measurements in living cells, as a means of monitoring lymphocyte activation. The CellScan may serve as a tool for diagnosis of rheumatoid arthritis (RA and systemic lupus erythematosus (SLE as well as other autoimmune diseases by monitoring FP changes in peripheral blood lymphocytes (PBLs following exposure to autoantigenic stimuli. Changes in FI and FP in atherosclerotic patients' PBLs following exposure to various stimuli have established the role of the immune system in atherosclerotic disease. The CellScan has been evaluated as a diagnostic tool for drug-allergy, based on FP reduction in PBLs following incubation with allergenic drugs. FI and FP changes in cancer cells have been found to be well correlated with the cytotoxic effect of anti-neoplastic drugs. In conclusion, the CellScan has a variety of applications in cell biology, immunology, cancer research and clinical pharmacology.

  18. Transformation of Physical DVHs to Radiobiologically Equivalent Ones in Hypofractionated Radiotherapy Analyzing Dosimetric and Clinical Parameters: A Practical Approach for Routine Clinical Practice in Radiation Oncology

    Zoi Thrapsanioti

    2013-01-01

    Full Text Available Purpose. The purpose of this study was to transform DVHs from physical to radiobiological ones as well as to evaluate their reliability by correlations of dosimetric and clinical parameters for 50 patients with prostate cancer and 50 patients with breast cancer, who were submitted to Hypofractionated Radiotherapy. Methods and Materials. To achieve this transformation, we used both the linear-quadratic model (LQ model and the Niemierko model. The outcome of radiobiological DVHs was correlated with acute toxicity score according to EORTC/RTOG criteria. Results. Concerning the prostate radiotherapy, there was a significant correlation between RTOG acute rectal toxicity and ( and ( dosimetric parameters, calculated for  Gy. Moreover, concerning the breast radiotherapy there was a significant correlation between RTOG skin toxicity and dosimetric parameter, calculated for both  Gy ( and  Gy (. The new tool seems reliable and user-friendly. Conclusions. Our proposed model seems user-friendly. Its reliability in terms of agreement with the presented acute radiation induced toxicity was satisfactory. However, more patients are needed to extract safe conclusions.

  19. 宫内节育器盆腹腔异位的临床研究%Clinic analysis of the intrauterine contraceptive device abdominal ectopia

    唐艳; 乔林; 徐克惠

    2011-01-01

    目的 探讨宫内节育器(intrauterine contraceptive device,IUD)盆腹腔异位的预防及诊断.方法 回顾性分析华西第二医院2006~2010年住院治疗的15例IUD盆腹腔异位患者的病历资料.结果 15例中有13例在分娩后一年内放置;金属圆形环10例,T型环3例;异位于膀胱1例,肠壁3例,大网膜2例,直肠子宫陷凹3例,阔韧带1例,盆壁1例,子宫表面4例.结论 接受宫内节育器避孕患者随访意识差,育龄妇女置环应定期随访及时发现节育器异常情况,及时处理,减少宫内节育器严重并发症的发生,重视围绝经期及绝经后妇女的取环问题,应加强对采取宫内节育器避孕育龄妇女的随访宣教,加强对计划生育技术人员的培训是减少宫内节育器并发症的关键.%Objective To investigate the prevention,Diagnosis and therapy of intrauterine contraceptive device (IUD) abdominal ectopia. Methods The clinical materials of 15 cases with intrauterine contraceptive device abdominal ec-topia treated in the hospital were analyzed retrospectively. Results Among the 15 cases with intrauterine contraceptive device abdominal ectopia. 13 cases were insert in a year after delivery, 10 cases were round metal IUD, 3 cases were T shape IUD,1 case was ectopic at bladder,3 were at bowel,2 were at caul,3 were at pouch of Douglas, 1 was at broad ligament, 1 was at pelvic wall,and 4 was at the surface of uterus. Conclusion The follow-up of intrauterine contraceptive device is poor. It need to follow up termly after intrauterine contraceptive device insert. The abnormal status can be found and dealt in time. It is important to pay attention to perimenopausal and postmenopausal removing intrauterine contraceptive device. It needs to enhance the intrauterine contraceptive device follow-up and the skill-training of the birth control medical workers, which is crucial for lessening intrauterine contraceptive device complications.

  20. Oncology Nursing Is Evidence-Based Care.

    Kennedy Sheldon, Lisa; Brown, Carlton G

    2016-06-01

    This issue of the Clinical Journal of Oncology Nursing (CJON) will be the final time that you will see the Evidence-Based Practice (EBP) feature column. Why? Because we have seen oncology nursing evolve in the past 20 years and EBP is everywhere! We use it in our clinics and hospital units, incorporate it into decisions about symptom management, and use evidence to develop survivorship guidelines. We discuss EBP in journal clubs and use applications on mobile devices to find the best interventions for our patients. We have oncology nurses sitting on committees to develop guidelines based on the best evidence and expert opinion. We have come a long way and it is our belief that EBP is included in almost every article in CJON and, therefore, a need no longer exists for an individual column about EBP. 
. PMID:27206287

  1. Undergraduate preparation of the oncology nurse.

    Pierce, M

    1992-09-01

    Determining appropriate cancer-related content for undergraduate nursing curricula requires careful consideration of content that is needed versus content that is desired for the nurse generalist. Studies have indicated a wide variety of topics and time allotment for this content among schools of nursing. Innovative strategies using games, computers, preceptors, and elective courses have allowed schools of nursing to include more comprehensive coverage of oncology-related topics. Issues concerning clinical oncology nursing opportunities for undergraduate studies still need to be clarified. Undergraduate students must be afforded the legitimacy of their status as novices in nursing and in the specialty of oncology. Didactic and clinical experiences should result in the knowledge and skills needed to develop professionally from novice to expert. PMID:1408964

  2. Detection of abdominal bleeding in blunt abdominal trauma

    Arterial hemorrhage is the most serious immediate complication of blunt abdominal trauma. This paper discusses the detection and localization of active hemorrhage in nonpenetrating injury, as a modification of the technique using technetium-99m sulfur colloid to localize the site of active bleeding in the gastrointestinal tract. Any imaging protocol for suspected hepatosplenic injury can be easily modified to search for active intra-abdominal hemorrhage. The timely detection of unsuspected bleeding improves patient management by allowing the surgeon to reorder his or her treatment priorities. The early detection of clinically unsuspected intra-abdominal, retroperitoneal, or pelvic hemorrhage will identify those patients who may need more definitive diagnostic procedures, interventional angiography for control of bleeding, or surgical intervention. The 500,000-count view of the abdomen and pelvis can be easily incorporated into any existing trauma protocol using technetium-99m sulfur colloid, is of proven value, and adds little additional time to the study

  3. Abdominal Burkitt lymphoma

    Purpose: As scarce information is available, in this research we have tried to describe the imaging findings of the Burkitt's lymphoma. Retrospective analysis of the clinical and imaging presentation of a 4 years old boy, is given. Biopsy confirmed the BL. Different imaging techniques were combined. The X-rays were negative. The US revealed a moderate hepatomegaly with multiple hypoechoic nodules and free fluid in the abdominal cavity. The CT showed the hepatomegaly as well as solid nodules in great number and different sizes(due to the densitometric behaviour and to post contrast enhancement), a scarce amount of ascites and a density increase of the mesentery fat. The MRI characterized and revealed in detail the US and the CT findings. The Burkitt's lymphoma is a rare entity; several methods are needed to approach the diagnosis. It represents a great clinical and imaging challenge. (author)

  4. CT appearances of abdominal tuberculosis

    Lee, W.-K., E-mail: leewk33@hotmail.com [Department of Medical Imaging, St Vincent' s Hospital, University of Melbourne, Fitzroy, Victoria (Australia); Van Tonder, F.; Tartaglia, C.J.; Dagia, C. [Department of Medical Imaging, St Vincent' s Hospital, University of Melbourne, Fitzroy, Victoria (Australia); Cazzato, R.L. [Department of Radiology, Universita Campus Bio-Medico di Roma, Rome (Italy); Duddalwar, V.A. [Department of Radiology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California (United States); Chang, S.D. [Department of Medical Imaging, Vancouver General Hospital, University of British Columbia, British Columbia (Canada)

    2012-06-15

    The purpose of this article is to review and illustrate the spectrum of computed tomography (CT) appearances of abdominal tuberculosis. Tuberculosis can affect any organ or tissue in the abdomen, and can be mistaken for other inflammatory or neoplastic conditions. The most common sites of tuberculosis in the abdomen include lymph nodes, genitourinary tract, peritoneal cavity and gastrointestinal tract. The liver, spleen, biliary tract, pancreas and adrenals are rarely affected, but are more likely in HIV-seropositive patients and in miliary tuberculosis. This article should alert the radiologist to consider abdominal tuberculosis in the correct clinical setting to ensure timely diagnosis and enable appropriate treatment.

  5. CT appearances of abdominal tuberculosis

    The purpose of this article is to review and illustrate the spectrum of computed tomography (CT) appearances of abdominal tuberculosis. Tuberculosis can affect any organ or tissue in the abdomen, and can be mistaken for other inflammatory or neoplastic conditions. The most common sites of tuberculosis in the abdomen include lymph nodes, genitourinary tract, peritoneal cavity and gastrointestinal tract. The liver, spleen, biliary tract, pancreas and adrenals are rarely affected, but are more likely in HIV-seropositive patients and in miliary tuberculosis. This article should alert the radiologist to consider abdominal tuberculosis in the correct clinical setting to ensure timely diagnosis and enable appropriate treatment.

  6. Gamma camera based FDG PET in oncology

    Positron Emission Tomography(PET) was introduced as a research tool in the 1970s and it took about 20 years before PET became an useful clinical imaging modality. In the USA, insurance coverage for PET procedures in the 1990s was the turning point, I believe, for this progress. Initially PET was used in neurology but recently more than 80% of PET procedures are in oncological applications. I firmly believe, in the 21st century, one can not manage cancer patients properly without PET and PET is very important medical imaging modality in basic and clinical sciences. PET is grouped into 2 categories; conventional (c) and gamma camera based (CB) PET. CBPET is more readily available utilizing dual-head gamma cameras and commercially available FDG to many medical centers at low cost to patients. In fact there are more CBPET in operation than cPET in the USA. CBPET is inferior to cPET in its performance but clinical studies in oncology is feasible without expensive infrastructures such as staffing, rooms and equipments. At Ajou university Hospital, CBPET was installed in late 1997 for the first time in Korea as well as in Asia and the system has been used successfully and effectively in oncological applications. Our was the fourth PET operation in Korea and I believe this may have been instrumental for other institutions got interested in clinical PET. The following is a brief description of our clinical experience of FDG CBPET in oncology

  7. Auricular or body acupuncture: which one is more effective in reducing abdominal fat mass in Iranian men with obesity: a randomized clinical trial

    Darbandi, Mahsa; Darbandi, Sara; Owji, Ali Akbar; Mokarram, Pooneh; Mobarhan, Majid Ghayor; Fardaei, Majid; Zhao, Baxiao; Abdi, Hamid; Nematy, Mohsen; Safarian, Mohammad; Parizadeh, Mohammad Reza; Dabbaghmanesh, Mohammad Hossein; Abbasi, Parisa; FERNS, Gordon

    2014-01-01

    Background The prevalence of abdominal obesity is on the rise worldwide. Previous studies have indicated the higher diagnostic value of body fat distribution pattern compared with general body in abdominal obesity assessments. Several non-pharmacological methods have been suggested for obesity management, of which acupuncture has gained a great deal of research interest with promising results. This study aimed to comparatively evaluate the effects of conventional auricular and body electroacu...

  8. Antibioticoterapia no trauma abdominal penetrante com lesão gastrintestinal: estudo comparativo entre dois esquemas terapêuticos Antibiotic therapy in penetrating abdominal trauma with gastrointestinal lesion: randomized clinical trial with two therapeutics schemes

    Hamilton Petry de Souza; Mario Mantovani; Ricardo Breigeiron; Mauro de Souza Siebert; Gémerson Gabiatti

    2002-01-01

    OBJETIVO: Comparar a eficácia de dois esquemas terapêuticos de antibióticos em vítimas de trauma penetrante de abdome com lesão gastrintestinal. MÉTODO: O estudo selecionou de forma prospectiva e randomizada, vítimas de trauma abdominal penetrante com lesão gastrintestinal, dividindo-os em dois grupos, conforme o esquema terapêutico: cefoxitina perioperatória exclusivamente (Grupo 1) e associação de gentamicina e metronidazol por cinco dias (Grupo 2). Os grupos foram estratificados em três ní...

  9. Soft-tissue masses in the abdominal wall

    Masses involving the abdominal wall arise from a large number of aetiologies. This article will describe a diagnostic approach, imaging features of the most common causes of abdominal wall masses, and highly specific characteristics of less common diseases. A diagnostic algorithm for abdominal wall masses combines clinical history and imaging appearances to classify lesions

  10. Gaps in Oncology

    The first plenary of the EPEC-O (Education in Palliative and End-of-Life Care for Oncology) Self-Study Original Version provides background for the curriculum and identifies gaps in current and desired comprehensive cancer care.

  11. Radiation Oncology in Undergraduate Medical Education: A Literature Review

    Purpose: To review the published literature pertaining to radiation oncology in undergraduate medical education. Methods and Materials: Ovid MEDLINE, Ovid MEDLINE Daily Update and EMBASE databases were searched for the 11-year period of January 1, 1998, through the last week of March 2009. A medical librarian used an extensive list of indexed subject headings and text words. Results: The search returned 640 article references, but only seven contained significant information pertaining to teaching radiation oncology to medical undergraduates. One article described a comprehensive oncology curriculum including recommended radiation oncology teaching objectives and sample student evaluations, two described integrating radiation oncology teaching into a radiology rotation, two described multidisciplinary anatomy-based courses intended to reinforce principles of tumor biology and radiotherapy planning, one described an exercise designed to test clinical reasoning skills within radiation oncology cases, and one described a Web-based curriculum involving oncologic physics. Conclusions: To the authors' knowledge, this is the first review of the literature pertaining to teaching radiation oncology to medical undergraduates, and it demonstrates the paucity of published work in this area of medical education. Teaching radiation oncology should begin early in the undergraduate process, should be mandatory for all students, and should impart knowledge relevant to future general practitioners rather than detailed information relevant only to oncologists. Educators should make use of available model curricula and should integrate radiation oncology teaching into existing curricula or construct stand-alone oncology rotations where the principles of radiation oncology can be conveyed. Assessments of student knowledge and curriculum effectiveness are critical.

  12. Breakthrough cancer medicine and its impact on novel drug development in China:report of the US Chinese Anti-Cancer Association (USCACA) and Chinese Society of Clinical Oncology (CSCO) Joint Session at the 17th CSCO Annual Meeting

    Feng Roger Luo; Ge Zhang; Li Xu; Pascal Qian; Li Yan; Jian Ding; Helen X. Chen; Hao Liu; Man-Cheong Fung; Maria Koehler; Jean Pierre Armand; Lei Jiang; Xiao Xu

    2014-01-01

    The US Chinese Anti-Cancer Association (USCACA) teamed up with Chinese Society of Clinical Oncology (CSCO) to host a joint session at the17th CSCO Annual Meeting on September 20th, 2014 in Xiamen, China. With a focus on breakthrough cancer medicines, the session featured innovative approaches to evaluate breakthrough agents and established a platform to interactively share successful experiences from case studies of 6 novel agents from both the United States and China. The goal of the session is to inspire scientific and practical considerations for clinical trial design and strategy to expedite cancer drug development in China. A panel discussion further provided in-depth advice on advancing both early and ful development of novel cancer medicines in China.

  13. Spectrum of abdominal organ injury in a primary blast type

    Amin Abid; Wani Rauf A; Sheikh Tariq; Parray Fazal Q; Wani Imtiaz; Gul Imran; Nazir Mir

    2009-01-01

    Abstract Introduction Abdominal organ injury in a primary blast type is always challenging for diagnosis. Air containing abdominal viscera is most vulnerable to effects of primary blast injury. In any patient exposed to a primary blast wave who presents with an acute abdomen, an abdominal organ injury is to be kept in a clinical suspicion. Aim Study various abdominal organ injuries occurring in a primary type of blast injury. Material and methods: All those who had exploratory laparotomy for ...

  14. Abdominal Pain or Cramping

    ... Body & lifestyle changes > Abdominal pain or cramping Abdominal pain or cramping E-mail to a friend Please ... signs of severe pain. What causes mild belly pain in pregnancy? There are different causes for mild ...

  15. Study and classification of the abdominal adiposity throughout the application of the two-dimensional predictive equation Garaulet et al., in the clinical practice Estudio y clasificación de la adiposidad abdominal mediante la aplicación de la ecuación predictiva bidimensional de Garaulet et al., en la práctica clínica

    C. M.ª Piernas Sánchez

    2010-04-01

    Full Text Available Introduction: The excess of visceral abdominal adipose tissue is one of the major concerns in obesity and its clinical treatment. Objective: To apply the two-dimensional predictive equation proposed by Garaulet et al. to determine the abdominal fat distribution and to compare the results with the body composition obtained by multi-frequency bioelectrical impedance analysis (M-BIA. Subjects/methods: We studied 230 women, who underwent anthropometry and M-BIA. The predictive equation was applied. Multivariate lineal and partial correlation analyses were performed with control for BMI and % body fat, using SPSS 15.0 with statistical significance P Introducción: El exceso de tejido adiposo abdominal visceral es una de las mayores preocupaciones en la obesidad y su tratamiento clínico. Objetivo: Aplicar la ecuación predictiva bidimensional propuesta por Garaulet et al., para determinar la distribución de la grasa abdominal y comparar los resultados con la composición corporal obtenida mediante el análisis de impedancia bioeléctrica multi-frecuencia (M-BIA. Sujetos/métodos: Estudiamos a 230 mujeres a las que se sometió a antropometría y M-BIA. Se aplicó la ecuación predicitiva. Se realizaron correlaciones lineales multivariadas y parciales controlando el IMC y el % de grasa corporal, utilizando SPSS 15.0 con significación estadística P < 0,05. Resultados: En global, se consideró que las mujeres tenían una distribución subcutánea de la grasa abdominal. La grasa troncal, regional y la masa muscular se asociaron negativamente con VA/SApredicted, mientras que le índice visceral obtenido mediante M-BIA se correlacionó positivamente con VA/SApredicted. Discusión/conclusión: La ecuación predictiva puede ser útil en la práctica clínica para obtener una clasificación segura, barata y precisa de la obesidad abdominal.

  16. Imaging in oncology. Terms and definitions

    Oncologic imaging includes the morphological description of the primary tumor region for an accurate classification of the tumor and lymph node stage and whether distant metastases have occurred according to the TNM staging system. Knowing the stage of the disease helps to plan the treatment and to estimate the prognosis. In clinical routine this is accomplished by conventional imaging techniques, such as ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). Additionally, oncologic imaging is essential in treatment monitoring to visualize and quantify the effect of cancer therapy according to response evaluation criteria in solid tumors (RECIST) and World Health Organization (WHO) criteria. The tremendous development in oncology and technical innovations in imaging represent a particular challenge for radiology. (orig.)

  17. The estimation of the magnitude of affective descriptors of pain by doctors, nurses and patients of an oncology service: a clinical psychophysics approach - doi:10.5020/18061230.2007.p143

    Catarina Nívea Bezerra Menezes

    2012-01-01

    Full Text Available The aim of this experimental study was to validate a psychophysical scale of languageperception and to rank the pain intensity associated to each one of the descriptors, verifying its consistency-reliability and inter-subjective agreement among professionals and patients. The research was held at the Clinics Hospital of Ribeirão Preto Medical School, from January to June, 2005, with 41 professionals and 20 patients. The pain descriptors were submitted to the analysis of psychophysical scale methods in a single method of category and magnitude estimation. The pain for the professionals of a Gynecologic Oncology service was referred as pungent, thin and piercing and for the patients, as cutting and burning. On the Pediatric Oncology, the professionals expressed the pain as pungent, thin and burning, while the patients as burning; compressive, persistent and piercing. By Spearman’s correlation (0,713, it was demonstrated that there is a high correlation among the doctors. Concerning to magnitude estimation, a high correlation between doctors and nurses (0,871 was verified. It was evidenced by the study that the correlation analyses suggest that the magnitude of different describers, associated to the displeasure of the pain judged by the patients, differ of those referred by different health professionals.

