The management of diabetes in patients with advanced cancer

Although a form of eating disorders had been described by Kampo (Chinese traditional medicine) physicians during the last quarter of the 18th century, the modern study on eating disorders in Japan dates from the end of the 1950s. With the rapid increase in the number of cases, research activities have become very active recently. Both the past and present status of eating disorders and of research activities relating to them in Japan are not well known in other countries. This study concentrates on a review of the literature, with a focus on prevalence, etiology, and symptoms.     

Endoscopically defined treatment strategies in patients with locally advanced esophageal cancer

Sixty-five consecutive, locally advanced esophageal cancer patients were treated by the West Side Medical Center Esophageal Service at the Cook County and University of Illinois hospitals. Each patient was prospectively evaluated with multiple endoscopies including esophagogastroduodenoscopy, bronchoscopy, nasopharyngoscopy, and laryngoscopy. Twenty-four patients (37%) had endoscopic findings that significantly altered therapeutic regimens. Patients identified as having an obvious or impending esophageal fistula or poor performance status were treated in a palliative fashion. Forty (61.5%) patients were considered candidates for treatment with multimodal therapy which included radiation, chemotherapy, and surgery. There was a response rate of 82.5% and a 1-year disease-free survival of 88.9% which was statistically significant when compared to the other patient treatment groups. These data illustrate the necessity of multiple endoscopic evaluation of locally advanced esophageal cancer patients for stratification into appropriate treatment groups. Aggressive treatment afforded selected patients excellent relief of presenting symptomatology, as well as an improved, more acceptable, disease-free survival.     

The roles of multimodality treatment and lymphadenectomy in the management of esophageal cancer

PURPOSE: To review the current status of multimodality treatment and lymphadenectomy in the management of esophageal cancer. DATA SOURCES: Literature review. STUDY SELECTION: Multimodality treatment and lymphadenectomy in esophageal cancer. DATA EXTRACTION: Results in research papers published selected by literature search. RESULTS: Numerous studies have been carried out attempting to define the roles of various neoadjuvant or adjuvant regimens in the treatment of esophageal cancer. These included the use of radiotherapy or chemotherapy alone or in different combinations, with or without surgical resection. Randomized trials have failed to show significant improvement compared with surgical resection alone, although downstaging of disease and benefits on subgroups of patients could be demonstrated. Whether the extent of resection can influence outcome was tested by varying the surgical approach, and by increasing the extent of lymphadenectomy. Although indirect evidence exists suggesting more extensive resection may improve long term prognosis, definitive proof is lacking. CONCLUSIONS: More well organized randomized controlled trials are needed to further elucidate the roles of these approaches in the treatment of esophageal cancer.     

Malignant tracheoesophageal fistula in patients with esophageal cancer

BACKGROUND: Patients with esophageal cancer and a malignant tracheoesophageal fistula (TEF) have an extremely poor prognosis. Additionally, these patients often are denied treatment with radiation therapy because there is concern that these treatments may increase the size and associated problems of the TEF. METHODS: To determine the appropriate treatment (use of radiation therapy) for patients with esophageal cancer and malignant TEF, a review was performed of all such cases seen at the Mayo Clinic between 1971 and 1991. RESULTS: Between 1971 and 1991, 41 patients with malignant TEF arising as a result of esophageal cancer were seen at the Mayo Clinic in Rochester. Twenty-eight of these cancers were locally recurrent, and this group of patients had a uniformly poor outcome (median survival time, 1.4 months). Thirteen patients had a malignant TEF and had not received previous treatment for their esophageal cancer. The median survival length was 4 months for this group of patients. Of the 41 patients in this study, 10 received radiation therapy for their malignant TEF (30-66 Gy). The median survival length of this group of patients was 4.8 months. Six of these 10 patients died of metastatic disease (median survival length, 9 months), and there was no evidence of progression of the local tumor. Four of these 10 patients died of local progression of the malignancy (median survival length, 3 months). CONCLUSIONS: Radiation therapy did not increase the severity of the TEF. The authors conclude that radiation therapy can be administered safely in patients with TEF resulting from esophageal cancer. In some patients, radiation treatment may contribute to stabilization of the local tumor process (60% of patients treated with radiation therapy died of metastatic disease without local progression of tumor); however, all patients in this study eventually died of esophageal cancer.     

Poor prognosis in esophageal cancer patients with postoperative complications

We describe a 49-year-old woman with a history of metastatic renal cell carcinoma and classic signs and symptoms of left-sided cavernous sinus syndrome. Magnetic resonance imaging showed a lesion in the left cavernous sinus consistent with metastatic renal cell carcinoma. The patient received radiation therapy totaling 4,600 cGy, with complete resolution of symptoms. This represents the first case report of renal cell carcinoma metastatic to the left cavernous sinus.     

