Current Issue : April - June Volume : 2019 Issue Number : 2 Articles : 7 Articles
Taking care of patients with delusional parasitosis can be challenging. This report illustrates\nthe added management complexity and ethical dilemmas surrounding a patient who was newly\ndiagnosed with an incurable lung cancer, while at the same time was suffering from delusional\nparasitosis. Her delusion was so profound that she blamed flukes for her respiratory failure and\nrefused treatment of her cancer. This paper emphasizes making the right decision with the greater\ngood in mind, even if this meant â??yieldingâ? to a patientâ??s delusion and treating the non-existing\nparasitosis in order for her to allow us to also treat the cancer....
Background: The presence of circulating tumor cells (CTCs) in patients with breast cancer correlates to a bad prognosis.\nYet, CTCs are detectable in only a minority of patients with progressive breast cancer, and factors that influence the\nabundance of CTCs remain elusive.\nMethods: We conducted CTC isolation and enumeration in a selected group of 73 consecutive patients characterized\nby progressive invasive breast cancer, high tumor load and treatment discontinuation at the time of CTC isolation.\nCTCs were quantified with the Parsortix microfluidic device. Clinicopathological variables, blood counts at the\ntime of CTC isolation and detailed treatment history prior to blood sampling were evaluated for each patient.\nResults: Among 73 patients, we detected at least one CTC per 7.5 ml of blood in 34 (46%). Of these, 22 (65%)\nhad single CTCs only, whereas 12 (35%) featured both single CTCs and CTC clusters. Treatment with the monoclonal\nantibody denosumab correlated with the absence of CTCs, both when considering all patients and when considering\nonly those with bone metastasis. We also found that low red blood cell count was associated with the presence of\nCTCs, whereas high CA 15-3 tumor marker, high mean corpuscular volume, high white blood cell count and high\nmean platelet volume associated specifically with CTC clusters.\nConclusions: In addition to blood count correlatives to single and clustered CTCs, we found that denosumab\ntreatment associates with most patients lacking CTCs from their peripheral circulation. Prospective studies will\nbe needed to validate the involvement of denosumab in the prevention of CTC generation....
Background & Objective: Hypofractionation has been used in curative setting\nin breast conservative surgery, but still no adequate information about its\napplication in the adjuvant setting after mastectomy in breast cancer patients.\nThe aim of this trial was to assess the efficacy and toxicity of hypofractionation\nradiotherapy (40 Gy in 15 fractions) in post mastectomy breast cancer\npatients and to compare these results with those of post mastectomy patients\ntreated retrospectively by conventional radiotherapy (50 Gy in 25 fractions)\nas regard overall survival (OS), disease free survival (DFS), locoregional disease\nfree survival (LDFS), and toxicities. Patients & Methods: One hundred\npost mastectomy breast cancer patients were included into this study, they\nwere divided into 2 groups, the 1st included 50 patients treated prospectively\nwith hypofractionated radiotherapy regimen (40 Gy in 15 fractions), and the\n2nd (control group) included 50 patients treated retrospectively with conventionally\nfractionated radiotherapy regimen (50 Gy in 25 fractions). Results:\nThe 2 year overall survival were 96% & 94% respectively (p = 0.7), while the\ndisease free survival were 91% & 89.8%, respectively (p = 0.9), and the LDFS\nwere 95.8% & 93.3%, respectively (p = 0.9), G1 acute dermatitis was observed\nin 22 (44%) & 25 (50%) patients in group I & II respectively, G2 in 8 (16%) &\n10 (20%) patients respectively, no G4 skin toxicity was detected. Radiation\npneumonitis was observed in 2 patients (4%) only in group II. Conclusion:\npost-mastectomy hypofractionated radiation therapy achieved comparable\nsurvival and toxicity to the conventionally fractionated radiotherapy with the\nadvantage of reducing overall treatment time, treatment burden & cost....
The study objective was to assess the influence of neutropenia on outcome of critically ill cancer\npatients by meta-analysis of individual data. Secondary objectives were to assess the influence of neutropenia on\noutcome of critically ill patients in prespecified subgroups (according to underlying tumor, period of admission,\nneed for mechanical ventilation and use of granulocyte colony stimulating factor (G-CSF)....