  18. MUST ONCOLOGICAL PRINCIPLES BE IN THE SURGERY OF MENINGIOMAS? EN BLOC REMOVAL OF GIANT RIGHT FRONTAL MENINGIOMA WITH EXTRACRANIAL SPREAD. DESCRIPTION OF A CLINICAL CASE

    V. B. Karakhan

    2014-01-01

    Full Text Available The use of the oncological principle – en bloc ablastic tumor resection – can expect a breakthrough in the treatment of baseline unfavorable patient groups. In the described case of atypical meningioma, its en bloc resection presents significant technical difficulties when accomplishing the task associated with the giant sizes of a tumor as an iceberg growing outside and into the cranial cavity, its rich vascularization from both the internal and external carotid artery system, with the involvement of the superior sagittal sinus, the presence of a dense bone crown that combines the three-component construction of a neoplasm, which made difficult safe mobilization and scanning in the cranial cavity.In such topographic variants, the criteria for the Simpson radical meningioma resection are inapplicable and only en bloc tumor resection may reflect the oncological principles of surgery. The technologies of en bloc resection of intracranial meningiomas should be more frequently used because preoperative neurovisualization and even histological diagnosis does not always allow the grade of meningiomas to be specified.

  19. Exploring the role of educational videos in radiation oncology practice

    Patient, staff, and medical student education are essential components of modern radiation oncology practice. Greater involvement of patients in the clinical decision-making process, and the need for other health professionals to be more informed about radiation oncology, provided further demand on resources, despite ever increasing logistic constraints. Videos made by individual departments may augment traditional teaching methods and have applications in documenting clinical practice and response. 8 refs., 1 tab

  20. The problems of surgical training in gynaecologic oncology

    Burger, CW; Oliveira, CF; Kehoe, ST

    2000-01-01

    During the late 60s and early 70s it was recognised that the surgical training for residents in Obstetrics and Gynaecology was inadequate to comprehensively acquire the surgical skills necessary in managing women with gynaecologic cancers. Gynaecologic Oncology (Gynae-Oncology) has three important goals: 1) to maintain the highest standards for patients with gynaecologic cancer, 2) to provide the trainee with clinical skills and structural clinical research after his/her surgical completion, ...

  1. Generation of Comprehensive Thoracic Oncology Database - Tool for Translational Research

    Surati, Mosmi; Robinson, Matthew; Nandi, Suvobroto; Faoro, Leonardo; Demchuk, Carley; Kanteti, Rajani; Ferguson, Benjamin; Gangadhar, Tara; Hensing, Thomas; Hasina, Rifat; Husain, Aliya; Ferguson, Mark; Karrison, Theodore; Salgia, Ravi

    2011-01-01

    The Thoracic Oncology Program Database Project was created to serve as a comprehensive, verified, and accessible repository for well-annotated cancer specimens and clinical data to be available to researchers within the Thoracic Oncology Research Program. This database also captures a large volume of genomic and proteomic data obtained from various tumor tissue studies. A team of clinical and basic science researchers, a biostatistician, and a bioinformatics expert was convened to design the ...

  2. Exploration of cooperation mode between clinical pharmacists and medical team in the Department of Oncology%肿瘤专科临床药师与医护团队协作模式探讨

    王伟兰; 郭代红; 朱曼; 陈超

    2013-01-01

    目的:探讨肿瘤专科临床药师与医护团队协作,共同促进合理用药的工作模式.方法:解放军总医院肿瘤中心的临床药师与医护团队实施协作4年多来,开展特色全程化药学服务,深入临床为医师、护士和患者提供用药咨询,开设系列药学专题讲座、对患者进行用药教育、编写肿瘤专科实用药物手册,并协助制订医嘱,处理药品不良反应.结果和结论:肿瘤专科的医、药、护团队协作工作模式促进了合理用药,提高了临床药学服务水平.%Objective:To explore the cooperation mode between clinical pharmacists and medical team in the Department of Oncology,so as to elevate the level of rational medication of drugs.Methods:Clinical pharmacists and the medical team in the tumor center of General Hospital of PLA experienced cooperation for over 4 years,during which clinical pharmacists carried out integrated specific pharmaceutical care,provided consultation for doctors,nurses as well as patients concerning medication of drugs,conducted a series of pharmaceutical lectures,gave lectures to patients on medication,compiled a practical medical handbook,helped doctors to prescribe medical advices and cope with adverse drug reactions.Results and Conclusion:The cooperation mode between pharmacists,the medical and nursing teams in the Department of Oncology promoted rational medication of drugs and elevated the level of pharmaceutical care.

  3. PET in oncology

    Dresel, Stefan (ed.) [HELIOS Klinikum Berlin-Buch, Berlin (Germany). Klinik fuer Nuklearmedizin

    2008-07-01

    In the management of oncologic diseases, modern imaging modalities contribute heavily to the decision of which form of treatment - local or systemic, surgical or interdisciplinary - will be most efficient. The addition of functional image information to conventional staging procedures helps improve the diagnostic pathway. The information needed for therapeutic management and for follow-up can be provided by correlative imaging such as positron emission tomography (PET) and computed tomography (CT) or PET/CT. This book is a comprehensive compilation of the accumulated knowledge on PET and PET/CT in oncology, covering the entire spectrum from solidly documented indications, such as staging and monitoring of lung and colorectal cancer, to the application of PET/CT in head and neck surgery, gynecology, radiation therapy, urology, pediatrics etc. It is aimed at nuclear medicine and radiology specialists as well as physicians interested in the possibilities and limitations of PET and PET/CT in oncology. (orig.)

  4. A prospective randomized comparative clinical trial comparing the efficacy between ondansetron and metoclopramide for prevention of nausea and vomiting in patients undergoing fractionated radiotherapy to the abdominal region

    This study is a prospective randomized clinical trial comparing the efficacy and complication of anti-emetic drugs for prevention of nausea and vomiting after radiotherapy which has moderate emetogenic potential. The aim of this study was to investigate whether the anti-emetic efficacy at ondansetron(Zofran) 8 mg bid dose (Group O) is better than the efficacy of metoclopramide 5 mg tid dose (Group M) in patients undergoing fractionated radiotherapy to the abdominal region. Study entry was restricted to those patients who met the following eligibility criteria: histologically confirmed malignant disease; no distant metastasis; performance status of not more than ECOG grade 2; no previous chemotherapy and radiotherapy. Between March 1997 and February 1998, 60 patients enrolled in this study. All patients signed a written statement of informed consent prior to enrollment. Blinding was maintained by dosing identical number of tables including one dose of matching placebo for Group O. The extent of nausea, appetite loss, and the number of emetic episodes were recorded everyday using diary card. The mean score of nausea, appetite loss and the mean number of emetic episodes were obtained in a weekly interval. Prescription error occurred in one patient. And diary cards have not returned in 3 patients due to premature refusal of treatment. Card from one patient was excluded from the analysis because she had a history of treatment for neurosis. As a result, the analysis consisted of 55 patients. Patient characteristics and radiotherapy characteristics were similar except mean age was 52.9± 11.2 in group M, 46.5±9.6 in group O. The difference of age was statistically significant. The mean score of nausea, appetite loss and emetic episodes in a weekly interval was higher in group M than O. In group M, the symptoms were most significant at 5th week. In a panel data analysis using mixed procedure, treatment group was only significant factor detecting the difference of weekly

  5. A prospective randomized comparative clinical trial comparing the efficacy between ondansetron and metoclopramide for prevention of nausea and vomiting in patients undergoing fractionated radiotherapy to the abdominal region

    Park, Hee Chul; Suh, Chang Ok; Seong, Jin Sil; Cho, Jae Ho; Lim, John Jihoon; Park, Won; Song, Jae Seok; Kim, Gwi Eon [College of Medicine, Yonsei Univ., Seoul (Korea, Republic of)

    2001-06-01

    This study is a prospective randomized clinical trial comparing the efficacy and complication of anti-emetic drugs for prevention of nausea and vomiting after radiotherapy which has moderate emetogenic potential. The aim of this study was to investigate whether the anti-emetic efficacy at ondansetron(Zofran) 8 mg bid dose (Group O) is better than the efficacy of metoclopramide 5 mg tid dose (Group M) in patients undergoing fractionated radiotherapy to the abdominal region. Study entry was restricted to those patients who met the following eligibility criteria: histologically confirmed malignant disease; no distant metastasis; performance status of not more than ECOG grade 2; no previous chemotherapy and radiotherapy. Between March 1997 and February 1998, 60 patients enrolled in this study. All patients signed a written statement of informed consent prior to enrollment. Blinding was maintained by dosing identical number of tables including one dose of matching placebo for Group O. The extent of nausea, appetite loss, and the number of emetic episodes were recorded everyday using diary card. The mean score of nausea, appetite loss and the mean number of emetic episodes were obtained in a weekly interval. Prescription error occurred in one patient. And diary cards have not returned in 3 patients due to premature refusal of treatment. Card from one patient was excluded from the analysis because she had a history of treatment for neurosis. As a result, the analysis consisted of 55 patients. Patient characteristics and radiotherapy characteristics were similar except mean age was 52.9{+-} 11.2 in group M, 46.5{+-}9.6 in group O. The difference of age was statistically significant. The mean score of nausea, appetite loss and emetic episodes in a weekly interval was higher in group M than O. In group M, the symptoms were most significant at 5th week. In a panel data analysis using mixed procedure, treatment group was only significant factor detecting the difference of

  6. Clinical trial of doxycycline for matrix metalloproteinase-9 inhibition in patients with an abdominal aneurysm doxycycline selectively depletes aortic wall neutrophils and cytotoxic t cells

    Lindeman, J.H.N.; Abdul-Hussien, H.; Bockel, J.H. van; Wolterbeek, R.; Kleemann, R.

    2009-01-01

    Background-Doxycycline has been shown to effectively inhibit aneurysm formation in animal models of abdominal aortic aneurysm. Although this effect is ascribed to matrix metalloproteinase-9 inhibition, such an effect is unclear in human studies. We reevaluated the effect of doxycycline on aortic wal

  7. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy.

    Carney, John

    2008-12-01

    Patients undergoing total abdominal hysterectomy suffer significant postoperative pain. The transversus abdominis plane (TAP) block is a recently described approach to providing analgesia to the anterior abdominal wall. We evaluated the analgesic efficacy of the TAP block in patients undergoing total abdominal hysterectomy via a transverse lower abdominal wall incision, in a randomized, controlled, double-blind clinical trial.

  8. Standardizing Naming Conventions in Radiation Oncology

    Purpose: The aim of this study was to report on the development of a standardized target and organ-at-risk naming convention for use in radiation therapy and to present the nomenclature for structure naming for interinstitutional data sharing, clinical trial repositories, integrated multi-institutional collaborative databases, and quality control centers. This taxonomy should also enable improved plan benchmarking between clinical institutions and vendors and facilitation of automated treatment plan quality control. Materials and Methods: The Advanced Technology Consortium, Washington University in St. Louis, Radiation Therapy Oncology Group, Dutch Radiation Oncology Society, and the Clinical Trials RT QA Harmonization Group collaborated in creating this new naming convention. The International Commission on Radiation Units and Measurements guidelines have been used to create standardized nomenclature for target volumes (clinical target volume, internal target volume, planning target volume, etc.), organs at risk, and planning organ-at-risk volumes in radiation therapy. The nomenclature also includes rules for specifying laterality and margins for various structures. The naming rules distinguish tumor and nodal planning target volumes, with correspondence to their respective tumor/nodal clinical target volumes. It also provides rules for basic structure naming, as well as an option for more detailed names. Names of nonstandard structures used mainly for plan optimization or evaluation (rings, islands of dose avoidance, islands where additional dose is needed [dose painting]) are identified separately. Results: In addition to its use in 16 ongoing Radiation Therapy Oncology Group advanced technology clinical trial protocols and several new European Organization for Research and Treatment of Cancer protocols, a pilot version of this naming convention has been evaluated using patient data sets with varying treatment sites. All structures in these data sets were

  9. Dehydration related abdominal pain (drap)

    Objective: To describe the frequency of dehydration as a medical cause of acute abdomen. Subjects and Methods: All the patients reporting with abdominal pain to the surgical outpatient department or the emergency department were reviewed in the study. The clinical findings in all these cases were studied along with the mode of their management and outcome. Results: Of all the patients presenting with abdominal pain, 3.3% (n=68) were suffering from dehydration related abdominal pain. They were predominantly males in a ratio of 8.7: 1, mostly in the 2nd and 3rd decades of their lives. All these cases were suffering from acute or chronic dehydration were provisionally diagnosed by general practitioners as 'acute abdomen' and referred for surgical consultation. Associated symptoms included vomiting in 42.6%, backache in 91.2%, headache in 95.6%, and pain in lower limbs in 97.1 % of the cases. 83.8% required indoor management with intravenous fluids. All the patients became asymptomatic with rehydration therapy. Conclusion: Dehydration is a possible cause of severe abdominal pain. There is a need to educate the general public about the benefits of adequate fluid intake. (author)

  10. Roentgenologic evaluation of blunt abdominal trauma

    This study comprises 25 cases of blunt abdominal trauma proved by surgery. It is concluded that visceral damage by blunt abdominal trauma may be suspected, but can not be satisfactorily diagnosed upon a single plane abdominal roentgenologic examination with clinical support. Contrary to some reports in the literature, rupture of the hallow, viscus is more susceptible than solid organ and ileum is more than jejunum. It is a useful roentgenologic sign denoting distension and small cresent air shadow in the duodenal sweep of the damaged pancreas

  11. Clinical Research on“Bo’s Abdominal Acupuncture”Therapy in Simple Obesity Treatment*%“薄氏腹针”为主治疗单纯性肥胖症的临床研究

    畅艳艳; 宿绍敏

    2013-01-01

    Objective:To explore the clinical research on“Bo’s abdominal acupuncture”thera-py in simple obesity treatment. Methods:200 patients with simple obesity were randomly divided into treatment group and control group. Treatment group was used“Bo’s abdominal acupuncture”therapy, while control group was used common body acupuncture therapy. Observed and compared the efficacy between two groups. Results: After one course of treatment, abdominal acupuncture group having 98 people was higher than body acupuncture group having 44 people (P0.05). Con-clusion:“Bo’s abdominal acupuncture”therapy and common body acupuncture therapy all have good effect, but“Bo’s abdominal acupuncture”therapy is better than common body acupuncture therapy.“Bo’s abdominal acupuncture”therapy is easy acception and insistence for a long time to patients for the painless treatment, and it is worthy of popularization and application.%  目的:探讨以“薄氏腹针”为主治疗单纯性肥胖症的临床研究.方法:选择200例单纯性肥胖症患者,随机分为2组,治疗组以“薄氏腹针”为主进行治疗,对照组给予普通体针治疗,观察比较两组临床疗效.结果:完成一个疗程后,腹针组有98人,体针组有44人,腹针组明显高于体针组(P0.05).结论:“薄氏腹针”为主与普通体针治疗单纯性肥胖症均有良效,但腹针的整体疗效较体针好,尤其“薄氏腹针“针刺的无痛性治疗更容易被患者接受和长期坚持,值得临床应用推广.

  12. Current management of surgical oncologic emergencies.

    Marianne R F Bosscher

    Full Text Available For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC. In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed.A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days.In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%.In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

  13. A Research Agenda for Radiation Oncology: Results of the Radiation Oncology Institute’s Comprehensive Research Needs Assessment

    Purpose: To promote the rational use of scarce research funding, scholars have developed methods for the systematic identification and prioritization of health research needs. The Radiation Oncology Institute commissioned an independent, comprehensive assessment of research needs for the advancement of radiation oncology care. Methods and Materials: The research needs assessment used a mixed-method, qualitative and quantitative social scientific approach, including structured interviews with diverse stakeholders, focus groups, surveys of American Society for Radiation Oncology (ASTRO) members, and a prioritization exercise using a modified Delphi technique. Results: Six co-equal priorities were identified: (1) Identify and develop communication strategies to help patients and others better understand radiation therapy; (2) Establish a set of quality indicators for major radiation oncology procedures and evaluate their use in radiation oncology delivery; (3) Identify best practices for the management of radiation toxicity and issues in cancer survivorship; (4) Conduct comparative effectiveness studies related to radiation therapy that consider clinical benefit, toxicity (including quality of life), and other outcomes; (5) Assess the value of radiation therapy; and (6) Develop a radiation oncology registry. Conclusions: To our knowledge, this prioritization exercise is the only comprehensive and methodologically rigorous assessment of research needs in the field of radiation oncology. Broad dissemination of these findings is critical to maximally leverage the impact of this work, particularly because grant funding decisions are often made by committees on which highly specialized disciplines such as radiation oncology are not well represented.

  14. 腹针治疗变应性鼻炎82例临床观察%Clinical observation on treating 82 cases of allergic rhinitis by abdominal acupuncture therapy

    杨小清; 王维明; 黎婵

    2013-01-01

      目的:观察腹针引气归元法治疗变应性鼻炎82例。方法:采用腹针疗法治疗2周。结果:大部分患者经2个疗程治疗都取得了较好的疗效,82例患者中痊愈48例,占58.7%;有效29例,占35.6%;无效5例,占5.7%。总有效率为94.3%。结论:腹针治疗变应性鼻炎效果显著。%Objective:To investigate clinical effects of the abdominal acupuncture entraining return element method on treating 82 cases of allergic rhinitis. Methods:Take the abdominal acupuncture entraining return element therapy for 2 weeks. Results:Most patients after two courses of treatment have achieved better results, 48 cases were cured(58.7%), 29 cases were effective(35.6%), 5 cases have no effect (5.7%). The total efficiency was 94.3%. Conclusion: The abdominal acupuncture therapy was significantly effective in treating allergic rhinitis.

  15. Handlebar Hernia: A Rare Type of Abdominal Wall Hernia

    Rooh-Allah Yegane

    2010-10-01

    Full Text Available Traumatic abdominal wall hernias are a type of acquired hernia secondary to blunt trauma Caused, by direct trauma from handlebar like objects. This rare hernia is named ‘Handlebar hernia'. We report a case of such hernia without any significant intra-abdominal injury. The abdominal wall defect was repaired in layers by Jones technique. Postoperative course was uneventful. The authors recommend clinical suspicion for traumatic hernia in all patients with traumatic abdominal wall injury. Definitive treatment includes surgical exploration with primary repair of all tissue layers of the abdominal wall.

  16. CLINICAL STUDY ON THE TREATMENT OF POSTOPERATIVE ABDOMINAL ADHESION%腹腔术后肠粘连的治疗的临床研究

    秦利民

    2011-01-01

    [Objective]For different types of abdominal adhesion types after surgery, to discuss the appropriate treatment of abdominal postoperative adhesion and improve the cure rate of abdominal adhesions after surgery.[Methods]Summarized and analyzed the treatments for patients with abdominal adhesion after abdominal surgery in our hospital, discussed the effective measures of treatment [Results]13 patients of conservative treatment and laparoscopic lysis treatment of 17 people in 30 patients with abdominal adhesions, including 3 improved, 25 cured, 1 invalid, 1 converted to open surgery, the cure rate was 83%.In 13 patients treated conservatively, the adhesions absorption and recovery after conservative treatment in 9 cases, improved in 3 cases, 1 case of obstructive symptoms deteriorated, the cure rate 69%; in 17 patients with laparoscopic lysis, endoscopic control in the abdomen 16 cases, 1 case of laparotomy due to diffuse abdominal adhesion, the cure rate was 94%.The average operation time was 90.00 ± 6.88 minutes, the duration was 6.25 ± 0.56 days, intraoperative complications and deaths were not found.[Conclusion]For different reasons and types of abdominal surgery adhesion, it should choose different methods of treatment that can effectively improve the treatment effect on adhesion after abdominal surgery.%[目的]针对不同类型腹腔手术后肠粘连类型,探讨适当的腹腔术后肠粘连治疗方法,提高腹腔术后肠粘连治愈率.[方法]总结分析某院外科腹腔术后肠粘连患者的治疗结果,探讨腹腔术后肠粘连的治疗有效措施.[结果130例腹腔术后肠粘连患者进行保守治疗13人,腹腔镜松解术治疗17人,其中好转3人,痊愈25人,无效1人,手术中转开腹1人,治愈率83%0.其中进行保守治疗患者13例,经保守治疗后粘连吸收痊愈9例,好转3例,梗阻症状加重1例,治愈率69%;行腹腔镜肠粘连松解术患者17例,在腹控镜下完成16例,1例因腹部广泛弥漫

  17. Thin's abdominal acupuncture for treatment 0f failed back surgery syndrome in 20 cases of clinical observation%薄氏腹针治疗腰椎手术失败综合征20例临床观察

    黄海涛; 郑盛惠; 冯军; 王曙辉; 任蓉; 姜健; 杨丽霞

    2012-01-01

    目的:观察薄氏腹针治疗腰椎手术失败综合征的临床疗效及对血清前列腺素E2(PGE2)、白介素-1β(IL-1β)的影响.方法:将40例本病患者随机分为腹针组与常规针刺组各20例,另设正常组20例.腹针组采用腹针疗法,常规针刺组采用常规针刺疗法.观察两组的临床疗效并测定两组患者治疗前、后血清PGE2、IL-1β水平.结果:两组患者治疗后VAS评分均明显降低,腹针组优于常规针刺组,差异有统计学意义(P<0.05,P<0.01);腹针组总有效率为95.0%,常规针刺组为80.0%,两组比较,差异有统计学意义(P<0.05).两组患者治疗前血清PGE:、IL-1β水平较正常组升高,经治疗后均明显降低,以腹针组更加明显,差异有统计学意义(P<0.05,P<0.01).结论:腹针疗法治疗腰椎手术失败综合征疗效确切,能有效降低VAS评分及血清PCE2、IL-1β含量,可能为其作用机制之一.%Objective: To observe the clinical efficacy of abdominal acupuncture for treatment of thin's failed back surgery syndrome and serum prostaglandin E2 (PGE2), white interleukin-1 β (IL-1β). Methods: 40 cases the patients were randomly divided into 20 cases of abdominal acupuncture group and the routine acupuncture group, separate group of 20 cases. Abdominal acupuncture group were treated with abdominal acupuncture, routine acupuncture group with routine acupuncture. The clinical efficacy of the two groups were observed and measured the two groups of patients, serum PGE2, IL-1β levels. Results: After treatment, VAS scores were significantly lower abdominal acupuncture group was better than the routine acupuncture group, the difference was statistically significant(PP<0.05, <0.01); abdominal acupuncture group, the total effective rate was 95.0%, the conventional needle The acupuncture group was 80.0%, respectively, the difference was statistically significantP< 0.05). The two groups before treatment serum PGE2, IL-1β levels than the normal group increased

  18. Traumatic pseudoaneurysm of the abdominal aorta.

    Barchiche, R; Bové, T; Demanet, H; Goldstein, J P; Deuvaert, F E

    1999-08-01

    A traumatic pseudoaneurysm of the abdominal aorta is a rare entity, occurring as the result of a missed aortic lesion at the time of the initial injury. Therefore, clinical suspicion and careful abdominal exploration at first laparotomy is mandatory to prevent aortic pseudoaneurysm formation and its risk of delayed rupture. We present a case of successful surgical treatment of a suprarenal aortic false aneurysm, presenting 4 weeks after a life-threatening gunshot wound in a 13-year-old child. PMID:10499389

  19. Abdominal integument atrophy after operative procedures

    Smereczyński, Andrzej; Kołaczyk, Katarzyna; Lubiński, Jan; Bojko, Stefania; Gałdyńska, Maria; Bernatowicz, Elżbieta

    2012-01-01

    The aim of the study was to analyze clinical material concerning postoperative atrophy of abdominal integument. Material and methods The evaluated group consisted of 29 patients with sonographically revealed atrophy of the abdominal wall. Those changes were observed after various surgical procedures: mainly after long, anterolateral laparotomies or several classical operations. Ultrasound examinations up to the year 2000 were performed with analog apparatus, in the latter years only with digi...

