1/82. review of mononuclear cell leukemia in F-344 rat bioassays and its significance to human cancer risk: A case study using alkyl phthalates.Elevated incidences of mononuclear cell leukemia (MNCL) have been observed in a number of chronic bioassays in the F-344 rat. As this tumor type is unique to the rat and is only common in the F-344 strain, its significance for human cancer risk is unclear. For this reason, a survey of the published literature was undertaken to assess the occurrence and etiology of MNCL in F-344 rats and to evaluate its potential significance to humans using alkyl phthalate data as an example. It was found that MNCL occurs in untreated, aged F-344 rats at a high and variable rate, it is uncommon in most other rat strains, and its background incidence has increased significantly over time. This complicates retrospective data interpretation. MNCL has not been found in other mammalian species and no histologically comparable tumor is found in humans. In general, a statistically significant increase in frequency of a common tumor in the F-344 rat is an insufficient basis for determining that a chemical presents a carcinogenic hazard to humans, particularly when that tumor is not observed in other species. As one example, the alkyl phthalates constitute one group of substances which has been associated with increased MNCL frequency in the F-344 rat after high dietary doses. In evaluating the significance of this increase in MNCL, an extensive toxicological database for phthalates indicates that toxicological effects occur only at relatively high doses, and tumor development (including MNCL) occurs only after an apparent threshold is exceeded. Phthalates are not genotoxic as a class, further supporting the hypothesis of the existence of a threshold. When these considerations are collectively evaluated, it can be concluded that a finding of increased MNCL in F-344 rats exposed for a lifetime to a nongenotoxic chemical is not toxicologically relevant to humans, even when MNCL is observed at an increased incidence that is statistically significant. Thus, the increased incidence of MNCL observed in F-344 rats exposed to some alkyl phthalates is likely a strain-specific effect of little or no relevance for humans, and characterization of these chemicals as carcinogens based on increased MNCL in F-344 rats is not scientifically supported.- - - - - - - - - - ranking = 1keywords = back (Clic here for more details about this article) |
2/82. A plea for incidental appendectomy in pediatric patients with malignancy.The evaluation of right lower quadrant (RLQ) abdominal pain in pediatric patients with malignancy can be difficult. However, since the mortality rate from peritoneal infections in these patients is very high, the differential diagnosis of RLQ peritoneal irritation, mainly of acute appendicitis (AA) versus neutropenic enterocolitis (NE), is crucial. Three cases of pediatric patients with malignancy demonstrating these difficulties are represented to enlighten this problem. The first patient died of multiorgan failure after operation for perforated appendicitis without generalized peritonitis. The second had a severe life-threatening postoperative complication because of delayed diagnosis of acute appendicitis. The third patient with malignant pelvic spread, underwent an unnecessary abdominal exploration for suspected AA. In all these cases and probably in many others, the clinical outcome could have been different if a previous incidental appendectomy had been performed during the primary abdominal operation. Incidental appendectomy in oncologic patients is recommended to facilitate the differential diagnosis of RLQ pain and to exclude the diagnosis of AA.- - - - - - - - - - ranking = 6.3988043135745keywords = abdominal pain (Clic here for more details about this article) |
3/82. Spinal epidural abscess complicating chronic epidural analgesia in 11 cancer patients: clinical findings and magnetic resonance imaging.We reviewed the records of all patients who had received an epidural catheter for management of chronic cancer pain in a 3-year period (1993-1996). patients with nervous system infections were identified, and pertinent clinical, radiological (magnetic resonance imaging), and bacteriological data were analyzed. We identified 11 patients who developed spinal epidural abscess (SEA). All of these had back pain; radicular signs occurred in seven patients and spinal cord compression in two patients. magnetic resonance imaging revealed SEA in all 11 patients. SEA was iso- to hypointense on T1-weighted images and hyperintense on T2-weighted images relative to spinal cord. After gadolinium administration seven lesions showed characteristic rim enhancement while three showed minimal enhancement. No signs of diskitis or osteomyelitis were present, and the abscess was always localized to the posterior epidural space. Cultures were positive in all cases and revealed staphylococcus epidermidis in eight and S. aureus in three. All patients were treated with intravenous antibiotics, and four had an additional decompressive laminectomy. Two patients died within 1 week of diagnosis from overwhelming septicemia despite apparently adequate antibiotic treatment. Within 4 weeks after diagnosis of SEA two patients died from widely metastatic disease, although infection may have contributed. One patient developed septicemia while receiving appropriate antibiotics and underwent emergency laminectomy. The neurological deficits recovered in all patients who survived the acute infectious episode. We conclude that patients with chronic epidural catheters for cancer pain require prompt neurological evaluation and magnetic resonance imaging when SEA is suspected. Early evaluation and treatment may lead to full recovery.- - - - - - - - - - ranking = 1keywords = back (Clic here for more details about this article) |
4/82. lung cancer in a child with a substantial family history of cancer.The occurrence of primary lung cancer is rare in childhood. The case of an 11-year-old boy with primary lung cancer is presented in this report. He had a substantial family history of cancer. His chief complaint was coughing with right chest pain. A chest radiograph showed a coin lesion in the right lower lung. A right lower lobectomy revealed a squamous cell carcinoma (stage IIIA at Japanese TNM classification). Systemic chemotherapy using cisplatin, vindesine, THP-adriamycin and cyclophosphamide was performed. Six months after surgery, a recurrent tumor occurred. An analysis of the familial cancer related genes (p53 gene and mismatch repair gene) showed no abnormality.- - - - - - - - - - ranking = 2.7963559476987keywords = chest (Clic here for more details about this article) |