Background and aim: Information on patients with differentiated thyroid carcinoma in South Africa is limited. The\nobjective of this study was to review demographics and tumour characteristics in a cohort of patients with differentiated\nthyroid carcinoma, presenting to Groote Schuur Hospital and evaluate risk factors for recurrence and survival.\nPatients and methodology: Retrospective demographic and clinical data were collected on all patients referred\nbetween January 2003 and December 2013. Prognostic factors for recurrence free survival and cancer specific survival\nwere assessed using univariate and multivariate analyses.\nResults: The total number of patients was 231.The median age at presentation was 44 years and 82% were female\npatients. The pathological sub-types were papillary (60.6%), follicular (38.9%) and poorly differentiated (0.5%). Total\nthyroidectomy was performed in 191 patients and 30 patients required neck dissections. A total of 171 (74%) patients\nreceived 131Iodine. The recurrence free and cause specific survival rates at 10 years were 83 and 91%, respectively. Nodal\ndisease at presentation was the only significant risk factor for recurrence (p < 0.001) on multivariate analysis. Significant\nrisk factors for cause specific mortality were age ..... 45 years (p = 0.006), follicular pathology (p = 0.004), extra-thyroid\nextension (p = 0.013) and residual tumour (p = 0.004).\nConclusions: Consistent with international trends, patients with differentiated thyroid carcinoma treated at Groote\nSchuur Hospital had a favourable prognosis. The known risk factors associated with recurrence and survival in this South\nAfrican cohort were consistent with those reported in developed countries....
Background: Testicular cancer (TC) represents 1% of all new male cancer cases but remains the most frequent cancer\nin adolescents and young adults in industrialized countries. In this study, we assessed time trends in use of sperm\ncryopreservation by men with TC from 1990 to 2013 in France.\nMethods: We collected data from patients diagnosed with TC who underwent sperm cryopreservation in the French\nnational network of sperm banks. Trends in the incidence of sperm cryopreservation were estimated through two\nstatistical models: the commonly used Poisson regression model and the Verhulst model.\nResults: Between 1990 and 2013, the overall incidence of sperm cryopreservation rose from 1.73 to 5.57 per 100,000\nperson-years. Poisson regression predicted an incidence of 9 per 100,000 [95% CI = 8.66â??9.34] in 2020. However, since\n2005, the observed sperm cryopreservation rate seems to be attenuating. The Verhulst model predicted an incidence\nof 6 per 100,000 after 2020.\nConclusions: Limitations include the impossibility of analyzing age-standardized incidence. Based on the Verhulst\nmodel, results suggest that it is still relevant to follow up TC incidence and sperm cryopreservation in order to confirm\nor refute the potential decrease already observed in this disease....
Background: It is becoming increasingly recognized that weight and nutritional status can impact cancer survival.\nWe have previously shown that obese mice with syngeneic acute lymphoblastic leukemia (ALL) have poorer response\nto chemotherapy treatment than control mice. We therefore investigated whether dietary intervention could improve\noutcome from the most common pediatric cancer, ALL.\nMethods: Diet-induced obese (DIO) mice raised on a 60% calories from fat diet and control mice were implanted with\nsyngeneic ALL cells. Some DIO mice were switched to the low-fat control diet. Survival from ALL was assessed without\nor with chemotherapy treatment starting at the time of the diet switch. Cells from DIO mice before and after diet\nswitch were assessed by FACS for BrdU incorporation and phosphorylation status of AKT, S6K, and EIF2a. Similar\nexperiments were done with human ALL xenografts. Mouse and human ALL cells were cultured in media with 10%\nor 5% fetal bovine serum, and sensitivity to chemotherapies assessed.\nResults: DIO mice had poorer survival (17%) after vincristine monotherapy than control mice on a 10% low fat diet (42%;n = 12/group; p = 0.09, log rank). However, switching obese mice to the low-fat diet prior to initiation of vincristine led to dramatically improved survival (92%, p < 0.01 vs both other groups). In vitro, FBS restriction made murine and human ALL cells more sensitive to vincristine. Interestingly, while serum restriction enhanced ALL sensitivity to dexamethasone and L-asparaginase, dietary switch did not improve survival of DIO mice treated with either drug in monotherapy. Thus, it appears that dietary intervention has a unique effect to improve ALL cell sensitivity to vincristine in vivo.\nConclusions: We report herein that a dietary intervention can improve ALL outcome in a preclinical model. Further work\nis needed to identify the mechanisms of this effect and investigate potential impact on human leukemia in patients....
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