  20. Quality Assessment in Oncology

    The movement to improve healthcare quality has led to a need for carefully designed quality indicators that accurately reflect the quality of care. Many different measures have been proposed and continue to be developed by governmental agencies and accrediting bodies. However, given the inherent differences in the delivery of care among medical specialties, the same indicators will not be valid across all of them. Specifically, oncology is a field in which it can be difficult to develop quality indicators, because the effectiveness of an oncologic intervention is often not immediately apparent, and the multidisciplinary nature of the field necessarily involves many different specialties. Existing and emerging comparative effectiveness data are helping to guide evidence-based practice, and the increasing availability of these data provides the opportunity to identify key structure and process measures that predict for quality outcomes. The increasing emphasis on quality and efficiency will continue to compel the medical profession to identify appropriate quality measures to facilitate quality improvement efforts and to guide accreditation, credentialing, and reimbursement. Given the wide-reaching implications of quality metrics, it is essential that they be developed and implemented with scientific rigor. The aims of the present report were to review the current state of quality assessment in oncology, identify existing indicators with the best evidence to support their implementation, and propose a framework for identifying and refining measures most indicative of true quality in oncologic care.

  1. Quality Assessment in Oncology

    Albert, Jeffrey M. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Das, Prajnan, E-mail: prajdas@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2012-07-01

    The movement to improve healthcare quality has led to a need for carefully designed quality indicators that accurately reflect the quality of care. Many different measures have been proposed and continue to be developed by governmental agencies and accrediting bodies. However, given the inherent differences in the delivery of care among medical specialties, the same indicators will not be valid across all of them. Specifically, oncology is a field in which it can be difficult to develop quality indicators, because the effectiveness of an oncologic intervention is often not immediately apparent, and the multidisciplinary nature of the field necessarily involves many different specialties. Existing and emerging comparative effectiveness data are helping to guide evidence-based practice, and the increasing availability of these data provides the opportunity to identify key structure and process measures that predict for quality outcomes. The increasing emphasis on quality and efficiency will continue to compel the medical profession to identify appropriate quality measures to facilitate quality improvement efforts and to guide accreditation, credentialing, and reimbursement. Given the wide-reaching implications of quality metrics, it is essential that they be developed and implemented with scientific rigor. The aims of the present report were to review the current state of quality assessment in oncology, identify existing indicators with the best evidence to support their implementation, and propose a framework for identifying and refining measures most indicative of true quality in oncologic care.

  2. Evaluation of Forty-Nine Patients with Abdominal Tuberculosis

    Murat Kilic

    2014-12-01

    Full Text Available Aim: Abdominal tuberculosis is an uncommon form of extrapulmonary infection. In this study, we aimed to highlight the nonspecific clinical presentations and diagnostic difficulties of abdominal tuberculosis. Material and Method: Clinical features, diagnostic methods, and the therapeutic outcomes of 49 patients diagnosed as abdominal tuberculosis between 2003 and 2014 were retrospectively analyzed. Results: The patients were classified into four subgroups including peritoneal (28, nodal (14, intestinal (5, and solid organ tuberculosis (2. The most frequent symptoms were abdominal pain, abdominal distention and fatique. Ascites appeared to be the most frequent clinical finding. Ascites and enlarged abdominal lymph nodes were the most frequent findings on ultrasonography and tomography. Diagnosis of abdominal tuberculosis was mainly depended on histopathology of ascitic fluid and biopsies from peritoneum, abdominal lymph nodes or colonoscopic materials. Forty patients healed with standart 6-month therapy while extended treatment for 9-12 months was needed in 8 whom had discontinued drug therapy and had persistent symptoms and signs. One patient died within the treatment period due to disseminated infection. Discussion: The diagnosis of abdominal tuberculosis is often difficult due to diverse clinical presentations. The presence of ascites, personal/familial/contact history of tuberculosis, and coexisting active extraabdominal tuberculosis are the most significant marks in diagnosis. Diagnostic laparoscopy and tissue sampling seem to be the best diagnostic approach for abdominal tuberculosis.

  3. Abdominal MRI in childhood

    MRI provides diagnostic information in multiple abdominal diseases in childhood. Additional information to sonographic findings can be achieved in the diagnosis of abdominal malformation as well as in several inflammatory processes. In childhood cancer imaging MRI is essential at the beginning as well as during therapy to assess response to therapy. Because of radiation protection MRI has to replace CT in abdominal imaging in children. Some technical details have to be considered when children are examined. (orig.)

  4. Recommendations for the clinical practice: Standards, options and recommendations 2003 for the use of recombinant erythropoietin (alpha and beta epoetine, alpha darbepoetine, EPO) in the taking charge of anemia in oncology for the patients treated by radiotherapy, update

    Standards, Options and Recommendations for the use of recombinant erythropoietin (epoietin alpha and beta darbepoietin alpha, EPO) in the management of anaemia in oncology for patient undergoing radiotherapy - UPDATE 2003. Context. - 'The Standards, Options and Recommendations' (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the twenty French cancer centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. Objectives. - To update the Standards, Options and Recommendations clinical practice guidelines for the use of recombinant erythropoietin (epoietin alpha and beta darbepoietin-alpha, EPO) in the management of anaemia in oncology for patient undergoing radiotherapy. Methods. - The working group identified the questions requiring up-dating from the previous guideline. Medline and Embase were searched using specific search strategies from January 1999 to October 2002. Literature monitoring was performed to identify randomized clinical trials published between October 2002 to November 2003. In addition several Internet sites were searched in October 2002. Results. - There is no standard attitude for use of rHuEPO in patients undergoing radiotherapy. There is no evidence to support use of rHuEPO in patients with ENT cancer receiving radiotherapy alone. In patients undergoing curative radiotherapy, it is recommended to correct anaemia under 10 g/dL using transfusion rather than rHuEPO. When the haemoglobin concentration is between 12 g/dL and 14 g/dL initial use of rHuEPO can be an option under certain conditions for radio-chemotherapy if the risk of anaemia is

  5. Videolaparoscopic cholecystectomy. Analysis of the clinical and functional aspects of mechanical lifting of the abdominal wall Colecistectomia videolaparoscópica. Análise de aspectos clínicos e funcionais da suspensão mecânica da parede abdominal

    Marco Aurelio SANTO

    2001-01-01

    Full Text Available Background - Mechanical lifting of the abdominal wall, a method based on traction and consequent elevation of the abdominal wall, is an alternative procedure to create enough intra-abdominal space necessary for videolaparoscopic surgery, dispensing the need for intraperitoneal gas insufflation. Objective - This study aims to evaluate the technical feasibilility of this procedure to carry out a videolaparoscopic cholecystectomy, while analyzing the clinical and functional aspects of this technique. Patients and Methods - In the Digestive Tract Surgery Discipline of the Medical School at the University of São Paulo, São Paulo, SP, Brazil, was created the equipment to perform videolaparoscopic surgery using this method. The equipment has two sections: an external part which consisted of a frame attached to the operating table, inside which there is a sliding steel cable, moved by a ratched which is located at the lower end of one of the frame rods; the internal rod, the support, has an "L" shape, and its horizontal branch is made up of three turning rods and which is connected to the steel cable after insertion into the abdominal cavity. Ten patients underwent videolaparoscopic cholecystectomy using this equipment. The time taken to install the equipment, the operating area characteristics, the interference from the lifting equipment on surgical movements and on the intra-operative cholangiography, the measurements made of the force used during traction and extension of the abdominal wall elevation, and the medication required for post-operative analgesia were all evaluated. Results - There were no intra-operative complications, and in none of the cases was it found necessary to convert to open surgery. We considered the insertion a safe and uncomplicated procedure, and the traction system efficient. Apart from the elevation of the abdominal wall, the distribution of the viscera inside the abdominal cavity is fundamental for the operating area

  6. Clinical Analysis of Cervical Vaginal Abdominal Fascia Suspension for the Treatment of Pelvic Organ Prolapse%宫颈阴道腹壁筋膜悬吊术治疗盆腔脏器脱垂的临床分析

    闫士琳

    2015-01-01

    Objective To analyze curative effect of cervical vaginal abdominal fascia suspension surgery for pelvic organ prolapse. Methods In our hospital from 38 patients with pelvic organ prolapse in January 2013 to December 2013 who were treated as the research object. All patients were given cervical fascia suspension in the treatment of abdominal wall. Observe and record the perioperative clinical indicators and treatment effect, complications. Results All the patients after treatment, the success rate of operation was 100%, no complications occurred after the operation, operation cost is low. Conclusion The application of cervical vaginal abdominal fascia suspension surgery for pelvic organ prolapse patients, a signiifcant clinical effect, low cost, wide clinical application.%目的:探讨宫颈阴道腹壁筋膜悬吊术对盆腔脏器脱垂的疗效分析。方法选取我院从2013年1月至2013年12月门诊收治的38例盆腔脏器脱垂患者作为研究对象。所有患者均给予宫颈阴道腹壁筋膜悬吊术治疗。观察记录患者的围手术期各项临床指标及治疗效果,并发症发生情况。结果所有患者经过治疗,手术成功率为100%,术后无并发症发生,手术费用较低。结论应用宫颈阴道腹壁筋膜悬吊术对盆腔脏器脱垂患者治疗,临床效果显著,费用较低,临床值得广泛推广应用。

  7. Clinical Observation on Treating Sequelae of Apoplexy with Acupuncture and Abdominal Massage Therapy%针刺结合腹部推拿治疗中风后遗症的疗效观察

    吴国良

    2012-01-01

    Objective: To observe the clinical efficacy on treating sequelae of apoplexy with acupuncture and abdominal massage therapy. Methods:60 patients with sequelae of apoplexy were randomly divided into treatment and control groups. 30 patients in treatment group were treated with combination of traditional acupuncture and abdominal massage; 30 patients in control group were treated with traditional acupuncture. 10 times'treat-ments were as one course. The clinical efficacy of both groups were observed after three treatment courses. Re-Sults:The significant progress rates in treatment group and control group were 60% and 10% respectively. Comparison of significant progress rates between the two groups showed a statistical significance ( P < 0. 01 ). Conclusion : Using the combination of acupuncture and abdominal massage on treating sequelae of apoplexy is better than pure acupuncture treatment. It is worthy of clinical promotion.%目的:观察针刺结合腹部推拿治疗中风后遗症的临床疗效.方法:将60例中风后遗症患者随机分为治疗组和对照组.其中治疗组30例,采用传统针刺结合腹部推拿治疗;对照组30例,采用传统针刺方法治疗.两组均10次为一疗程,3个疗程后观察疗效.结果:治疗组显著进步率为60%,对照组显著进步率为10%,两组显著进步率比较差异有统计学意义(P<0.01).结论:运用针刺结合腹部推拿治疗中风后遗症疗效优于单纯针刺治疗,值得临床推广.

  8. Quality of life in oncology with emphasis upon neuro-oncology.

    Choucair, Ali K

    2007-01-01

    Quality of life, as a science has been steadily gaining importance in both clinical practice as well as research. Despite major progress in the development of validated and clinically-relevant health-related quality of life (HRQOL) measures, we still face many challenges in bridging the gap between what we know and how to apply it in clinical practice: in making the transfer from the mere collection of QOL data to its utilization in improving patient outcome through interventional symptomatic therapy. This manuscript traces the development of QOL as a science to its potential utility in both clinical care and clinical research, as well as an outcomes measure. The emphasis has been placed upon quality of life in oncology with special attention to neuro-oncology. PMID:17127306

  9. DEGRO 2009. Radiation oncology - medical physics - radiation biology. Abstracts

    The special volume of the journal covers the abstracts of the DEGRO 2009 meeting on radiation oncology, medical physics, and radiation biology, covering the following topics: seldom diseases, gastrointestinal tumors, radiation reactions and radiation protection, medical care and science, central nervous system, medical physics, the non-parvicellular lung carcinomas, ear-nose-and throat, target-oriented radiotherapy plus ''X'', radio-oncology - young academics, lymphomas, mammary glands, modern radiotherapy, life quality and palliative radiotherapy, radiotherapy of the prostate carcinoma, imaging for planning and therapy, the digital documentation in clinics and practical experiences, NMR imaging and tomography, hadrons - actual status in Germany, urinal tract oncology, radiotoxicity

  10. 腹针耳针艾灸结合异病同治临床体会%Clinical experience for same treatment of different diseases by abdominal and auricular acupuncture plus moxibustion

    梁飞飞; 彭丽辉

    2014-01-01

    采用中医“异病同治”的原则,通过腹针、耳针和艾灸相结合治疗“脾胃虚弱型”的“痞满”和“呃逆”,取得了满意的临床疗效。%As one of the TCM principles, same treatment in different diseases, the abdominal acupuncture, ear acupuncture and moxibustion therapy were combined for treating weak stomach type of fullness and hiccup, and achieved satisfactory in clinical efficacy.

  11. Clinical trial of doxycycline for matrix metalloproteinase-9 inhibition in patients with an abdominal aneurysm doxycycline selectively depletes aortic wall neutrophils and cytotoxic t cells

    Lindeman, J. H. N.; Abdul-Hussien, H.; van Bockel, J H; Wolterbeek, R.; Kleemann, R.

    2009-01-01

    Background-Doxycycline has been shown to effectively inhibit aneurysm formation in animal models of abdominal aortic aneurysm. Although this effect is ascribed to matrix metalloproteinase-9 inhibition, such an effect is unclear in human studies. We reevaluated the effect of doxycycline on aortic wall protease content in a inical trial and found that doxycycline selectively reduces neutrophil-derived proteases. We thus hypothesized that doxycycline acts through an effect on ascular nflammation...

  12. 腹部肿瘤手术切口不缝合皮下组织联合无针缝合器效果观察%Preliminary effects of closing surgical incision with needleless incision and non-suturing subcutaneous tissue in abdominal oncological surgery

    解亦斌; 崔亮; 卢德虎; 刘昊; 田艳涛

    2013-01-01

    目的 观察不缝合皮下组织并采用无针缝合器对合皮肤及皮下组织的切口缝合方法应用于腹部肿瘤腹壁切口的效果.方法 新方法组为2012年4至9月中国医学科学院肿瘤医院腹部外科应用不缝合皮下组织并采用无针缝合器,关闭各类腹部肿瘤腹壁切口的52例患者,其中男33例,女19例.传统方法组为2011年4至9月同组医生进行的腹部肿瘤切除术后采用常规间断缝合皮下组织并以钉皮器对合皮肤的患者68例,其中男47例,女21例.X2检验比较两组间愈合不良事件发生率,对切口愈合不良事件危险因素的分析采用Logistic回归分析.结果 新方法组与传统方法组比较,切口愈合不良事件差异无统计学意义[11.54% (6/52)比5.88% (4/68),P=0.2666].年龄(OR=0.918,95% CI:0.224~ 3.764),性别(OR=1.371,95% CI:0.364~5.163),切口长度(OR=2.567,95%CI:0.520~12.665),术前糖尿病(OR=1.469,95%CI:0.286~7.554),术后血清白蛋白(OR=0.536,95% CI:0.108~2.655),腹腔镜手术(OR=0.390,95%CI:0.079~1.922),缝合方法(OR=0.479,95%CI:0.128~1.795)均不是术后切口愈合不良事件的危险因素.传统方法组皮下组织平均缝合时间15 min,新方法组术后切口两侧无瘢痕.结论 采用不缝合皮下组织并联合无针缝合器的新方法关腹不增加切口愈合不良事件发生率,缩短了手术时间,并具有潜在的美容功效.%Objective To observe the preliminary effects of closing surgery incision with needleless incision and leaving subcutaneous tissue non-sutured in the operations of abdominal tumor.Methods There were 52 patients (33 males and 19 females) undergoing abdominal tumor operations between April 2012 and September 2012.Abdominal incision was sutured by a new method of leaving subcutaneous tissue nonsutured closing with a needleless incision close.As a control,the clinical data of 68 patients (47 male and 21 females) received similar operations between April

  13. The clinical value of combined use of MR imaging and multi-slice spiral CT in limb salvage surgery for orthopaedic oncology patients: initial experience in nine patients

    The purpose of this prospective study was to evaluate the value of the combined use of MR imaging and multi-slice spiral CT for limb salvage surgery in orthopaedic oncology patients. Nine consecutive patients with lower/upper limb malignant bone tumours (7 osteosarcomas and 2 chondrosarcomas) were treated with limb-salvaging procedures. Preoperative planning including determination of the osteotomy plane and diameters of the prosthesis was performed basing on the preoperative CT and MR images. The histopathology was performed as golden diagnostic criteria to evaluate the accuracy of CT and MR-based determination for tumour’s boundary. The tumour extension measured on MRI was consistent with the actual extension (P>0.05, paired Student’s t test), while the extension measured on CT imaging was less than the actual extension. The length, offset and alignment of the affected limb were reconstructed accurately after the operation. An excellent functional outcome was achieved in all patients. In the present study, MRI was found to be superior to CT for determining the tumour extension, combined use of MRI and CT measurement provided high precision for the fit of the prosthesis and excellent functional results

  14. PET/MR in oncology

    Balyasnikova, Svetlana; Löfgren, Johan; de Nijs, Robin;

    2012-01-01

    a number of different MRI techniques, such as DWI-MR (diffusion weighted imaging MR), DCE-MR (dynamic contrast enhanced MR), MRS (MR spectroscopy) and MR for attenuation correction of PET. All MR techniques presented in this paper have shown promising results in the treatment of patients with solid......After more than 20 years of research, a fully integrated PET/MR scanner was launched in 2010 enabling simultaneous acquisition of PET and MR imaging. Currently, no clinical indication for combined PET/MR has been established, however the expectations are high. In this paper we will discuss some of...... the challenges inherent in this new technology, but focus on potential applications for simultaneous PET/MR in the field of oncology. Methods and tracers for use with the PET technology will be familiar to most readers of this journal; thus this paper aims to provide a short and basic introduction to...