5/82. Fatal pulmonary toxicity related to the administration of granulocyte colony-stimulating factor in amyloidosis: a report and review of growth factor-induced pulmonary toxicity.We report on a 59-year-old man with renal amyloidosis who died after three doses of granulocyte colony-stimulating factor were administered. Noncardiac pulmonary edema was precipitated by the growth factor. autopsy revealed amyloid in the lung not visible by plain chest radiograph. patients with amyloidosis who are candidates for stem cell transplantation and are mobilized with growth factors must be monitored for unexpected pulmonary toxicity. We review the in vitro experimental evidence as well as the clinical data on the pulmonary toxicity of growth factors.- - - - - - - - - - ranking = 1.3981779738493keywords = chest (Clic here for more details about this article) |
6/82. risk in numbers--difficulties in the transformation of genetic knowledge from research to people--the case of hereditary cancer.Difficulties in communicating diagnostic information are exacerbated when the 'diagnosis' is a 'genetic risk' for cancer. The risk estimation demanded in this situation differs from other types of probability estimations. Observations of participants in 45 consultation sessions between physicians and potential patients were conducted at a clinic for hereditary cancer to explore the communication of genetic information. Thirty-three sessions were audiotaped, transcribed verbatim and analyzed, along with notes from the other sessions. A dominant theme was found to be numerical discussion of risk. Further analysis resulted in the description of problems for practitioners in the process of translating scientific knowledge into clinical management. Problems in providing information include unclear aims of the consultation sessions, mixing various types of background information and probabilities, recognizing how low the predictive values are, and difficulties in communicating the relationship between probability and conclusions. Problems in communicating information about the genetic risk for cancer are of at least two types: dilemmas arising from uncertainties implicit in the nature of the information itself and difficulties in communicating information in a manner that those concerned can interpret. These issues need clarification, so that information with far-reaching consequences can be made as clear and comprehensible as possible for those involved.- - - - - - - - - - ranking = 1keywords = back (Clic here for more details about this article) |
7/82. Treating the discomfort of oral ulceration resulting from cancer chemotherapy.Chemotherapy-induced oral mucositis can result in inadequate oral intake, local and systemic infection, a prolonged hospital stay, and increased cost of treatment. Treatment of the pain resulting from this condition can greatly lessen these problems. Hydroxypropyl cellulose gel with benzocaine (Zilactin B) has been shown to effectively reduce the pain of mucositis for up to 3 hours.- - - - - - - - - - ranking = 218.47988515808keywords = discomfort (Clic here for more details about this article) |
8/82. When cultures clash: physician, patient, and family wishes in truth disclosure for dying patients.We describe two cases involving male foreign nationals (a Chinese and a Georgian) treated in a U.S. hospital. Both patients had terminal illnesses, and both cases involved clashes between families and the treating physicians, which occurred because of differing cultural beliefs about truth disclosure. Based on the specific backgrounds of these two patients, we discuss ethical and cultural considerations and make suggestions for physicians who care for ethnically diverse patients.- - - - - - - - - - ranking = 1keywords = back (Clic here for more details about this article) |
9/82. pruritus, an uncommon but important symptom of systemic carcinoma.A distinctive pruritic syndrome associated with systemic cancer is described. Prolonged, variably severe pruritus with a tendency to localization on the legs, upper trunk, and extensor surfaces of the upper extremities is the presenting symptom. patients with unexplained persistent itching as herein described should be investigated for a hidden malignancy. The persistence or recurrence of itching, months or even years after apparent cure of a systemic carcinoma, suggests that destruction or removal of the primary tumor was incomplete, or that metastasis has supervened. A small carcinomatous focus may exist for many months and at times for years before clinical recognition is possible with diagnostic methods currently available.- - - - - - - - - - ranking = 1.468904761349keywords = upper (Clic here for more details about this article) |
10/82. Understanding peripheral neuropathy in patients with cancer: background and patient assessment.PN is a troublesome symptom that frequently occurs in patients with cancer and is associated with certain neurotoxic chemotherapeutic agents. By understanding the basic principles of PN and recognizing the potential toxicities of specific chemotherapy drugs, nurses can take an active role in minimizing their occurrence. nursing assessment is critical to early identification of toxicities and successful intervention. nurses need to educate their patients regarding potential drug side effects and review safety issues that may put them at risk for injury. patients need to be instructed to report symptoms of PN to their nurses and physicians. Healthcare professionals, in turn, need to assess neurologic function on a routine basis, monitor those at risk, and intervene when appropriate. Ultimately, PN can be recognized as a significant symptom, such as pain or fatigue. Current treatment options include both pharmacologic and nonpharmacologic therapies, and the success of the treatment often depends on the cause. research is needed to find better and more effective therapies for PN. The Neuropathy association is a national organization that offers patients with PN the chance to contact others to share experiences and information to help them to cope with symptoms, increase public awareness of the problem, and promote the development of better therapies. This organization provides a newsletter, information booklets, and activities for members and can be contacted at 800-247-6968 or www.neuropathy.org.- - - - - - - - - - ranking = 4keywords = back (Clic here for more details about this article) |
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