  15. Preclinical models in radiation oncology

    As the incidence of cancer continues to rise, the use of radiotherapy has emerged as a leading treatment modality. Preclinical models in radiation oncology are essential tools for cancer research and therapeutics. Various model systems have been used to test radiation therapy, including in vitro cell culture assays as well as in vivo ectopic and orthotopic xenograft models. This review aims to describe such models, their advantages and disadvantages, particularly as they have been employed in the discovery of molecular targets for tumor radiosensitization. Ultimately, any model system must be judged by its utility in developing more effective cancer therapies, which is in turn dependent on its ability to simulate the biology of tumors as they exist in situ. Although every model has its limitations, each has played a significant role in preclinical testing. Continued advances in preclinical models will allow for the identification and application of targets for radiation in the clinic

  16. Drug interactions in female oncologic inpatients: differences among databases

    Patricia Moriel; Jorge Augusto Siqueira; Renata Cavalcanti Carnevale; Caroline de Godoi Rezende Costa; Aline Aparecida da Cruz; Nice Maria Oliveira da Silva; Adélia Corina Bernardes; Roberta Paro Carvalho; Priscila Gava Mazzola

    2013-01-01

    The aim of the present study was to quantify drug interactions in prescriptions for women undergoing supportive therapy in an oncology setting at a women’s hospital in Brazil and compare the information provided by different databases regarding these drug interactions. A convenience sample was selected of prescriptions for patients diagnosed with breast or gynecological tumors hospitalized in the clinical oncology and surgery wards from April to June 2009. DRUGDEX/M...

  17. Serum HER-2 concentrations for monitoring women with breast cancer in a routine oncology setting

    Sørensen, Patricia Diana; Jakobsen, Erik Hugger; Langkjer, Sven Tyge;

    2009-01-01

    1348 patients with breast cancer: 837 during routine oncology clinic visits and 511 following new diagnosis. All patients with positive serum HER-2, 1/5 of negative patients from the oncology clinic, and all the newly diagnosed were followed; a total of 862 patients. Serum HER-2 was measured using the...

  18. 小儿腹部肿瘤临床表现与彩色多普勒超声诊断研究%To study the clinical manifestations and diagnosis of color doppler ultrasonography of abdominal tumor in children

    李微; 王晓磊; 曹海玮

    2014-01-01

    Objective To investigate the diagnosis of abdominal tumor clinical manifestation and color doppler ultrasound. Method From April 2013 to January 2014 in the diagnosis of abdominal tumor department for 31 children, for two dimensional ultrasound and color doppler ultrasound examination. Observed abdominal tumor types in children, age distribution, clinical manifestations, internal echo and blood flow, statistical analysed of two-dimensional ultrasound and color doppler ultrasound diagnostic accuracy. Result Neuroblastoma abdominal tumor in children, the highest incidence of wilms tumor, followed by retroperitoneal teratoma and ovarian teratoma, different type of tumor and age and sex were different, the retroperitoneal teratoma good hair age was (1.1±0.8) years old, neuro blastoma from (6.7±5.4) years old, ovarian teratoma good hair at (8.4±5.7) years old, nephroblastoma good hair at (1.7±0.5) years old, hepatoblastoma good hair at (0.5±0.3) years old. Retroperitoneal teratoma of the main clinical manifestations were abdominal mass and abdominal distension, neuroblastoma were abdominal mass, abdominal pain, fever, abdominal pain and abdominal mass of ovarian teratoma, wilms tumor were abdominal mass and hematuria, hepatoblastoma were abdominal mass and abdominal distension. Retroperitoneal cystic teratoma with no echo, neuroblastoma was the essence of low echo, teratoma of ovary cystic anechoic, nephroblastoma substance mixed echo, hepatoblastoma solid strong echo. Retroperitoneal teratoma ultrasound color doppler for tumor inside no or less blood, no blood lfow around the tumor, neuroblastoma internal rich blood lfow, blood lfow of ovarian teratoma surrounding, for no or less blood, peripheral without blood, nephroblastoma internal rich blood, peripheral blood flow, hepatic blastoma for the internal rich blood, peripheral blood flow. Through determined after pathology, two dimensional ultrasonography in clinical diagnosis of 24 cases, misdiagnosis of 7 cases

  19. Radiotherapy and immune reaction of oncologic patients

    Represented is a review of data accumulated in literature (1970-1976) on oppression of protection of oncologic patients and more oppression of immune reactions during radiotherapy. Underlined is the significance of studying immune homeostasis in a clinic of radiotherapy to evaluate total resistance of patients before the beginning and in the process of treatment. The prognostic significance of immunodepressive disturbances in patients with malignant tumors is elucidated

  20. Radiopharmaceuticals in oncology

    Radiopharmaceuticals are generally made of an artificial radionuclide chemically bound to a molecule showing an affinity for a particular type of cells. In oncology, the radionuclide emits either photons for scintigraphic imaging, either beta or alpha particles for metabolic radiotherapy. The development of new radiopharmaceuticals is mostly hampered by the modifications of conformation and hence, of biological behavior, of the original molecule induced by its radiolabelling. The use of positron emitters can be a solution to this difficulty, but their short half-life generates serious management limitations. Radiopharmaceutical used in oncology are targeted toward the cellular and tissular tumorous abnormalities. They belong to different categories: membrane agents, metabolic substrates (such as fluorodeoxyglucose), receptors ligands, antibodies and other agents under development such as hypoxia, apoptosis and genes markers. (authors)

  1. Adhesive intestinal obstruction following blunt abdominal trauma

    Advances in diagnosis and management of multiple trauma patients have lead to adopting a conservative approach for most patients with blunt abdominal trauma. Intestinal obstruction is a rare complication for this approach. Herein, we report a 37-year-old male, who did not have an abdominal operation, and who developed adhesive intestinal obstruction 7 weeks following blunt abdominal trauma. We detected no signs of peritonitis or intra-abdominal bleeding clinically or radiologically on admission. We initially treated the intestinal obstruction conservatively, but the obstruction did not resolve. Finally, we performed laparotomy, which showed that the small bowel was matted together by thick fibrous layers of adhesions. We performed adhesiolysis, and the patient was discharged home 3 weeks later. Histopathological findings of the fibrous layer were consistent with repair due to previous trauma and hemorrhage. We review the literature of this rare condition. (author)

  2. Oncology and palliative care

    Bausewein, Claudia; Hartenstein, R.

    2000-01-01

    Oncology developed as a discipline over the last decades. Treatment is concentrated on cure or palliation of the illness with the help of chemotherapy, radiotherapy or surgery. Palliative care has its origin in the hospice movement that started around 1960 in the UK. Centre of care is the patient and his family. Focus of care has moved from quantity to quality of life. Symptom control, communication, rehabilitation and care for the dying are main areas of palliative care. Palliative care and ...

  3. Clinical Use and Advances of ω-3 Fish Oil Emulsion in Abdominal Surgery%ω-3鱼油脂肪乳对腹部手术患者的临床应用及进展

    黄小羚

    2011-01-01

    Patients undergoing abdominal surgery are prone to systemic inflammatory response syndrome and further multiple organ dysfunction syndrome, due to surgical stress, massive release of inflammatory factors, and initiation of inflammatory response. ω-3 polyunsaturated fatty acids are regulatory in inflammation and immunity and able to improve the postsurgical early inflammatory response and immunity.The clinical use and potential of ω-3 have been increasingly recognized. This article reviews the clinical use and advances of ω-3 fish oil emulsion in patients undergoing abdominal surgeries.%腹部手术后患者因为手术应激打击、炎性因子大量释放、启动炎性反应,引起全身炎性反应综合征,进一步可导致多器官功能不全综合征.ω-3多不饱和脂肪酸具有调节炎症和免疫功能的作用,它能够改善术后早期患者的炎性反应和免疫功能,它的临床应用价值和潜力逐渐得到人们的认识.在此就目前国内外ω-3鱼油脂肪乳对腹部手术后患者的临床应用及进展予以综述.

  4. The role of Advanced Practice Providers in interdisciplinary oncology care in the United States.

    Reynolds, Rae Brana; McCoy, Kimberly

    2016-06-01

    Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs), generally referred to as Advanced Practice Providers (APPs), are fundamental to interdisciplinary oncology care. As the projected demand for oncology services is anticipated to outpace the supply of oncologists, APPs will become increasingly vital in the delivery of oncology care and services. The training, education, and scope of practice for APPs gives the interdisciplinary care team professionals that deliver high-quality clinical services and provide valuable contributions and leadership to health care quality improvement initiatives. Optimizing the integration of APPs in oncology care offers immense advantages towards improvement of clinical outcomes. PMID:27197514

  5. [Factitious diseases in oncology].

    Reich, Michel; Clermont, Amélie; Amela, Éric; Kotecki, Nuria

    2015-12-01

    Factitious diseases and pathomimias and particularly Munchausen's syndrome, due to their rarity, are poorly diagnosed by medical teams working in oncology. Consequences can be serious and result in unadapted surgery or non justified implementation of chemotherapy and radiotherapy regimens. These patients simulate diseases in order to attract medical attention. They might become belligerent and are likely to promptly discharge themselves from hospital if they do not get the desired attention or are unmasked. With two following case reports and literature review, we would like to alert clinicians about difficulties encountered in diagnosis and management of factitious disorders. When faced with this diagnosis, the patient will tend to deny reality and break contact with the medical team who exposed him. Medical peregrinating behavior surrounded by conflicts with medical team, past psychiatric illness, history of working in the medical and paramedical field and social isolation can guide the diagnosis. Somaticians and especially surgeons working in the oncologic field must remain vigilant about this diagnosis and collaborate with either the psycho-oncologic team or the consultation-liaison psychiatric team. Some recommendations for medical professionals how to cope with these patients will be suggested. PMID:26597474

  6. Clinical performance of a free-breathing spatiotemporally accelerated 3-D time-resolved contrast-enhanced pediatric abdominal MR angiography

    Zhang, Tao; Cheng, Joseph Y. [Stanford University, Department of Radiology, Stanford, CA (United States); Stanford University, Department of Electrical Engineering, Stanford, CA (United States); Yousaf, Ufra; Alley, Marcus T.; Vasanawala, Shreyas S. [Stanford University, Department of Radiology, Stanford, CA (United States); Hsiao, Albert [University of California, San Diego, Department of Radiology, San Diego, CA (United States); Lustig, Michael [Stanford University, Department of Electrical Engineering, Stanford, CA (United States); University of California, Berkeley, Department of Electrical Engineering and Computer Sciences, Berkeley, CA (United States); Pauly, John M. [Stanford University, Department of Electrical Engineering, Stanford, CA (United States)

    2015-10-15

    Pediatric contrast-enhanced MR angiography is often limited by respiration, other patient motion and compromised spatiotemporal resolution. To determine the reliability of a free-breathing spatiotemporally accelerated 3-D time-resolved contrast-enhanced MR angiography method for depicting abdominal arterial anatomy in young children. With IRB approval and informed consent, we retrospectively identified 27 consecutive children (16 males and 11 females; mean age: 3.8 years, range: 14 days to 8.4 years) referred for contrast-enhanced MR angiography at our institution, who had undergone free-breathing spatiotemporally accelerated time-resolved contrast-enhanced MR angiography studies. A radio-frequency-spoiled gradient echo sequence with Cartesian variable density k-space sampling and radial view ordering, intrinsic motion navigation and intermittent fat suppression was developed. Images were reconstructed with soft-gated parallel imaging locally low-rank method to achieve both motion correction and high spatiotemporal resolution. Quality of delineation of 13 abdominal arteries in the reconstructed images was assessed independently by two radiologists on a five-point scale. Ninety-five percent confidence intervals of the proportion of diagnostically adequate cases were calculated. Interobserver agreements were also analyzed. Eleven out of 13 arteries achieved acceptable image quality (mean score range: 3.9-5.0) for both readers. Fair to substantial interobserver agreement was reached on nine arteries. Free-breathing spatiotemporally accelerated 3-D time-resolved contrast-enhanced MR angiography frequently yields diagnostic image quality for most abdominal arteries in young children. (orig.)

  7. Clinical performance of a free-breathing spatiotemporally accelerated 3-D time-resolved contrast-enhanced pediatric abdominal MR angiography

    Pediatric contrast-enhanced MR angiography is often limited by respiration, other patient motion and compromised spatiotemporal resolution. To determine the reliability of a free-breathing spatiotemporally accelerated 3-D time-resolved contrast-enhanced MR angiography method for depicting abdominal arterial anatomy in young children. With IRB approval and informed consent, we retrospectively identified 27 consecutive children (16 males and 11 females; mean age: 3.8 years, range: 14 days to 8.4 years) referred for contrast-enhanced MR angiography at our institution, who had undergone free-breathing spatiotemporally accelerated time-resolved contrast-enhanced MR angiography studies. A radio-frequency-spoiled gradient echo sequence with Cartesian variable density k-space sampling and radial view ordering, intrinsic motion navigation and intermittent fat suppression was developed. Images were reconstructed with soft-gated parallel imaging locally low-rank method to achieve both motion correction and high spatiotemporal resolution. Quality of delineation of 13 abdominal arteries in the reconstructed images was assessed independently by two radiologists on a five-point scale. Ninety-five percent confidence intervals of the proportion of diagnostically adequate cases were calculated. Interobserver agreements were also analyzed. Eleven out of 13 arteries achieved acceptable image quality (mean score range: 3.9-5.0) for both readers. Fair to substantial interobserver agreement was reached on nine arteries. Free-breathing spatiotemporally accelerated 3-D time-resolved contrast-enhanced MR angiography frequently yields diagnostic image quality for most abdominal arteries in young children. (orig.)

  8. The therapeutic impact of abdominal ultrasound in patients with acute abdominal symptoms

    AIM: The technical performance of abdominal ultrasound in the investigation of acute abdominal pain has been thoroughly investigated but its therapeutic effects are less well understood. We aimed to determine the therapeutic effect of abdominal ultrasound in the investigation of acute abdominal pain. MATERIAL AND METHODS: A pre- and post-intervention observational study design was used to determine the diagnostic and therapeutic effects of abdominal ultrasound for acute abdominal pain. Referring clinicians completed a pre-ultrasound questionnaire that detailed their leading diagnosis, confidence in this and intended management in 100 consecutive adult patients. Following ultrasound a second questionnaire was completed. This again detailed the leading diagnosis, confidence in this and their intended management. Clinicians quantified the management contribution of ultrasound both for the individual case in question and in their clinical experience generally. RESULTS: The leading diagnosis was either confirmed or rejected in 72 patients and a new diagnosis provided where no prior differential diagnosis existed in 10. Diagnostic confidence increased significantly following ultrasound (mean score 6·5 pre-ultrasound vs 7·6 post-ultrasound, P < 0·001). Intended management changed following ultrasound in 22 patients; 15 intended laparotomies were halted and a further seven patients underwent surgery where this was not originally intended. Ultrasound was rated either 'very' or 'moderately' helpful in 87% of patients, with 99% of clinicians finding it either 'very' or 'moderately' helpful generally. CONCLUSION: Abdominal ultrasound has considerable diagnostic and therapeutic effect in the setting of acute abdominal pain. Dhillon, S. et al. (2002)

  9. Functional Abdominal Pain: "Get" the Function, Loose the Pain.

    Draeger-Muenke, Reinhild

    2015-07-01

    Functional abdominal pain is a mind-body, psychosocial, and self-reinforcing experience with significant consequences for the sufferer and the surrounding support network. The occurrence of unpredictable symptoms and their severity add an element of dread and feeling out-of-control to daily life and often reduce overall functioning in a downward spiral. Two clinical presentations of functional abdominal pain are offered in this article (composites to protect confidentiality) dealing with abdominal pain syndrome and abdominal migraines. The treatment demonstrates the use of hypnotic principles for self-regulation, exploration, and meaning-making. Hypnosis treatment is conducted in combination with mindfulness-based interventions and Traditional Chinese Medicine's (TCM) teachings regarding abdominal health and illness. The clinical examples illustrate medical findings that suggest children with early life stress and an early onset of gastrointestinal somatization may not simply outgrow their functional abdominal pain but may suffer into adulthood. PMID:26046716

  10. Quality Indicators in Radiation Oncology

    Oncologic specialty societies and multidisciplinary collaborative groups have dedicated considerable effort to developing evidence-based quality indicators (QIs) to facilitate quality improvement, accreditation, benchmarking, reimbursement, maintenance of certification, and regulatory reporting. In particular, the field of radiation oncology has a long history of organized quality assessment efforts and continues to work toward developing consensus quality standards in the face of continually evolving technologies and standards of care. This report provides a comprehensive review of the current state of quality assessment in radiation oncology. Specifically, this report highlights implications of the healthcare quality movement for radiation oncology and reviews existing efforts to define and measure quality in the field, with focus on dimensions of quality specific to radiation oncology within the “big picture” of oncologic quality assessment efforts

  11. Guidelines for treatment naming in radiation oncology.

    Denton, Travis R; Shields, Lisa B E; Hahl, Michael; Maudlin, Casey; Bassett, Mark; Spalding, Aaron C

    2015-01-01

    Safety concerns may arise from a lack of standardization and ambiguity during the treatment planning and delivery process in radiation therapy. A standardized target and organ-at-risk naming convention in radiation therapy was developed by a task force comprised of several Radiation Oncology Societies. We present a nested-survey approach in a community setting to determine the methodology for radiation oncology departments to standardize their practice. Our Institution's continuous quality improvement (CQI) committee recognized that, due to growth from one to three centers, significant variability existed within plan parameters specific to patients' treatment. A multidiscipline, multiclinical site consortium was established to create a guideline for standard naming. Input was gathered using anonymous, electronic surveys from physicians, physicists, dosimetrists, chief therapists, and nurse managers. Surveys consisted of several primary areas of interest: anatomical sites, course naming, treatment plan naming, and treatment field naming. Additional concepts included capitalization, specification of later-ality, course naming in the event of multiple sites being treated within the same course of treatment, primary versus boost planning, the use of bolus, revisions for plans, image-guidance field naming, forbidden characters, and standard units for commonly used physical quantities in radiation oncology practice. Guidelines for standard treatment naming were developed that could be readily adopted. This multidisciplinary study provides a clear, straightforward, and easily implemented protocol for the radiotherapy treatment process. Standard nomenclature facilitates the safe means of communication between team members in radiation oncology. The guidelines presented in this work serve as a model for radiation oncology clinics to standardize their practices. PMID:27074449

  12. Technology for Innovation in Radiation Oncology.

    Chetty, Indrin J; Martel, Mary K; Jaffray, David A; Benedict, Stanley H; Hahn, Stephen M; Berbeco, Ross; Deye, James; Jeraj, Robert; Kavanagh, Brian; Krishnan, Sunil; Lee, Nancy; Low, Daniel A; Mankoff, David; Marks, Lawrence B; Ollendorf, Daniel; Paganetti, Harald; Ross, Brian; Siochi, Ramon Alfredo C; Timmerman, Robert D; Wong, John W

    2015-11-01

    Radiation therapy is an effective, personalized cancer treatment that has benefited from technological advances associated with the growing ability to identify and target tumors with accuracy and precision. Given that these advances have played a central role in the success of radiation therapy as a major component of comprehensive cancer care, the American Society for Radiation Oncology (ASTRO), the American Association of Physicists in Medicine (AAPM), and the National Cancer Institute (NCI) sponsored a workshop entitled "Technology for Innovation in Radiation Oncology," which took place at the National Institutes of Health (NIH) in Bethesda, Maryland, on June 13 and 14, 2013. The purpose of this workshop was to discuss emerging technology for the field and to recognize areas for greater research investment. Expert clinicians and scientists discussed innovative technology in radiation oncology, in particular as to how these technologies are being developed and translated to clinical practice in the face of current and future challenges and opportunities. Technologies encompassed topics in functional imaging, treatment devices, nanotechnology, and information technology. The technical, quality, and safety performance of these technologies were also considered. A major theme of the workshop was the growing importance of innovation in the domain of process automation and oncology informatics. The technologically advanced nature of radiation therapy treatments predisposes radiation oncology research teams to take on informatics research initiatives. In addition, the discussion on technology development was balanced with a parallel conversation regarding the need for evidence of efficacy and effectiveness. The linkage between the need for evidence and the efforts in informatics research was clearly identified as synergistic. PMID:26460989

  13. Penetrating abdominal trauma.

    Henneman, P L

    1989-08-01

    The management of patients with penetrating abdominal trauma is outlined in Figure 1. Patients with hemodynamic instability, evisceration, significant gastrointestinal bleeding, peritoneal signs, gunshot wounds with peritoneal violation, and type 2 and 3 shotgun wounds should undergo emergency laparotomy. The initial ED management of these patients includes airway management, monitoring of cardiac rhythm and vital signs, history, physical examination, and placement of intravenous lines. Blood should be obtained for initial hematocrit, type and cross-matching, electrolytes, and an alcohol level or drug screen as needed. Initial resuscitation should utilize crystalloid fluid replacement. If more than 2 liters of crystalloid are needed to stabilize an adult (less in a child), blood should be given. Group O Rh-negative packed red blood cells should be immediately available for a patient in impending arrest or massive hemorrhage. Type-specific blood should be available within 15 minutes. A patient with penetrating thoracic and high abdominal trauma should receive a portable chest x-ray, and a hemo- or pneumothorax should be treated with tube thoracostomy. An unstable patient with clinical signs consistent with a pneumothorax, however, should receive a tube thoracostomy prior to obtaining roentgenographic confirmation. If time permits, a nasogastric tube and Foley catheter should be placed, and the urine evaluated for blood (these procedures can be performed in the operating room). If kidney involvement is suspected because of hematuria or penetrating trauma in the area of a kidney or ureter in a patient requiring surgery, a single-shot IVP should be performed either in the ED or the operating room. An ECG is important in patients with possible cardiac involvement and in patients over the age of 40 going to the operating room. Tetanus status should be updated, and appropriate antibiotics covering bowel flora should be given. Operative management should rarely be delayed

  14. The minutes of Beijing-Tianjin seminar of Chinese Society of Clinical Oncology experts'-consensus on the diagnosis and treatment of osteosarcoma%CSCO骨肉瘤诊治专家共识北京-天津研讨会会议纪要

    孙扬; 金韬; 张清

    2012-01-01

    In order to reach a consensus on the standardized clinical diagnosis and treatment of osteosarcoma and lay the foundation for the future Chinese version of "Experts' Consensus of the Clinical Diagnosis and Treatment of Osteosarcoma", the Beijing-Tianjin seminar of Chinese Society of Clinical Oncology (CSCO) experts' consensus on the diagnosis and treatment of osteosarcoma was held at the China National Convention Centre on April 20, 2012. More than 40 representatives from over 20 hospitals nationwide attended the conference. Insisting on the aim of multidisciplinary mutual learning, communication and enhancement, in the conference there was a heated exchange and discussion in the area of the standardized clinical diagnosis and treatment of osteosarcoma.

  15. 辩证思维在肿瘤放射治疗学临床教学中的应用探讨%Application of dialectical thinking in clinical teaching of radiation oncology

    江浩

    2015-01-01

    The scientific way of thinking to explore the nature of clinical phenomena that exist,is one of the basic requirements of modern medical model.Clinical Radiation Oncology teaching mostly video images as a carrier-based training image thinking,logical thinking and abstract thinking that,especially in the form of dialectical logic thinking in clinical teaching less general application,the instructor is not easily mastered.Training medical students of dialectical thinking ability,and to achieve thinking ability combined image thinking,formal logic thinkingand dialectical logic thinking is a qualified medical students training in basic aspirations.Therefore,in addition to clinical theory class teacher to teach clinical knowledge,strengthenability to the scientific way of thinking of medical students,especially the culture of dialectical thinking ability is very necessary and urgent.In our practice on teaching of radiation oncology,that to teach inducing carcinoma and treating carcinoma by radiation,the pros and cons of gene mutation,damaging normal tissues and killing cancer cells by radiation,grasping intensity of cancer treatment,selectingcancer radiotherapy strategy,and its conversion protagonist and a supporting role of comprehensive treatment,analyzed with dialectical thinking to guide medical students should not only master the micro-level of radiation oncology phenomenon of life,but should learn to understand the use of dialectical thinking from a macro level and explore life movement in a variety of phenomena,and thus more easily to digest and absorb all the important points of radiation oncology.So it not only can make students get knowledge of long-term memory,but can make the medical students handy use the tools of dialectical thinking to solve a lot of complex issues of the clinical practice in the future,in order to better service for future clinical practice.%运用科学的思维方式探讨临床医学中存在的现象与本质,是现代医学模式

  16. Abdominal and pelvic CT: is positive enteric contrast still necessary? Results of a retrospective observational study

    Kammerer, S.; Hoeink, A.J.; Wessling, J.; Schuelke, C.; Heindel, W.; Buerke, B. [University Hospital Muenster, Department of Clinical Radiology, Muenster (Germany); Heinzow, H. [University Hospital Muenster, Department of Gastroenterology and Metabolic Diseases, Muenster (Germany); Koch, R. [University Muenster, Institute of Biostatistics and Clinical Research, Muenster (Germany)

    2014-10-15

    Evaluation of diagnostic accuracy of abdominal CT depending on the type of enteric contrast agent. Multislice CTs of 2,008 patients with different types of oral preparation (positive with barium, n = 576; neutral with water, n = 716; and no enteric contrast, n = 716) were retrospectively evaluated by two radiologists including delineation of intestinal segments and influence on diagnosis and diagnostic reliability exerted by the enteric contrast, using a three-point scale. Furthermore, diagnostic reliability of the delineation of selected enteric pathologies was noted. CT data were assigned into groups: oncology, inflammation, vascular, pathology, trauma and gastrointestinal pathology. Delineation of the bowel was clearly practicable across all segments irrespective of the type of enteric contrast, though a slight impairment was observed without enteric contrast. Although delineation of intestinal pathologies was mostly classified ''clearly delimitable'' more difficulties occurred without oral contrast (neutral/positive/no contrast, 0.8 %/3.8 %/6.5 %). Compared to examinations without enteric contrast, there was a significant improvement in diagnosis that was even increased regarding the reader's diagnostic reliability. Positive opacification impaired detection of mucosal enhancement or intestinal bleeding. Water can replace positive enteric contrast agents in abdominal CTs. However, selected clinical questions require individual enteric contrast preparations. Pathology detection is noticeably impaired without any enteric contrast. circle Neutral oral contrast ensures an equivalent delineation of the bowel. (orig.)

  17. Abdominal and pelvic CT: is positive enteric contrast still necessary? Results of a retrospective observational study

    Evaluation of diagnostic accuracy of abdominal CT depending on the type of enteric contrast agent. Multislice CTs of 2,008 patients with different types of oral preparation (positive with barium, n = 576; neutral with water, n = 716; and no enteric contrast, n = 716) were retrospectively evaluated by two radiologists including delineation of intestinal segments and influence on diagnosis and diagnostic reliability exerted by the enteric contrast, using a three-point scale. Furthermore, diagnostic reliability of the delineation of selected enteric pathologies was noted. CT data were assigned into groups: oncology, inflammation, vascular, pathology, trauma and gastrointestinal pathology. Delineation of the bowel was clearly practicable across all segments irrespective of the type of enteric contrast, though a slight impairment was observed without enteric contrast. Although delineation of intestinal pathologies was mostly classified ''clearly delimitable'' more difficulties occurred without oral contrast (neutral/positive/no contrast, 0.8 %/3.8 %/6.5 %). Compared to examinations without enteric contrast, there was a significant improvement in diagnosis that was even increased regarding the reader's diagnostic reliability. Positive opacification impaired detection of mucosal enhancement or intestinal bleeding. Water can replace positive enteric contrast agents in abdominal CTs. However, selected clinical questions require individual enteric contrast preparations. Pathology detection is noticeably impaired without any enteric contrast. circle Neutral oral contrast ensures an equivalent delineation of the bowel. (orig.)

  18. Nursing student attitudes toward oncology nursing: an evidence-based literature review.

    Komprood, Sarah R

    2013-02-01

    Oncology education can impact nursing students' attitudes toward oncology and their interest in oncology nursing. To explore that relationship, a literature search was conducted using the CINAHL®, Cochrane Library, ERIC®, PubMed, and Scopus® databases. Nineteen pertinent studies were incorporated into the review, and recommendations were graded by strength of evidence schemas. The reviewed literature indicated undergraduate oncology education may be effective in encouraging nursing students to consider oncology as a practice area. Negative attitudes toward oncology such as fear and pessimism often are seen in students and practicing nurses. Educational interventions for students and nurses are effective in increasing knowledge and skills that are instrumental in fostering confidence and positive attitudes toward oncology nursing. All nursing students should have organized, mandatory clinical and didactic oncology nursing education experiences. Additional research is needed to support the effectiveness of educational strategies in influencing students' intent to practice oncology nursing. Innovative strategies including nontraditional clinical experiences, internships, fellowships, high-fidelity simulation, and postgraduate residencies are needed to provide adequate educational opportunities for nursing students to foster a strong and proficient oncology nursing workforce. PMID:23372107

  19. 腹针与神阙灸治疗慢性疲劳综合征临床研究%Clinical Study of Chronic Fatigue Syndrome Treated by Abdominal Acupuncture Combined with Moxibustion at Shenque (CV8)

    高建芸

    2016-01-01

    Objective:To explore the clinical curative effect of abdominal acupuncture combined with moxi-bustion at Shenque(CV8) on treatment of chronic fatigue Ssyndrome. Methods:A total of 80 outpatients in hospitals of Singapore area were randomly divided into abdominal acupuncture combined with moxibustion group of 42 cases and ordinary acupuncture group of 38 cases. Ten sessions were a course of treatment. Af-ter two courses,the curative effects and symptom scores of the two groups were compared. Results:The total effective rate was 92.86% in the abdominal acupuncture combined with moxibustion group and 84.21% in the ordinary acupuncture group,and the difference was statistically significant (P<0.05). The difference of symptom scores before and after treatment was 9.85 ±2.90 in the abdominal acupuncture combined with moxibustion group and 6.46 ±2.27 in the ordinary acupuncture group. The symptoms in the abdominal acupuncture combined with moxibustion group were improved more obviously than those in the ordinary acupuncture group,with significant difference(P<0.01).Conclusion:The clinical curative effect of abdominal acupuncture combined with moxibustion at Shenque(CV8) on treating chronic fatigue syndrome is better than that of the ordinary acupuncture.%目的:探究腹针配合神阙灸法治疗慢性疲劳综合征的临床疗效。方法:收集新加坡地区医院门诊病例80例,随机分为两组,腹针配合神阙灸组42例和常规体针组38例,治疗10次为1个疗程,2个疗程后观察临床疗效、统计治疗前后症状评分进行比较。结果:腹针配合神阙灸组总有效率92.86%,常规体针组为84.21%,差异有统计学意义(P<0.05);腹针配合神阙灸组治疗前后症状评分差值为9.85±2.90,常规体针组治疗前后差值为6.46±2.27,症状改善程度前者优于单纯体针治疗组,差异有统计学意义(P<0.01)。结论:腹针配合神阙灸法治疗慢性疲劳综合征临床

  20. MO-G-BRE-05: Clinical Process Improvement and Billing in Radiation Oncology: A Case Study of Applying FMEA for CPT Code 77336 (continuing Medical Physics Consultation)

    Purpose: The improvement of quality in healthcare can be assessed by Failure Mode and Effects Analysis (FMEA). In radiation oncology, FMEA, as applied to the billing CPT code 77336, can improve both charge capture and, most importantly, quality of the performed services. Methods: We created an FMEA table for the process performed under CPT code 77336. For a given process step, each member of the assembled team (physicist, dosimetrist, and therapist) independently assigned numerical values for: probability of occurrence (O, 1–10), severity (S, 1–10), and probability of detection (D, 1–10) for every failure mode cause and effect combination. The risk priority number, RPN, was then calculated as a product of O, S and D from which an average RPN was calculated for each combination mentioned above. A fault tree diagram, with each process sorted into 6 categories, was created with linked RPN. For processes with high RPN recommended actions were assigned. 2 separate R and V systems (Lantis and EMR-based ARIA) were considered. Results: We identified 9 potential failure modes and corresponding 19 potential causes of these failure modes all resulting in unjustified 77336 charge and compromised quality of care. In Lantis, the range of RPN was 24.5–110.8, and of S values – 2–10. The highest ranking RPN of 110.8 came from the failure mode described as “end-of-treatment check not done before the completion of treatment”, and the highest S value of 10 (RPN=105) from “overrides not checked”. For the same failure modes, within ARIA electronic environment with its additional controls, RPN values were significantly lower (44.3 for end-of-treatment missing check and 20.0 for overrides not checked). Conclusion: Our work has shown that when charge capture was missed that also resulted in some services not being performed. Absence of such necessary services may result in sub-optimal quality of care rendered to patients

  1. 薄氏腹针结合加味逍遥胶囊治疗中风后抑郁症临床研究%Clinical Study in Bo's Abdominal Acupuncture Combined with Jiawei Xiaoyao Capsule Treating Depression after Stroke

    曾姿霈; 吴绍汉

    2014-01-01

    To observe the therapeutic effect of Bo's abdominal acupuncture combined with Jiawei Xiaoyao capsule treating depression af-ter stroke. Methods:100 patients with depression after stroke were randomly divided into treatment group and control group with each of 50 cases, treatment group treated with Bo's abdominal acupuncture and Jiawei Xiaoyao capsule, control group with oral doxepin hydrochloride, to observe the clinical efficacy of the two groups. Results:HMAD scores of the two groups after treatment were both significantly lower than those before treat-ment (P<0.05);the total effective rate of treatment group was significantly higher than that of control group (P<0.05). Conclusion:The effect of Bo's abdominal acupuncture combined with Jiawei Xiaoyao capsule treating depression after stroke is significant.%目的:观察薄氏腹针结合加味逍遥胶囊治疗中风后抑郁症的疗效。方法:100例中风后抑郁症患者随机分为治疗组与对照组各50例,治疗组采用薄氏腹针结合加味逍遥胶囊治疗,对照组口服盐酸多塞平片,观察两组临床疗效。结果:两组患者治疗后HMAD评分均显著低于治疗前(P<0.05);治疗组总有效率显著高于对照组(P<0.05)。结论:薄氏腹针结合加味逍遥胶囊治疗中风后忧郁症疗效显著。

  2. 腹针联合梅花针治疗原发性失眠的临床研究%Clinical study on abdominal acupuncture plus plum-blossom needle tapping for primary insomnia

    邓越; 马迎歌; 王丽平; 韩丑萍

    2016-01-01

    Objective:To investigate the clinical efficacy and action mechanism of abdominal acupuncture plus plum-blossom needle tapping for primary insomnia.Methods:A total of 66 eligible cases were randomly allocated into an observation group (n=33) and a control group (n=33). Cases in the observation group received abdominal acupuncture plus plum-blossom needle tapping, whereas cases in the control group received abdominal acupuncture alone. After 2, 6 weeks of treatment and 4 weeks after end of treatment, the patients in both groups were evaluated using the Pittsburgh sleep quality index (PSQI) and measure your medical outcome profile (MYMOP) based on the patients' self-report. Results:After 2 weeks of treatment, the total effective rate was 90.9% in the observation group, versus 63.6% in the control group, showing a statistical difference (P0.05). After 6 weeks, the sleep quality and efficiency scores in the observation group were better than those in the control group. Four weeks after end of treatment, the scores of sleep quality and MYMOP in the observation group were better than those in the control group (P0.05).治疗6星期后, 观察组睡眠质量及睡眠效率评分优于对照组; 治疗结束4星期后, 观察组睡眠质量、MYMOP评分优于腹针组, 组间差异有统计学意义(P<0.05).结论:腹针联合梅花针疗法治疗失眠症起效快, 疗效确切, 能较好改善患者睡眠质量, 提高睡眠效率.

  3. 头针、腹针结合火针治疗腰椎间盘突出症临床研究%The clinical research on scalp acupuncture, abdominal acupuncture combining fire needle treating Lumbar Disc Herniation

    谭俊健

    2013-01-01

      目的:观察头针、腹针结合火针治疗腰椎间盘突出症的临床疗效.方法:选择我科2009年2月至2010年2月门诊治疗的腰椎间盘突出症患者68例,随机分为治疗组和对照组.治疗组用头针、腹针加火针的方法治疗,对照组用电针治疗.观察两组治疗前后症状改善情况.结果:两组相比治愈率及治疗次数均有显著性差异(P<0.01).结论:头针、腹针配合火针治疗腰椎间盘突出症效果明显优于电针.%Objective:To observe the efficacy of scalp acupuncture, abdominal acupuncture com-bining fire needle treating lumbar disc herniation (LDH). Methods:68 patients with LDH treating in outpatient Clinic were randomly divided into treatment group and control group. The treatment group was used the method of scalp acupuncture, abdominal acupuncture combining fire needle to treat LDH, While the control group used electroacupuncture. Observed the situation of symptoms improved between two groups before and after treatment. Results:The recovery rate and treatment times had significant difference between two groups (P<0.01). Conclusion: The effect of using scalp acupuncture, abdominal acupuncture combining fire needle treating LDH is better than that of electroacupuncture

  4. An Increase in Medical Student Knowledge of Radiation Oncology: A Pre-Post Examination Analysis of the Oncology Education Initiative

    Purpose: The Oncology Education Initiative was created to advance oncology and radiation oncology education by integrating structured didactics into the existing core radiology clerkship. We set out to determine whether the addition of structured didactics could lead to a significant increase in overall medical student knowledge about radiation oncology. Methods and Materials: We conducted a pre- and posttest examining concepts in general radiation oncology, breast cancer, and prostate cancer. The 15-question, multiple-choice exam was administered before and after a 1.5-hour didactic lecture by an attending physician in radiation oncology. Individual question changes, overall student changes, and overall categorical changes were analyzed. All hypothesis tests were two-tailed (significance level 0.05). Results: Of the 153 fourth-year students, 137 (90%) took the pre- and posttest and were present for the didactic lecture. The average test grade improved from 59% to 70% (p = 0.011). Improvement was seen in all questions except clinical vignettes involving correct identification of TNM staging. Statistically significant improvement (p ≤ 0.03) was seen in the questions regarding acute and late side effects of radiation, brachytherapy for prostate cancer, delivery of radiation treatment, and management of early-stage breast cancer. Conclusions: Addition of didactics in radiation oncology significantly improves medical students' knowledge of the topic. Despite perceived difficulty in teaching radiation oncology and the assumption that it is beyond the scope of reasonable knowledge for medical students, we have shown that even with one dedicated lecture, students can learn and absorb general principles regarding radiation oncology

  5. The Radiation Therapy Oncology in the context of oncological practice

    This work is about the radiation therapy oncology in the context of oncological practice. The radiotherapy is a speciality within medicine that involves the generation, application and dissemination of knowledge about the biology, causes, prevention and treatment of the cancer and other pathologies by ionising radiation

  6. Abdominal ultrasound (image)

    Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X- ... use high frequency sound waves to produce an image and do not expose the individual to radiation. ...

  7. Abdominal CT scan

    Computed tomography scan - abdomen; CT scan - abdomen; CAT scan - abdomen; CT abdomen and pelvis ... An abdominal CT scan makes detailed pictures of the structures inside your belly (abdomen) very quickly. This test may be used to ...

  8. Abdominal Pain Syndrome

    ... inspection of a drop of urine), and urine culture for bacterial infection. Stools can be analyzed for ... Hepatitis C Inflammatory Bowel Disease Irritable Bowel Syndrome Obesity Digestive Health Topics Abdominal Pain Syndrome Belching, Bloating, ...

  9. Abdominal tuberculosis: Imaging features

    Radiological findings of abdominal tuberculosis can mimic those of many different diseases. A high level of suspicion is required, especially in high-risk population. In this article, we will describe barium studies, ultrasound (US) and computed tomography (CT) findings of abdominal tuberculosis (TB), with emphasis in the latest. We will illustrate CT findings that can help in the diagnosis of abdominal tuberculosis and describe imaging features that differentiate it from other inflammatory and neoplastic diseases, particularly lymphoma and Crohn's disease. As tuberculosis can affect any organ in the abdomen, emphasis is placed to ileocecal involvement, lymphadenopathy, peritonitis and solid organ disease (liver, spleen and pancreas). A positive culture or hystologic analysis of biopsy is still required in many patients for definitive diagnosis. Learning objectives:1.To review the relevant pathophysiology of abdominal tuberculosis. 2.Illustrate CT findings that can help in the diagnosis

  10. The clinical study of acupuncture and moxibustion treating postpartum abdominal pain%选穴针灸治疗产后腹痛临床研究

    孙会云

    2013-01-01

    目的:寻求一种简单、有效、副作用小的治疗产后腹痛的方法。方法:2012年6月至2013年6月,我院对86人采用选穴针灸治疗法治疗,效果确切。结果:治疗组产妇平均治疗天数3天,对照组平均治疗天数5天,治疗组86人治疗过程中无任何副反应,治疗组有效率达98.81%,对照组仅84.04%。结论:针灸治疗可提高产妇抵抗力,针刺止痛,价格适宜,疗程短,治愈率高,既减轻了产后腹痛患者因长期服用西药引起的不良反应和过重的经济负担,又为患者解除了腹痛难耐的痛苦,针到病除,无任何毒副作用。%Objective To find a simple, effective method for treatment of abdominal pain, postpartum the side effect is smal:Method in 2012 June to 2013 June, our hospital on the 86 people with acupoint acupuncture therapy, to observe the effect of treatment. Results the average number of days to 3 days of maternal treatment, control group mean treatment time was 5 days, without any side reactions in the treatment group 86 people in the course of treatment, the effective rate of treatment group was 98.81%, control group was only 84.04%. Conclusion acupuncture treatment can improve maternal resistance, acupuncture analgesia, reasonable price, short treatment course, high cure rate, reduce postpartum abdominal pain patients because of adverse reactions caused by long-term use of Western medicine and heavy economic burden, but also relieve the abdominal pain unbearable pain to the patient, the needle to the disease, without any side effects.

  11. Novas diretrizes na abordagem clínica da neutropenia febril e da sepse em oncologia pediátrica New guidelines for the clinical management of febrile neutropenia and sepsis in pediatric oncology patients

    Ana Verena Almeida Mendes

    2007-05-01

    precoce são fundamentais para a melhora da sobrevida.OBJECTIVES: To provide a foundation for the diagnostic, prophylactic and therapeutic management of febrile neutropenia and sepsis in children with oncological diseases, with special attention to new protocols and guidelines. SOURCES: A review of the scientific literature utilizing an electronic bibliographic search on MEDLINE, Medscape, SciELO, Google, Cochrane and PubMED using the keywords febrile, neutropenic, cancer, children, sepsis, intensive, care. Articles published between 1987 and 2007 were selected, with preference given to review articles, protocols, systematic reviews, epidemiological studies, task force recommendations and phase III clinical trials. Consensus documents published by the Infectious Diseases Society of America, the Center for Diseases Control and the Infectious Diseases Working Party of the German Society of Hematology and Oncology, in addition to the recommendations of the World Federation of Pediatric Intensive and Critical Care Societies and Society of Critical Care Medicine, were also reviewed. SUMMARY OF THE FINDINGS: The use of aggressive chemotherapy regimens, bone marrow transplantation and intensive care resources have increased the survival rates of children with cancer and also their infectious morbidity, with septic complications as the principal cause of mortality. Several risk factors have been identified, such as neutropenia, oncology type, clinical signs and inflammatory response markers (polymerase chain reaction, procalcitonin and also increased resistance to antimicrobials and antifungal agents. Protocols for risk classification, diagnosis and treatment should be established at each service, taking into account the microbiological flora of each population. Pediatric intensive care has increased the short and long-term survival of these patients. CONCLUSIONS: Oncology patients are particularly vulnerable to infectious complications. Early identification and treatment are

  12. Radiation oncology a physicist's-eye view

    Goitein, Michael

    2007-01-01

    Radiation Oncology: A Physicist's-Eye View was written for both physicists and medical oncologists with the aim of helping them approach the use of radiation in the treatment of cancer with understanding, confidence, and imagination. The book will let practitioners in one field understand the problems of, and find solutions for, practitioners in the other. It will help them to know "why" certain approaches are fruitful while, at the same time, encouraging them to ask the question "Why not?" in the face of assertions that some proposal of theirs is impractical, unreasonable, or impossible. Unlike a textbook, formal and complete developments of the topics are not among the goals. Instead, the reader will develop a foundation for understanding what the author has found to be matters of importance in radiation oncology during over thirty years of experience. Presentations cover, in largely non-technical language, the principal physical and biological aspects of radiation treatment and address practical clinical c...

  13. Neuro-oncology of CNS tumors

    Tonn, J.C. [Klinikum Grosshadern, Muenchen (Germany). Dept. of Neurosurgery; Westphal, M. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Neurochirurgische Klinik; Rutka, J.T. [Toronto Univ. Hospital for Sick Children, ON (Canada). Div. of Neurosurgery; Grossmann, S.A. (eds.) [Johns Hopkins Oncology Center Neuro-Oncology, Baltimore, MD (United States)

    2006-07-01

    Diagnosis and treatment modalities for neuro-oncologic diseases have made considerable advances in recent years. There is hardly a segment of the field of solid tumours that is experiencing such dynamic development with regard to basic scientific findings and clinical results. In the present book the world's leading experts have compiled the current practice-relevant knowledge of neuro-oncologic diseases. The book's clear structure and the uniform presentation of all chapters make this volume a valuable reference, especially for practice-oriented activities, allowing swift access to information about current treatment standards. Hence it will be of great value to both clinicians and researchers. (orig.)

  14. Ultra-low dose abdominal MDCT: Using a knowledge-based Iterative Model Reconstruction technique for substantial dose reduction in a prospective clinical study

    Khawaja, Ranish Deedar Ali, E-mail: rkhawaja@mgh.harvard.edu [MGH Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Singh, Sarabjeet; Blake, Michael; Harisinghani, Mukesh; Choy, Gary; Karosmangulu, Ali; Padole, Atul; Do, Synho [MGH Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Brown, Kevin; Thompson, Richard; Morton, Thomas; Raihani, Nilgoun [CT Research and Advanced Development, Philips Healthcare, Cleveland, OH (United States); Koehler, Thomas [Philips Technologie GmbH, Innovative Technologies, Hamburg (Germany); Kalra, Mannudeep K. [MGH Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States)

    2015-01-15

    Highlights: • Limited abdominal CT indications can be performed at a size specific dose estimate of (SSDE) 1.5 mGy (∼0.9 mSv) in smaller patients (BMI less than or equal to 25 kg/m{sup 2}) using a knowledge based Iterative Model Reconstruction (IMR) technique. • Evaluation of liver tumors and pathologies is unacceptable at this reduced dose with IMR technique especially in patients with a BMI greater than 25 kg/m{sup 2}. • IMR body soft tissue and routine settings perform substantially better than IMR sharp plus setting in reduced dose CT images. • At SSDE of 1.5 mGy, objective image noise in reduced dose IMR images is 8–56% less than compared to standard dose FBP images, with lowest image noise in IMR body-soft tissue images. - Abstract: Purpose: To assess lesion detection and image quality parameters of a knowledge-based Iterative Model Reconstruction (IMR) in reduced dose (RD) abdominal CT examinations. Materials and methods: This IRB-approved prospective study included 82 abdominal CT examinations performed for 41 consecutive patients (mean age, 62 ± 12 years; F:M 28:13) who underwent a RD CT (SSDE, 1.5 mGy ± 0.4 [∼0.9 mSv] at 120 kV with 17–20 mAs/slice) immediately after their standard dose (SD) CT exam (10 mGy ± 3 [∼6 mSv] at 120 kV with automatic exposure control) on 256 MDCT (iCT, Philips Healthcare). SD data were reconstructed using filtered back projection (FBP). RD data were reconstructed with FBP and IMR. Four radiologists used a five-point scale (1 = image quality better than SD CT to 5 = image quality unacceptable) to assess both subjective image quality and artifacts. Lesions were first detected on RD FBP images. RD IMR and RD FBP images were then compared side-by-side to SD-FBP images in an independent, randomized and blinded fashion. Friedman's test and intraclass correlation coefficient were used for data analysis. Objective measurements included image noise and attenuation as well as noise spectral density (NSD) curves

  15. Clinical application of 13C breath test in pediatric abdominal pain%13C呼气试验在儿科腹痛症状疾病中的临床应用

    张莹莹

    2016-01-01

    目的:探讨13C 呼气试验对儿科腹痛疾病的诊断价值。方法:收治腹痛患儿446例,采用13C 呼气试验法检测,主要检测幽门螺杆菌感染。对确诊幽门螺杆菌感染的患者实施针对性治疗,于治疗后2个月进行回访调查,统计治疗前后感染症状的差异性。结果:本次13C呼气试验检测阳性169例,阳性率37.9%。患儿感染症状表现反酸、胃灼热、胃痛、口臭、上腹部不适等症状。结论:13C呼气试验是临床检测幽门螺杆菌的有效方法,对儿科腹痛诊断具有较高价值。%Objective:To explore the diagnostic value of 13C breath test in pediatric abdominal pain.Methods:446 patients with abdominal pain were selected.They were given 13C breath test for detection of helicobacter pylori infection.Patients diagnosed with helicobacter pylori infection were given targeted therapy.After 2 months of treatment,all patients received a return visit survey.We compared the differences of symptoms before and after treatment.Results:In this 13C breath test,169 cases were positive,and the positive rate was 37.9%.Symptoms of infection were mainly acid reflux,heartburn,stomach pain,bad breath,abdominal discomfort and other symptoms.Conclusion: 13C breath test was an effective method for clinical detection of helicobacter pylori,and it was of high value in the diagnosis of pediatric abdominal pain.

  16. Recurrent incisional hernia, enterocutaneous fistula and loss of the substance of the abdominal wall: plastic with organic prosthesis, skin graft and VAC therapy. Clinical case.

    Nicodemi, Sara; Corelli, Sergio; Sacchi, Marco; Ricciardi, Edoardo; Costantino, Annarita; Di Legge, Pietro; Ceci, Francesco; Cipriani, Benedetta; Martellucci, Annunziata; Santilli, Mario; Orsini, Silvia; Tudisco, Antonella; Stagnitti, Franco

    2015-01-01

    Surgical wounds dehiscence is a serious post-operatory complication, with an incidence between 0.4% and 3.5%. Mortality is more than 45%. Complex wounds treatment may require a multidisciplinary management. VAC Therapy could be an alternative treatment regarding complex wound. VAC therapy has been recently introduced on skin's graft tissue management reducing skin graft rejection. The use of biological prosthesis has been tested in a contaminated field, better than synthetic meshes, which often need to be removed. The Permacol is more resistant to degradation by proteases due to its cross-links. Surgery is still considered the best treatment for digestive fistula. A 58 years old obese woman come to our attention, she was operated for an abdominal hernia. She had a post-operatory entero-cutaneous fistula. She was submitted to bowel resection, the anastomosis has been tailored and the hernia of the abdominal wall has been repaired with biological mesh for managing such condition. She had a wound dehiscence with loss of substance and the exposure of the biological prosthesis, nearly 20 cm diameter. She was treated first with antibiotic therapy and simple medications. In addiction, antibiotic therapy was necessary late associated to 7 months with advanced medications allowed a small reduction's defect. Because of its, treatment went on for two more months using VAC therapy. Antibiotic's therapy was finally suspended. The VAC therapy allowed the reduction of the gap, between skin and subcutaneous tissue, and the defect's size preparing a suitable ground for the skin graft. The graft, managed with the vac therapy, was necessary to complete the healing process. PMID:25953007

  17. Oncology nurses awareness of drug interactions

    Azize Karahan

    2015-01-01

    Full Text Available Objective: The aim of this study was to determine oncology nurses awareness of drug interactions. Methods: This descriptive study was conducted with nurses working in the oncology clinics who are a member of Oncology Nursing Association of Turkey. A total of 115 nurses (response rate %20 were responded to the online survey that consists of 28 questions. Results: The mean age of the nurses was 33 ± 6.8. The majority of nurses work in university hospital (60% as a clinical nurse (62.6% and have a Bachelor Degree in Nursing (63.5%. The mean working years in oncology was 4 years. Half of them stated receiving information on drug interactions mostly through in-service education and courses/congresses in last 5 years. The majority of them (84.3% indicated that they are considering the possibility of drug interactions when they are scheduling the medication administration time. More than half of the responders (59.1% encountered drug interactions; however, few explored drug interactions with food, drinks, and nutritional supplements. Their practices to assess possibility of drug interactions were reviewing the drug prospectus (78.3%; consulting with their colleagues (58.3% and searching on the available website (42.6% and looking at the drug interaction (39.1%. More than half (65.2% stated lack of any system to identify drug interactions in their workplace. Nearly half of them indicated to including the drug interaction into patient education mostly for food-drug (73.9% and drug-drug (63.5% interactions. Conclusions: Almost all indicated the needs for further education on drug interactions and suggested to have guideline/packet guide.

  18. Case Study for Integration of an Oncology Clinical Site in a Semantic Interoperability Solution based on HL7 v3 and SNOMED-CT: Data Transformation Needs.

    Ibrahim, Ahmed; Bucur, Anca; Perez-Rey, David; Alonso, Enrique; de Hoog, Matthy; Dekker, Andre; Marshall, M Scott

    2015-01-01

    This paper describes the data transformation pipeline defined to support the integration of a new clinical site in a standards-based semantic interoperability environment. The available datasets combined structured and free-text patient data in Dutch, collected in the context of radiation therapy in several cancer types. Our approach aims at both efficiency and data quality. We combine custom-developed scripts, standard tools and manual validation by clinical and knowledge experts. We identified key challenges emerging from the several sources of heterogeneity in our case study (systems, language, data structure, clinical domain) and implemented solutions that we will further generalize for the integration of new sites. We conclude that the required effort for data transformation is manageable which supports the feasibility of our semantic interoperability solution. The achieved semantic interoperability will be leveraged for the deployment and evaluation at the clinical site of applications enabling secondary use of care data for research. This work has been funded by the European Commission through the INTEGRATE (FP7-ICT-2009-6-270253) and EURECA (FP7-ICT-2011-288048) projects. PMID:26306242

  19. [Intestinal occlusion and abdominal compartment syndrome (ACS)].

    Stagnitti, Franco

    2009-01-01

    a critical clinical condition of Polycompartment Syndrome. The monitoring of Abdominal Perfusion Pressure (APP) is more correct than the measurement of IAP because it reveals hydrodynamic alterations in the abdominal compartment. The APP (MAP-IAP) depends on arterial flow, venous outflow and capacity of the abdominal compartments response to increased internal volumes. The medical therapy used to decrease IAH and to contrast ACS is intestinal decompression with gastric and rectal tube; colonic endoscopic detention; correction of electrolytic abnormalities and prokinetic agents. Surgery, besides being decompressive and resolutive, must prevent a recurrence of ACS through the "tension-free closure" procedure. PMID:20476671

  20. [Dignity therapy in oncology].

    Ripamonti, Carla Ida

    2016-04-01

    In oncology, little is known about dignity, dignity-related distress and the issues that influence the sense of dignity for patients. Dignity is personal, subject to changes depending on the experience and the path of life. In oncology some patients feel that their dignity is directly related to the disease, to physical and emotional symptoms, to the highest level of physical and cognitive autonomy and to the continuity of the self. Patient dignity inventory (PDI) is a validate tool designed to measure various sources of dignity-related distress among patients nearing the end of life and serve as a screening tool to assess a broad range of issues that influence the sense of dignity. Dignity therapy is a novel focused psychotherapy consisting in a brief semi-structured interview, audio-recorded and transcribed in order to obtain the "generativity document". The patients are invited to tell about their life history, and to leave words of guidance and offer instructions to pass along to their son, daughters, husband, wife, parents, others. The generativity document is the result of process of emotional and existential care for the patients and a gift for everybody will receive it. PMID:27093325

  1. Urgent Abdominal Re-Explorations

    Peskersoy Mustafa

    2006-04-01

    Full Text Available Abstract Background Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Abdominal Re-explorations (UARs, the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing UARs, outcomes of relaparotomies (RLs and factors that affect mortality. Methods Demographic characteristics; initial diagnoses; information from and complications of the first surgery received; durations and outcomes of UAR(s performed in patients who received early RLs because of complicated abdominal surgeries in our clinic between 01.01.2000 and 31.12.2004 were investigated retrospectively. Statistical analyses were done using the chi-square and Fisher exact tests. Results Early UAR was performed in 81 out of 4410 cases (1.8%. Average patient age was 50.46 (13–81 years with a male-to-female ratio of 60/21. Fifty one (62.96% patients had infection, 41 (50.61% of them had an accompanying serious disease, 24 (29.62% of them had various tumors and 57 (70.37% patients were operated under emergency conditions during first operation. Causes of urgent abdominal re-explorations were as follows: leakage from intestinal repair site or from anostomosis (n:34; 41.97%; hemorrhage (n:15; 18.51%; intestinal perforation (n:8; 9.87%; intraabdominal infection or abscess (n:8; 9.87%; progressive intestinal necrosis (n:7; 8.64%; stomal complications (n:5; 6.17%; and postoperative ileus (n:4; 4.93%. Two or more UARs were performed in 18 (22.22% cases, and overall mortality was 34.97% (n:30. Interval between the first laparotomy and UAR averaged as 6.95 (1–20 days, and average hospitalization period was 27.1 (3–78 days. Mortality rate was found to be higher among the patients who received multiple UARs. The most common (55.5% cause of mortality was sepsis/multiple organ failure (MOF. The rates for common mortality and sepsis/MOF-dependent mortality that occured following UAR were

  2. Rasburicase in the prevention of laboratory/clinical tumour lysis syndrome in children with advanced mature B-NHL: A Children’s Oncology Group Report

    Galardy, Paul; Hochberg, Jessica; Perkins, Sherrie L.; Harrison, Lauren; Goldman, Stanton; Cairo, Mitchell S

    2013-01-01

    Laboratory (LTLS) and clinical (CTLS) tumour lysis syndrome (TLS) are frequent complications in newly diagnosed children with advanced mature B cell non-Hodgkin lymphoma (B-NHL). Rasburicase, compared to allopurinol, results in more rapid reduction of uric acid in paediatric patients at risk for TLS. However, the safety and efficacy of rasburicase for the treatment or or prevention of TLS has not been prospectively evaluated. Children with newly diagnosed stage III–IV, bone marrow+ and/or cen...

  3. Natural history of abdominal aortic aneurysm

    Perko, M J; Schroeder, T V; Olsen, P S;

    1993-01-01

    During a 10-year period in which 735 patients presented with abdominal aortic aneurysms to our clinic, 63 were not offered operative treatment. The primary reason for choosing conservative treatment was concomitant diseases that increased the risk of operation. After 2 years of followup, half of ...

  4. National Institutes of Health Funding in Radiation Oncology: A Snapshot

    Currently, pay lines for National Institutes of Health (NIH) grants are at a historical low. In this climate of fierce competition, knowledge about the funding situation in a small field like radiation oncology becomes very important for career planning and recruitment of faculty. Unfortunately, these data cannot be easily extracted from the NIH's database because it does not discriminate between radiology and radiation oncology departments. At the start of fiscal year 2013 we extracted records for 952 individual grants, which were active at the time of analysis from the NIH database. Proposals originating from radiation oncology departments were identified manually. Descriptive statistics were generated using the JMP statistical software package. Our analysis identified 197 grants in radiation oncology. These proposals came from 134 individual investigators in 43 academic institutions. The majority of the grants (118) were awarded to principal investigators at the full professor level, and 122 principal investigators held a PhD degree. In 79% of the grants, the research topic fell into the field of biology, 13% in the field of medical physics. Only 7.6% of the proposals were clinical investigations. Our data suggest that the field of radiation oncology is underfunded by the NIH and that the current level of support does not match the relevance of radiation oncology for cancer patients or the potential of its academic work force

  5. Clinical study on laparoscopic vs.open treatments for geriatric abdominal wall incision hernia%腹腔镜与开放手术治疗老年腹壁切口疝的临床研究

    王嘉; 安伟德; 李玉文; 徐雪东; 张伟国

    2015-01-01

    目的 探讨开放与腹腔镜切口疝修补术对老年腹壁切口疝患者的临床疗效.方法 分析60周岁以上腹壁切口疝患者52例的临床资料,其中开放组24例,腹腔镜组28例.结果 两组在手术时间、切口感染、血清肿方面比较差异无统计学意义(P>0.05),但腹腔镜组术中出血量[(9±4) ml]、住院时间[(8±3)d]、术后疼痛7例(25.01%),明显优于开放组(P<0.05).两组均无患者死亡,随访3个月至2年,开放组复发3例,腹腔镜组未见复发.结论 两种治疗方法同样安全有效,但腹腔镜切口疝修补术具有创伤小、疼痛轻、恢复快、住院时间短等优点.%Objective To explore the clinical effectiveness of open incisional hernia repair vs.laparoscopic incisional hernia repair for geriatric abdominal wall incisional hernia.Methods The clinical data of 52 patients above 60 years old with abdominal wall incisional hernia were analyzed,including 24 cases in the open group and 28 cases in the laparoscopic group.Results No significant difference in operation time,wound infection,and seromas was observed.However,blood loss [(9 ± 4) ml] was reduced,and hospital stay [(g ±3) d] was shortened in the laparoscopic group as compared with the open group.Postoperative pain occurred in 7 cases (25.01%) of laparoscopie group.There were no deaths in both two groups.During a follow-up period of 3 months to 2 years,there were 3 relapsed cases in the open group,and no recurrence occurred in the laparoscopic group.Conclusion Both open and laparoscopic treatments are safe and effective,but laparoseopie incisional hernia repair has the less trauma,milder pain,more rapid recovery,and shorter hospital stays for geriatric abdominal wall incisional hernia.

  6. Balancing high accrual and ethical recruitment in paediatric oncology: a qualitative study of the 'look and feel' of clinical trial discussions

    Eden Tim OB

    2010-10-01

    Full Text Available Abstract Background High accrual to clinical trials enables new treatment strategies to be tested rapidly, accurately and with generalisability. Ethical standards also must be high so that participation is voluntary and informed. However, this can be difficult to achieve in trials with complex designs and in those which are closely embedded in clinical practice. Optimal recruitment requires a balance of both ethical and accrual considerations. In the context of a trial of stratified treatments for children with acute lymphoblastic leukaemia (UKALL2003 we examined how recruitment looked to an observer and how it felt to the parents, to identify how doctors' communication could promote or inhibit optimal recruitment. Methods We audio-recorded, transcribed and analysed routine doctor-patient consultations (n = 20 and interviews between researchers and parents (n = 30 parents across six UK treatment centres. Analysis was informed by the constant comparative method. For consultation transcripts, analysis focussed on how doctors presented the trial. We compared this with analysis of the interview transcripts which focussed on parents' perceptions and understanding of the trial. Results Parents and doctors discussed the trial in most consultations, even those that did not involve a decision about randomisation. Doctors used language allying them both with the trial and with the parent, indicating that they were both an 'investigator' and a 'clinician'. They presented the trial both as an empirical study with a scientific imperative and also as offering personalisation of treatment for the child. Parents appeared to understand that trial involvement was voluntary, that it was different from routine care and that they could withdraw from the trial at any time. Some were confused about the significance of the MRD test and the personalisation of treatment. Conclusions Doctors communicated in ways that generally promoted optimal recruitment, indicating that

  7. Significance of residual abdominal masses in children with abdominal Burkitt's lymphoma

    Karmazyn, B.; Horev, G.; Kornreich, L. [Dept. of Diagnostic Radiology, Schneider Children' s Medical Center of Israel, Petah-Tikva (Israel); Ash, S.; Goshen, Y.; Yaniv, I. [Dept. of Hematology and Oncology, Schneider Children' s Medical Center of Israel, Petah-Tikva (Israel)

    2001-11-01

    Purpose: To evaluate the natural history of children with abdominal Burkitt's lymphoma who had complete clinical remission and residual abdominal mass after treatment. Material and methods: The charts and imaging findings of all children with abdominal Burkitt's lymphoma treated and followed at our medical center between 1988 and 1999 were reviewed for the presence, management, clinical course, and prognosis of residual mass. Results: Only children who achieved complete clinical remission were included. The study group consisted of 33 children (20 boys and 13 girls) aged 2.6-17.6 years (mean 7.2 years). Of these, seven (20.6 %) were found to have a residual abdominal mass. Two underwent second-look operation with no evidence of viable tumor on histology. The remaining five were followed by imaging studies for 2.2-9.1 years (mean 6.1 years); none relapsed. Conclusion: Residual mass is not uncommon in children with abdominal Burkitt's lymphoma. The presence of residual mass in a child with complete clinical remission does not alter the long-term prognosis. Therefore, in children with Burkitt's lymphoma and residual mass with no other signs of disease activity, expectant watching may be appropriate. (orig.)

  8. Significance of residual abdominal masses in children with abdominal Burkitt's lymphoma

    Purpose: To evaluate the natural history of children with abdominal Burkitt's lymphoma who had complete clinical remission and residual abdominal mass after treatment. Material and methods: The charts and imaging findings of all children with abdominal Burkitt's lymphoma treated and followed at our medical center between 1988 and 1999 were reviewed for the presence, management, clinical course, and prognosis of residual mass. Results: Only children who achieved complete clinical remission were included. The study group consisted of 33 children (20 boys and 13 girls) aged 2.6-17.6 years (mean 7.2 years). Of these, seven (20.6 %) were found to have a residual abdominal mass. Two underwent second-look operation with no evidence of viable tumor on histology. The remaining five were followed by imaging studies for 2.2-9.1 years (mean 6.1 years); none relapsed. Conclusion: Residual mass is not uncommon in children with abdominal Burkitt's lymphoma. The presence of residual mass in a child with complete clinical remission does not alter the long-term prognosis. Therefore, in children with Burkitt's lymphoma and residual mass with no other signs of disease activity, expectant watching may be appropriate. (orig.)

  9. Osteonecrosis - complication at oncological treatment in childhood

    Osteonecrosis is one of serious complications at oncological treatment of children. The etiopathogenesis has not been completely elucidated, mostly it has a multifactorial character. The incidence is in 1,5 - 9,3 % range. ON affects predominantly the weight bearing joints. It affects mostly the patients with acute lymphoblastic leukemia and those at adolescent age. The course of disease is unpredictable. The changes at early stages can be reversible, but at some patients the disease progresses and can lead to a disability. At Children oncology clinic of Children teaching hospital in Bratislava during the years 1992 - 2008 we identified 12 patients affected by ON out of 146 children with ALL (8,2 %), 1 out of 42 with NHL (2,4 %) and 1 out of 42 with HL (2,4 %). The age at diagnosis of malignity: 4y7m - 17y, the age at diagnosis ON: 10y5m - 19y. Further course: regression - 2 patients, stabilised state - 6 patients, progression - 3 patients. 3 patients were lost from our follow up. The treatment was conservative, with the exception of one patient, who had to undergo surgery due to the progression of disease. To avoid the risk of inducing ON during the treatment of oncological patient in childhood it is important to optimalize the therapeutical protocols and to diagnose this complication early. (author)

  10. Single-photon emission computed tomography/computed tomography in abdominal diseases.

    Schillaci, Orazio; Filippi, Luca; Danieli, Roberta; Simonetti, Giovanni

    2007-01-01

    Single-photon emission computed tomography (SPECT) studies of the abdominal region are established in conventional nuclear medicine because of their easy and large availability, even in the most peripheral hospitals. It is well known that SPECT imaging demonstrates function, rather than anatomy. It is useful in the diagnosis of various disorders because of its ability to detect changes caused by disease before identifiable anatomic correlates and clinical manifestations exist. However, SPECT data frequently need anatomic landmarks to precisely depict the site of a focus of abnormal tracer uptake and the structures containing normal activity; the fusion with morphological studies can furnish an anatomical map to scintigraphic findings. In the past, software-based fusion of independently performed SPECT and CT or magnetic resonance images have been demonstrated to be time consuming and not useful for routine clinical employment. The recent development of dual-modality integrated imaging systems, which provide SPECT and CT images in the same scanning session, with the acquired images co-registered by means of the hardware, has created a new scenario. The first data have been mainly reported in oncology patients and indicate that SPECT/CT is very useful because it is able to provide further information of clinical value in several cases. In SPECT studies of abdominal diseases, hybrid SPECT/CT can play a role in the differential diagnosis of hepatic hemangiomas located near vascular structures, in precisely detecting and localizing active splenic tissue caused by splenosis in splenectomy patients, in providing important information for therapy optimization in patients submitted to hepatic arterial perfusion scintigraphy, in accurately identifying the involved bowel segments in patients with inflammatory bowel diseases, and in correctly localizing the bleeding sites in patients with gastrointestinal bleeding. PMID:17161039

  11. Guidelines for timely initiation of chemotherapy: a proposed framework for access to medical oncology and haematology cancer clinics and chemotherapy services.

    Alexander, M; Beattie-Manning, R; Blum, R; Byrne, J; Hornby, C; Kearny, C; Love, N; McGlashan, J; McKiernan, S; Milar, J L; Murray, D; Opat, S; Parente, P; Thomas, J; Tweddle, N; Underhill, C; Whitfield, K; Kirsa, S; Rischin, D

    2016-08-01

    These guidelines, informed by the best available evidence and consensus expert opinion, provide a framework to guide the timely initiation of chemotherapy for treating cancer. They sit at the intersection of patient experience, state-of-the-art disease management and rational efficient service provision for these patients at a system level. Internationally, cancer waiting times are routinely measured and publicly reported. In Australia, there are existing policies and guidelines relating to the timeliness of cancer care for surgery and radiation therapy; however, until now, equivalent guidance for chemotherapy was lacking. Timeliness of care should be informed, where available, by evidence for improved patient outcomes. Independent of this, it should be recognised that shorter waiting periods are likely to reduce patient anxiety. While these guidelines were developed as part of a proposed framework for consideration by the Victorian Department of Health, they are clinically relevant to national and international cancer services. They are intended to be used by clinical and administrative staff within cancer services. Adoption of these guidelines, which are for the timely triage, review and treatment of cancer patients receiving systemic chemotherapy, aims to ensure that patients receive care within a timeframe that will maximise health outcomes, and that access to care is consistent and equitable across cancer services. Local monitoring of performance against this guideline will enable cancer service providers to manage proactively future service demand. PMID:27553996

  12. Abdominal tuberculosis. On-going challenge to gastroenterologists

    The aim of this study is to record the observations and experience on the diagnosis and management of abdominal tuberculosis (TB) and to highlight the difficulties in the diagnosis and management of this condition. Two hundred consecutive patients attending the Gastroenterology Department of the King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia between May 1991 and May 2001, suspected with abdominal TB were investigated. A detailed clinical history and physical examination were obtained. Data of 75 confirmed cases of abdominal TB were analyzed. The most common presenting symptoms were anorexia (84%), abdominal pain (84%) and weight loss (72%). Abdominal tenderness was the most common clinical finding, followed by ascites and abdominal mass (42%). The chest radiograph suggestive of pulmonary TB was diagnosed in 24 patients (32%). Computed tomographic (CT) scanning revealed abnormalities in all 51 patients who underwent the procedure, while positive findings were observed by abdominal ultrasound in 66% of the tested patients. Histopathological examination of patients showed tuberculosis granuloma, while acid fast bacilli were seen in 34%. Mycobacterium tuberculosis was identified by microbiological methods in 60% of patients. The most common presenting symptoms were anorexia (84%), abdominal pain (84%) and weight loss (72%). Abdominal tenderness was the most common clinical finding, followed by ascites and abdominal mass (42%). The chest radiograph suggestive of pulmonary TB was diagnosed in 24 patients (32%). Computed tomographic (CT) scanning revealed abnormalities in all 51 patients who underwent the procedure, while positive findings were observed by abdominal ultrasound in 66% of the tested patients. Histopathological examination of patients showed tuberculous granuloma, while acid fast bacilli were seen in 34%. Mycobacterium tuberculosis was identified by microbiological methods in 60% of patients. A high index of clinical suspicion is

  13. Indium 111 leucocyte scintigraphy in abdominal sepsis

    We have studied the clinical utility of indium 111 autologous leucocyte scintigraphy retrospectively in 45 patients presenting with suspected intra-abdominal sepsis. The sensitivity was 95% (21/22) and the specificity was 91% (21/23). Some 34 of the studies (17 positive and 17 negative) were considered helpful in furthering patient management (76%) and 8, unhelpful (18%). In 3, the study results were misleading and led to inappropriate treatment. Indium 111 scintigraphy, whether positive or negative, provides information in patients with suspected intra-abdominal sepsis upon which therapeutic decisions can be based. (orig.)

  14. Mathematical oncology 2013

    Gandolfi, Alberto

    2014-01-01

    With chapters on free boundaries, constitutive equations, stochastic dynamics, nonlinear diffusion–consumption, structured populations, and applications of optimal control theory, this volume presents the most significant recent results in the field of mathematical oncology. It highlights the work of world-class research teams, and explores how different researchers approach the same problem in various ways. Tumors are complex entities that present numerous challenges to the mathematical modeler. First and foremost, they grow. Thus their spatial mean field description involves a free boundary problem. Second, their interiors should be modeled as nontrivial porous media using constitutive equations. Third, at the end of anti-cancer therapy, a small number of malignant cells remain, making the post-treatment dynamics inherently stochastic. Fourth, the growth parameters of macroscopic tumors are non-constant, as are the parameters of anti-tumor therapies. Changes in these parameters may induce phenomena that a...

  15. Abdominal Dual Energy Imaging

    Sommer, F. Graham; Brody, William R.; Cassel, Douglas M.; Macovski, Albert

    1981-11-01

    Dual energy scanned projection radiography of the abdomen has been performed using an experimental line-scanned radiographic system. Digital images simultaneously obtained at 85 and 135 kVp are combined, using photoelectric/Compton decomposition algorithms to create images from which selected materials are cancelled. Soft tissue cancellation images have proved most useful in various abdominal imaging applications, largely due to the elimination of obscuring high-contrast bowel gas shadows. These techniques have been successfully applied to intravenous pyelography, oral cholecystography, intravenous abdominal arteriog-raphy and the imaging of renal calculi.

  16. Abdominal Vascular Catastrophes.

    Singh, Manpreet; Koyfman, Alex; Martinez, Joseph P

    2016-05-01

    Abdominal vascular catastrophes are among the most challenging and time sensitive for emergency practitioners to recognize. Mesenteric ischemia remains a highly lethal entity for which the history and physical examination can be misleading. Laboratory tests are often unhelpful, and appropriate imaging must be quickly obtained. A multidisciplinary approach is required to have a positive impact on mortality rates. Ruptured abdominal aortic aneurysm likewise may present in a cryptic fashion. A specific type of ruptured aneurysm, the aortoenteric fistula, often masquerades as the more common routine gastrointestinal bleed. The astute clinician recognizes that this is a more lethal variant of gastrointestinal hemorrhage. PMID:27133247

  17. Vesicular monoamine transporter protein expression correlates with clinical features, tumor biology, and MIBG avidity in neuroblastoma: a report from the Children's Oncology Group

    Temple, William; Mendelsohn, Lori; Nekritz, Erin; Gustafson, W.C.; Matthay, Katherine K. [UCSF School of Medicine, Department of Pediatrics, San Francisco, CA (United States); UCSF Benioff Children' s Hospital, San Francisco, CA (United States); Kim, Grace E. [UCSF School of Medicine, Department of Pathology, San Francisco, CA (United States); Lin, Lawrence; Giacomini, Kathy [UCSF School of Pharmacy, Department of Bioengineering and Therapeutic Sciences, San Francisco, CA (United States); Naranjo, Arlene; Van Ryn, Collin [University of Florida, Children' s Oncology Group Statistics and Data Center, Gainesville, FL (United States); Yanik, Gregory A. [University of Michigan, CS Mott Children' s Hospital, Ann Arbor, MI (United States); Kreissman, Susan G. [Duke University Medical Center, Durham, NC (United States); Hogarty, Michael [University of Pennsylvania, Children' s Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, PA (United States); DuBois, Steven G. [UCSF School of Medicine, Department of Pediatrics, San Francisco, CA (United States); UCSF Benioff Children' s Hospital, San Francisco, CA (United States); UCSF School of Medicine, San Francisco, CA (United States)

    2016-03-15

    Vesicular monoamine transporters 1 and 2 (VMAT1 and VMAT2) are thought to mediate MIBG uptake in adult neuroendocrine tumors. In neuroblastoma, the norepinephrine transporter (NET) has been investigated as the principal MIBG uptake protein, though some tumors without NET expression concentrate MIBG. We investigated VMAT expression in neuroblastoma and correlated expression with MIBG uptake and clinical features. We evaluated VMAT1 and VMAT2 expression by immunohistochemistry (IHC) in neuroblastoma tumors from 76 patients with high-risk metastatic disease treated in a uniform cooperative group trial (COG A3973). All patients had baseline MIBG diagnostic scans centrally reviewed. IHC results were scored as the product of intensity grading (0 - 3+) and percent of tumor cells expressing the protein of interest. The association between VMAT1 and VMAT2 scores and clinical and biological features was tested using Wilcoxon rank-sum tests. Patient characteristics were typical of high-risk neuroblastoma, though the cohort was intentionally enriched in patients with MIBG-nonavid tumors (n = 20). VMAT1 and VMAT2 were expressed in 62 % and 75 % of neuroblastoma tumors, respectively. VMAT1 and VMAT2 scores were both significantly lower in MYCN amplified tumors and in tumors with high mitotic karyorrhectic index. MIBG-avid tumors had significantly higher VMAT2 scores than MIBG-nonavid tumors (median 216 vs. 45; p = 0.04). VMAT1 expression did not correlate with MIBG avidity. VMAT1 and VMAT2 are expressed in the majority of neuroblastomas. Expression correlates with other biological features. The expression level of VMAT2 but not that of VMAT1 correlates with avidity for MIBG. (orig.)

  18. Vesicular monoamine transporter protein expression correlates with clinical features, tumor biology, and MIBG avidity in neuroblastoma: a report from the Children's Oncology Group

    Vesicular monoamine transporters 1 and 2 (VMAT1 and VMAT2) are thought to mediate MIBG uptake in adult neuroendocrine tumors. In neuroblastoma, the norepinephrine transporter (NET) has been investigated as the principal MIBG uptake protein, though some tumors without NET expression concentrate MIBG. We investigated VMAT expression in neuroblastoma and correlated expression with MIBG uptake and clinical features. We evaluated VMAT1 and VMAT2 expression by immunohistochemistry (IHC) in neuroblastoma tumors from 76 patients with high-risk metastatic disease treated in a uniform cooperative group trial (COG A3973). All patients had baseline MIBG diagnostic scans centrally reviewed. IHC results were scored as the product of intensity grading (0 - 3+) and percent of tumor cells expressing the protein of interest. The association between VMAT1 and VMAT2 scores and clinical and biological features was tested using Wilcoxon rank-sum tests. Patient characteristics were typical of high-risk neuroblastoma, though the cohort was intentionally enriched in patients with MIBG-nonavid tumors (n = 20). VMAT1 and VMAT2 were expressed in 62 % and 75 % of neuroblastoma tumors, respectively. VMAT1 and VMAT2 scores were both significantly lower in MYCN amplified tumors and in tumors with high mitotic karyorrhectic index. MIBG-avid tumors had significantly higher VMAT2 scores than MIBG-nonavid tumors (median 216 vs. 45; p = 0.04). VMAT1 expression did not correlate with MIBG avidity. VMAT1 and VMAT2 are expressed in the majority of neuroblastomas. Expression correlates with other biological features. The expression level of VMAT2 but not that of VMAT1 correlates with avidity for MIBG. (orig.)

  19. Clinical practice and outcome of radiotherapy for esophageal cancer between 1999 and 2003. The Japanese Radiation Oncology Study Group (JROSG) survey

    The background of this study was to determine the clinical results of radiotherapy (RT) for esophageal cancer in Japan. A questionnaire-based survey was conducted for esophageal cancer treated by definitive RT between 1999 and 2003. Clinical results of definitive RT for patients were collected from 9 major institutions. Only patients with good performance status (PS 0-2) who received a total dose of 50 Gy or more were included. Patients were classified into three groups: (A) stage I, (B) resectable stages II-III, (C) unresectable stages III-IVA. For group A, all patients treated by RT alone or chemo-radiotherapy (CRT) were included. For groups B and C, only those treated by CRT were included. In total, 167 patients were included in group A, 239 in group B, and 244 in group C. Approximately half of the patients in group A were treated by CRT. The median total RT dose ranged from 60 to 66 Gy. The median and range of the 5-year overall survival rates were 56% (48-83%) for group A, 29% (12-52%) for group B, and 19% (0-31%) for group C, respectively. A wide disparity in overall survival rates was noted among the institutions. A significant correlation between the number of patients treated per year and the 5-year overall survival rate was noted for groups B and C (both p<0.05). Although the overall survival rates for stage I esophageal cancer were excellent, a significant disparity in survival rates was noted among the institutions for stage II-IVA tumors treated by CRT. (author)

  20. Molecular oncology of lung cancer.

    Toyooka, Shinichi; Mitsudomi, Tetsuya; Soh, Junichi; Aokage, Keiju; Yamane, Masaomi; Oto, Takahiro; Kiura, Katsuyuki; Miyoshi, Shinichiro

    2011-08-01

    Progress in genetic engineering has made it possible to elucidate the molecular biological abnormalities in lung cancer. Mutations in KRAS and P53 genes, loss of specific alleles, and DNA methylation of the tumor suppressor genes were the major abnormalities investigated between 1980 and the 2000s. In 2004, mutations in the epidermal growth factor receptor (EGFR) gene that cause oncogene addiction were discovered in non-small-cell lung cancers (NSCLCs), especially in adenocarcinomas. Because they are strongly associated with sensitivity to EGFR-tyrosine kinase inhibitors (EGFR-TKIs), a great deal of knowledge has been acquired in regard to both EGFR and other genes in the EGFR family and their downstream genes. Moreover, in 2007 the existence of the echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) fusion gene was discovered in NSCLC; and the same as EGFR-TKIs, ALK inhibitors are being found to be highly effective in lung cancers that have this translocation. These discoveries graphically illustrate that molecular biological findings are directly linked to the development of clinical oncology and to improving the survival rates of lung cancer patients. Here, we review the remarkable progress in molecular biological knowledge acquired thus far in regard to lung cancer, especially NSCLC, and the future possibilities. PMID:21850578

  1. Radiolanthanides in therapeutic nuclear oncology

    Radiolanthanides such as Holmium-166 (T1/2 26.8h), Samarium-153 (T1/2 46.3h) and Lutetium-177 (T1/2 6.7 days) all have beta emissions suitable for radiopharmaceutical therapy, bone marrow ablation and for pain palliation of skeletal metastases. They also emit gamma photons of energies which permit quantitative imaging on conventional gamma cameras which facilitates calculation of dosimetry in individual patients. The range of half-lives has the potential to match the irradiation of tumour cells to the residence time of the radiopharmaceutical thus minimising radiotoxicity to normal tissues. Relative ease and low cost of production of these radiolanthanides in rectors such as HIFAR at ANSTO render radiolanthanides a practical option for radiopharmaceutical treatment of cancer for patients in whom conventional therapy has failed. Radioimmunotherapy of cancer using various monoclonal antibodies targeted to specific tumor-cell antigens has been performed with Samarium-153, Holmium-166 and Lutetium-177-labelled antibodies in human tumor xenographs in nude mice and in clinical trials. The development of a large animal model of human cancer will be described, in particular in relation to improving the accuracy of prediction of dosimetry and preclinical evaluation of efficacy and toxicity of radiolanthanides in therapeutic nuclear oncology

  2. CT diagnosis of abdominal ectopic pheochromocytoma

    Objective: To discuss the value of CT in diagnosis of abdominal ectopic pheochromocytoma. Methods: CT findings of 5 cases surgically and pathologically proved with ectopic pheochromocytoma were retrospectively analyzed. Results: Soft tissue mass with light asymmetry enhancement was found between the abdominal aorta and the inferior vena ca-va in one case. 1 case was completely cystic with light enhancement of the cystwall located in front of the left side of the abdominal aorta. 1 case of large solid mass occurred between the renal hilum and the tail of pancreas, with irregular shape, unclear boundary, central necrosis, calcification and obviously enhancement at the solid part. 2 cases showed as oval soft lump with even density, moderate strengthening located before the abdominal aorta. Paroxysmal hypertension occurred in 3 cases and didn't in 2 cases. Hypertension happened in 1 case during the operation because of stimulation. Blood pressure appeared in 1 case during and after operation. Blood and urinary catecholamine increased significantly in 4 cases. Conclusion: Ectopic pheochromocytoma mainly located surround the abdominal aorta with diverse CT performance. It is helpful for diagnosing when finding a lesion locates at the specified sites combined with typical clinical presentation. CT can not only depict small tumor, but also can show the relationship with surrounding structure, and it provides important information for the operation and prognosis. (authors)

  3. Paediatric emergencies: non-traumatic abdominal emergencies

    Presentation with acute abdominal pain or abdominal symptopathology is a very common cause of presentation of children to hospital. The causes are dependent in part on the age of the child, in part on the presence of previous surgery, and can be divided into those that relate to congenital abnormalities at whatever age they present, acquired disease and infection. Children, particularly young children are often poor historians, and therefore the clinical examination and the laboratory investigations are important in helping to come to a diagnosis. Primary imaging of abdominal emergencies in childhood is a radiograph of the abdomen, followed by ultrasound. Further imaging depends on the results of these studies. An ordered review of the abdomen radiograph is important if the salient features on X-ray are not to be missed. Practitioners should be competent with abdominal ultrasound in children and know where to seek the causes of disease, as these are different from those that are obtained in many instances in adults. Familiarity with the likely causes is important. The three commonest causes of acute abdominal pain in childhood are, in young infants, intussusception, appendicitis and mesenteric adenitis. In older children, inflammatory bowel disease and ovarian pathology are also included. This article details the approach to imaging and the salient features of some of the conditions. (orig.)

  4. Clinical study on the treatment of lumbar disc herniation with Bo's abdominal acupuncture%薄氏腹针治疗腰椎间盘突出症的临床研究

    周丽云

    2015-01-01

    目的:探讨薄氏腹针治疗腰椎间盘突出症的临床疗效。方法:收治腰椎间盘突出症患者80例,随机平分成两组,观察组采用薄氏腹针治疗,对照组采用常规针刺治疗,观察两组的治疗效果。结果:两组治疗后的生存质量评分以及健康状况评分都得到明显提升,观察组患者的生存质量评分明显高于对照组;观察组患者的治疗显效率以及治疗有效率都明显高于对照组(P<0.05),差异有统计学意义。结论:对腰椎间盘突出症患者实施薄氏腹针治疗,能够有效提升患者的生存质量水平以及治疗有效率,效果显著。%Objective:To explore the clinical effect of Bo's abdominal acupuncture in the treatment of patients with lumbar disc herniation.Methods:80 patients with lumbar disc herniation were selected,they were randomly divided into the two groups.Patients in the observation group received Bo's abdominal acupuncture therapy,patients in the control group received routine acupuncture therapy.We observed the treatment effect of the two groups.Results:After treatment,the quality of life score and health status score were significantly improved of the two groups.The quality of life score of the patients in the observation group was significantly higher than that in the control group,the treatment effective rate and efficiency of the patients in the observation group were significantly higher than that in the control group after treatment(P<0.05),there were statistical significance.Conclusion:For the patients with lumbar disc herniation,the Bo's abdominal acupuncture can effectively improve the quality of life and treatment efficiency,the effect is remarkable.

  5. RTOG Sarcoma Radiation Oncologists Reach Consensus on Gross Tumor Volume and Clinical Target Volume on Computed Tomographic Images for Preoperative Radiotherapy of Primary Soft Tissue Sarcoma of Extremity in Radiation Therapy Oncology Group Studies

    Wang Dian, E-mail: dwang@mcw.edu [Medical College of Wisconsin, Milwaukee, WI (United States); Bosch, Walter [Washington University, St. Louis, MO (United States); Roberge, David [McGill University, Montreal, Quebec (Canada); Finkelstein, Steven E. [Moffitt Cancer Center, Tampa, FL (United States); Petersen, Ivy; Haddock, Michael [Mayo Clinic, Rochester, MN (United States); Chen, Yen-Lin E.; Saito, Naoyuki G. [Roswell Park Cancer Institute, Buffalo, NY (United States); Kirsch, David G. [Duke University, Durham, NC (United States); Hitchcock, Ying J. [University of Utah, Salt Lake City, UT (United States); Wolfson, Aaron H. [University of Miami Miller School of Medicine, Miami, FL (United States); DeLaney, Thomas F. [Massachusetts General Hospital, Boston, MA (United States)

    2011-11-15

    Objective: To develop a Radiation Therapy Oncology Group (RTOG) atlas delineating gross tumor volume (GTV) and clinical target volume (CTV) to be used for preoperative radiotherapy of primary extremity soft tissue sarcoma (STS). Methods and Materials: A consensus meeting was held during the RTOG meeting in January 2010 to reach agreement about GTV and CTV delineation on computed tomography (CT) images for preoperative radiotherapy of high-grade large extremity STS. Data were presented to address the local extension of STS. Extensive discussion ensued to develop optimal criteria for GTV and CTV delineation on CT images. Results: A consensus was reached on appropriate CT-based GTV and CTV. The GTV is gross tumor defined by T1 contrast-enhanced magnetic resonance images. Fusion of magnetic resonance and images is recommended to delineate the GTV. The CTV for high-grade large STS typically includes the GTV plus 3-cm margins in the longitudinal directions. If this causes the field to extend beyond the compartment, the field can be shortened to include the end of a compartment. The radial margin from the lesion should be 1.5 cm, including any portion of the tumor not confined by an intact fascial barrier, bone, or skin surface. Conclusion: The consensus on GTV and CTV for preoperative radiotherapy of high-grade large extremity STS is available as web-based images and in a descriptive format through the RTOG. This is expected to improve target volume consistency and allow for rigorous evaluation of the benefits and risks of such treatment.

  6. Use of dermal-fat grafts in the post-oncological reconstructive surgery of atrophies in the zygomatic region: clinical evaluations in the patients undergone to previous radiation therapy

    Inchingolo Francesco

    2012-12-01

    Full Text Available Abstract Introduction Grafting of autologous adipose tissue can be recommended in some cases of facial plastic surgery. Rhabdomyosarcoma is a type of cancer that can also affect the orbit. Enucleation of the eye can cause atrophy of the corresponding hemiface and decreased orbital growth. Case report We report a case of a female patient with a medical history of surgical enucleation of the right eyeball, who had received rhabdomyosarcoma radiation therapy in her youth. The patient presented with a depression in the right zygomatic region. We took a dermal-fat flap from the abdominal region, which had been previously treated. Results The surgical outcome, 48 hours, and much clearly 31 days after the surgery, revealed that the right zygomatic region had returned to its proper anatomical shape, although there were still signs of postoperative edema. Discussion Very damaged tissues, like those exposed to radiation therapy, are generally not suitable for grafting of adipose tissue. Conclusions In the described case, we achieved a technically and aesthetically satisfying result despite the patient's medical history involving several perplexities about the use of autologous dermal-fat tissues, because of prior radiation therapy exposure. The clinical case shows that even a region exposed to radiation therapy can be a valid receiving bed for dermal-fat grafting.

  7. Selected clinically established and scientific techniques of diffusion-weighted MRI. In the context of imaging in oncology; Ausgewaehlte klinisch etablierte und wissenschaftliche Techniken der diffusionsgewichteten MRT. Im Kontext der onkologischen Bildgebung

    Freitag, M.T.; Bickelhaupt, S.; Ziener, C.; Mosebach, J.; Schlemmer, H.P. [Deutsches Krebsforschungszentrum, Abteilung fuer Radiologie, Heidelberg (Germany); Meier-Hein, K. [Deutsches Krebsforschungszentrum, Abteilung fuer medizinische Informatik, Heidelberg (Germany); Radtke, J.P. [Deutsches Krebsforschungszentrum, Abteilung fuer Radiologie, Heidelberg (Germany); Universitaetsklinik Heidelberg, Abteilung fuer Urologie, Heidelberg (Germany); Kuder, T.A.; Laun, F.B. [Deutsches Krebsforschungszentrum, Abteilung fuer Medizinische Physik in der Radiologie, Heidelberg (Germany)

    2016-02-15

    Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) technique that was established in the clinical routine primarily for the detection of brain ischemia. In the past 15 years its clinical use has been extended to oncological radiology, as tumor and metastases can be depicted in DWI due to their hypercellular nature. The basis of DWI is the Stejskal-Tanner experiment. The diffusion properties of tissue can be visualized after acquisition of at least two diffusion-weighted series using echo planar imaging and a specific sequence of gradient pulses. The use of DWI in prostate MRI was reported to be one of the first established applications that found its way into internationally recognized clinical guidelines of the European Society of Urological Radiology (ESUR) and the prostate imaging reporting and data system (PI-RADS) scale. Due to recently reported high specificity and negative predictive values of 94 % and 92 %, respectively, its regular use for breast MRI is expected in the near future. Furthermore, DWI can also reliably be used for whole-body imaging in patients with multiple myeloma or for measuring the extent of bone metastases. New techniques in DWI, such as intravoxel incoherent motion imaging, diffusion kurtosis imaging and histogram-based analyses represent promising approaches to achieve a more quantitative evaluation for tumor detection and therapy response. (orig.) [German] Die diffusionsgewichtete Bildgebung (''diffusion-weighted imaging'', DWI), ein Verfahren aus der Magnetresonanztomographie (MRT), wurde in der klinischen Routine primaer fuer die Detektion von Schlaganfaellen etabliert. Der Einsatz dieser Methode hat in den letzten 15 Jahren auch fuer die onkologische Diagnostik stark zugenommen, da Tumoren und Metastasen aufgrund ihrer hochzellulaeren Zusammensetzung in der DWI sehr gut sichtbar gemacht werden koennen. Basis der diffusionsgewichteten Bildgebung ist das Experiment nach Stejskal-Tanner. Hier

  8. Endometriosis Abdominal wall

    Endometriosis of abdominal wall is a rare entity wi ch frequently appears after gynecological surgery. Case history includes three cases of parietal endometriosis wi ch were treated in Maciel Hospital of Montevideo. The report refers to etiological diagnostic aspects and highlights the importance of total resection in order to achieve definitive healing

  9. Diagnostic profiles of acute abdominal pain with multinomial logistic regression

    Ohmann, Christian; Franke, Claus; Yang, Qin; Decker, Franz; Verde, Pablo E

    2007-01-01

    Purpose: Application of multinomial logistic regression for diagnostic support of acute abdominal pain, a diagnostic problem with many differential diagnoses. Methods: The analysis is based on a prospective data base with 2280 patients with acute abdominal pain, characterized by 87 variables from history and clinical examination and 12 differential diagnoses. Associations between single variables from history and clinical examination and the final diagnoses were investigated with multinomial ...

  10. Exercise Promotion in Geriatric Oncology.

    Burhenn, Peggy S; Bryant, Ashley Leak; Mustian, Karen M

    2016-09-01

    Evidence of the benefits of exercise for people with cancer from diagnosis through survivorship is growing. However, most cancers occur in older adults and little exercise advice is available for making specific recommendations for older adults with cancer. Individualized exercise prescriptions are safe, feasible, and beneficial for the geriatric oncology population. Oncology providers must be equipped to discuss the short- and long-term benefits of exercise and assist older patients in obtaining appropriate exercise prescriptions. This review provides detailed information about professionals and their roles as it relates to functional assessment, intervention, and evaluation of the geriatric oncology population. This review addresses the importance of functional status assessment and appropriate referrals to other oncology professionals. PMID:27484061

  11. Jejunal perforation after abdominal liposuction, bilateral breast augmentation and facial fat grafting

    Coronado-Malagón, Martin; Tauffer-Carrion, Luis Tomas

    2012-01-01

    A 54-year-old woman presented to the emergency department 24 h after undergoing abdominal liposuction, bilateral breast augmentation and facial fat grafting at a private plastic surgery clinic. She presented with the classic evolution of a bowel perforation secondary to abdominal liposuction. A computed tomography (CT) scan found free air in her abdominal cavity. Based on the CT scan and the persistent pain experienced by the patient, an abdominal laparatomy was urgently performed. A jejunum ...

  12. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... Resources Professions Site Index A-Z Children's (Pediatric) Ultrasound - Abdomen Children’s (pediatric) ultrasound imaging of the abdomen ... limitations of Abdominal Ultrasound Imaging? What is Abdominal Ultrasound Imaging? Ultrasound is safe and painless, and produces ...

  13. Abdominal ultrasound in AIDS patients

    To analyze the ultrasonography findings in abdomen in the AIDS patients in our hospital, as well as the indications for this exploration, assessing the role of abdominal ultrasound (AU). The ultrasonographic and clinical findings in 527 patients who underwent a total of 715 explorations between 1992 and 1996 were studied. Hepatomegaly and/or splenomegaly, usually homogeneous, were observed in nearly half of the studies (45%); one third of the patients with marked splenomegaly presented visceral leishmaniasis. Focal lesions in liver and/or spleen, corresponding to angiomas, abscesses, lymphomatous lesions and metastasis, were detected in 5.7% of the explorations. Thirty-five percent of the AU revealed the presence of lymphadenopathy; nodes measuring over 2.5 cm were usually related to potential treatable infection or neoplasm. Thickening of the gallbladder wall did not usually indicate the presence of acute cholecystitis unless Murphy''s sign was also detected. Bile duct dilation and wall thickening was related to opportunistic cholangitis, and the increase in the echogenicity of the renal parenchyma was linked to AIDS-related nephropathy. Despite the fact that many of findings with AU are nonspecific, we consider that this approach should be the principal diagnostic technique in AIDS patients with suspected abdominal pathology or fever of unknown origin. (Author) 43 refs,

  14. Radiation Oncology reviewer acknowledgement 2015

    The editorial team of Radiation Oncology would like to thank all our reviewers who have contributed to the journal in 2015. Without the participation of skilful reviewers, no academic journal could succeed, and we are grateful to the committed individuals who have given their time and expertise to the peer review of manuscripts for Radiation Oncology. We look forward to your continued support in 2016

  15. A Study of Layered Learning in Oncology.

    Bates, Jill S; Buie, Larry W; Lyons, Kayley; Rao, Kamakshi; Pinelli, Nicole R; McLaughlin, Jacqueline E; Roth, Mary T

    2016-05-25

    Objective. To explore use of pharmacy learners as a means to expand pharmacy services in a layered learning practice model (LLPM), to examine whether an LLPM environment precludes achievement of knowledge-based learning objectives, and to explore learner perception of the experience. Design. An acute care oncology pharmacy practice experience was redesigned to support the LLPM. Specifically, the redesign focused on micro discussion, standardized feedback (eg, rubrics), and cooperative learning to enhance educational gain through performing clinical activities. Assessment. Posttest scores evaluating knowledge-based learning objectives increased in mean percentage compared to pretest values. Learners viewed the newly designed practice experience positively with respect to perceived knowledge attainment, improved clinical time management skills, contributions to patient care, and development of clinical and self-management skills. A fifth theme among students, comfort with learning, was also noted. Conclusion. Layered learning in an oncology practice experience was well-received by pharmacy learners. Data suggest a practice experience in the LLPM environment does not preclude achieving knowledge-based learning objectives and supports further studies of the LLPM. PMID:27293235

  16. Radiation oncology physics: A handbook for teachers and students

    Radiotherapy, also referred to as radiation therapy, radiation oncology or therapeutic radiology, is one of the three principal modalities used in the treatment of malignant disease (cancer), the other two being surgery and chemotherapy. In contrast to other medical specialties that rely mainly on the clinical knowledge and experience of medical specialists, radiotherapy, with its use of ionizing radiation in the treatment of cancer, relies heavily on modern technology and the collaborative efforts of several professionals whose coordinated team approach greatly influences the outcome of the treatment. The radiotherapy team consists of radiation oncologists, medical physicists, dosimetrists and radiation therapy technologists: all professionals characterized by widely differing educational backgrounds and one common link - the need to understand the basic elements of radiation physics, and the interaction of ionizing radiation with human tissue in particular. This specialized area of physics is referred to as radiation oncology physics, and proficiency in this branch of physics is an absolute necessity for anyone who aspires to achieve excellence in any of the four professions constituting the radiotherapy team. Current advances in radiation oncology are driven mainly by technological development of equipment for radiotherapy procedures and imaging; however, as in the past, these advances rely heavily on the underlying physics. This book is dedicated to students and teachers involved in programmes that train professionals for work in radiation oncology. It provides a compilation of facts on the physics as applied to radiation oncology and as such will be useful to graduate students and residents in medical physics programmes, to residents in radiation oncology, and to students in dosimetry and radiotherapy technology programmes. The level of understanding of the material covered will, of course, be different for the various student groups; however, the basic

  17. Effects of ovariohysterectomy on intra-abdominal pressure and abdominal perfusion pressure in cats.

    Bosch, L; Rivera del Álamo, M M; Andaluz, A; Monreal, L; Torrente, C; García-Arnas, F; Fresno, L

    2012-12-15

    Intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) have shown clinical relevance in monitoring critically ill human beings submitted to abdominal surgery. Only a few studies have been performed in veterinary medicine. The aim of this study was to assess how pregnancy and abdominal surgery may affect IAP and APP in healthy cats. For this purpose, pregnant (n=10) and non-pregnant (n=11) queens undergoing elective spaying, and tomcats (n=20, used as controls) presented for neutering by scrotal orchidectomy were included in the study. IAP, mean arterial blood pressure (MAP), APP, heart rate and rectal temperature (RT) were determined before, immediately after, and four hours after surgery. IAP increased significantly immediately after abdominal surgery in both female groups when compared with baseline (P<0.05) and male (P<0.05) values, and returned to initial perioperative readings four hours after surgery. Tomcats and pregnant females (P<0.05) showed an increase in MAP and APP immediately after surgery decreasing back to initial perioperative values four hours later. A significant decrease in RT was appreciated immediately after laparotomy in both pregnant and non-pregnant queens. IAP was affected by abdominal surgery in this study, due likely to factors, such as postoperative pain and hypothermia. Pregnancy did not seem to affect IAP in this population of cats, possibly due to subjects being in early stages of pregnancy. PMID:23118052

  18. Payment Reform: Unprecedented and Evolving Impact on Gynecologic Oncology.

    Apte, Sachin M; Patel, Kavita

    2016-01-01

    With the signing of the Medicare Access and CHIP Reauthorization Act in April 2015, the Centers for Medicare and Medicaid Services (CMS) is now positioned to drive the development and implementation of sweeping changes to how physicians and hospitals are paid for the provision of oncology-related services. These changes will have a long-lasting impact on the sub-specialty of gynecologic oncology, regardless of practice structure, physician employment and compensation model, or local insurance market. Recently, commercial payers have piloted various models of payment reform via oncology-specific clinical pathways, oncology medical homes, episode payment arrangements, and accountable care organizations. Despite the positive results of some pilot programs, adoption remains limited. The goals are to eliminate unnecessary variation in cancer treatment, provide coordinated patient-centered care, while controlling costs. Yet, meaningful payment reform in oncology remains elusive. As the largest payer for oncology services in the United States, CMS has the leverage to make cancer services more value based. Thus far, the focus has been around pricing of physician-administered drugs with recent work in the area of the Oncology Medical Home. Gynecologic oncology is a unique sub-specialty that blends surgical and medical oncology, with treatment that often involves radiation therapy. This forward-thinking, multidisciplinary model works to keep the patient at the center of the care continuum and emphasizes care coordination. Because of the breadth and depth of gynecologic oncology, this sub-specialty has both the potential to be disrupted by payment reform as well as potentially benefit from the aspects of reform that can align incentives appropriately to improve coordination. Although the precise future payment models are unknown at this time, focused engagement of gynecologic oncologists and the full care team is imperative to assure that the practice remains patient centered

  19. Perspectives on psycho-neuro-immunology in oncology

    Vallath Nandini

    2006-01-01

    Psycho-oncology and psycho-neuro-immunology are both powerful new disciplines. Although a lot of literature exists in both of these fields the evidence is often controversial. This paper gives a brief perspective on the origins of psycho-neuro-immunology and discusses how our current understanding of this subject can be translated into clinical practice in an Indian setting.

  20. NCI Community Oncology Research Program Approved | Division of Cancer Prevention

    On June 24, 2013, the National Cancer Institute (NCI) Board of Scientific Advisors approved the creation of the NCI Community Oncology Research Program (NCORP). NCORP will bring state-of-the art cancer prevention, control, treatment and imaging clinical trials, cancer care delivery research, and disparities studies to individuals in their own communities. |