Chemotherapy and radiotherapy as part of curative management of esophageal cancer

Chemotherapy and irradiation it combination or alone have been employed in the treatment of oesophageal carcinomas for many years. However, their place in curative treatment is not definitively clarified. Several non-randomized studies indicate an effect from combined chemotherapy and irradiation possibly followed by surgery. Randomized studies published during the last few years confirm an increased curability in patients who have received combined treatment. New multicentre trials show that a more aggressive attitude is indicated in selected groups of patients with oesophageal carcinoma. Due to the variable spectrum of the disease and complexity of the treatment the treatment should be given in centres which master the different modalities.     

Palliative intubation of esophageal prosthesis in two patients with lung cancer

PURPOSE: Severe eye burns often result in extensive necrosis of the conjunctiva and episcleral tissue. Video fluorescein angiography was performed to reveal the perfusion of the anterior eye segment after severe eye burns. METHODS: A scanning laser ophthalmoscope was used for anterior segment fluorescein angiography in 12 patients (14 eyes) with severe burns grade III-IV and in 7 healthy volunteers. RESULTS: Necrotic tissues occurred as non perfused areas and remained dark throughout the whole angiogram. In general, the borders from healthy to necrotic conjunctival tissue were sharply demarcated. Thus, the extent of scleral and limbal ischemia could be determined exactly. Injured vessels showed hyperfluorescence with late leakage. Damage of the subconjunctival tissue appeared as a deep weak fluorescence in the early angiography and exhibited patchy leakage in the late angiogram. CONCLUSIONS: Anterior segment angiography provides a basis for deciding the extent of surgical debridement of necrotic tissue in the acute phase of the burn. The determination of the extent of limbal and scleral ischemia may give useful information for early plastic-reconstructive procedures.     

Islet amyloid polypeptide in patients with pancreatic cancer and diabetes

Population-based psychiatric admission rates vary across geographic areas, but reasons for this variation are unknown. Insofar as Community Mental Health Centers (CMHCs) provide outpatient services that may deter the need for hospitalization, the presence and structural characteristics of CMHCs may have an impact on a population's psychiatric admission rates. This study uses small area analysis to examine how general hospital psychiatric admission rates are associated with CMHC characteristics. Based on a survey of all CMHCs in Iowa and corresponding small area variation data, it was found that population admission rates were higher in areas closer to the CMHC and lower in outlying catchment areas, adjusting for age, sex, and urban/rural differences in populations. There was little evidence that differences in staffing and service variables influenced admission rates, although greater CMHC staff coverage by social workers and psychiatric residents was associated with lower admission rates. The results suggest that CMHCs do not lower an area's hospitalization rate, and in fact, the presence of CMHCs may promote a "supplier-induced demand" phenomenon of higher admissions.     

Extrathoracic esophagectomy in the treatment of esophageal cancer

Extrathoracic esophagectomy has the potential of improving the results of resectional therapy for carcinoma of the esophagus by eliminating the need for thoracotomy and decreasing postoperative pulmonary complications. This report compares the operative and functional results of blunt extrathoracic esophagectomy and substernal reversed gastric tube reconstruction in patients with esophageal cancer to results in 10 consecutive nonrandomized control patients treated by standard esophagogastrectomy. Extrathoracic esophagectomy was associated with greater pulmonary dysfunction than standard esophagogastrectomy. While there was no significant difference in survival in the two groups, three patients in the standard esophagogastrectomy group (mean survival 9.0 months) and none in the extrathoracic esophagectomy group (mean survival 7.4 months) developed anastomotic recurrence. Extrathoracic esophagectomy evidently does not afford patients with esophageal carcinoma better palliation than standard esophagogastrectomy.     

The management of cervical esophageal cancer by head and neck surgeons

Aspergillosis became an important opportunistic mycosis during the last years, with a great variety of clinical manifestations. To contribute to the replenishing of this mycosis serodiagnosis, biologic reactives (antigens and antisera) were prepared from strains of the species Aspergillus niger, Aspergillus flavus and Aspergillus terreus for their use in immunoprecipitation assays. The reactives were assessed by double immunospreading versus a reference commercial system; satisfactory results were obtained, and this guarantees the widening of the aspergillosis serodiagnosis in the Mycology Laboratory of the "Pedro Kourí" the Tropical Medicine Institute (IPK) with important imports savings.     

Nedaplatin and 5-FU combined with radiation in the treatment for esophageal cancer

A direct differentiation of the internal and external drug-deposition pattern into hair was made using two fluorescent dyes and fluorescence microscopy after systemic administration to mice or external exposure of untreated hair. Mice (23 days old, C57 and Balb/C) were administered either rhodamine or fluorescein intraperitoneally at varied doses on 3 consecutive days of 3 weeks, and hair was sampled 1 week later. Another group was given 10 mg/kg rhodamine or 100 mg/kg fluorescein and sampled at time points from 5 min to 168 hr. The time courses of external deposition of rhodamine and fluorescein into untreated hair were examined after hair was soaked in 0.1 mg/ml solutions at pH 3, pH 6, and pH 9 aqueous buffer or methanol. The hair was then extracted in pH 6 phosphate buffer or methanol for 24 hr. In vivo accumulation was distinguishable as fluorescent bands along the length of the hair for rhodamine and fluorescein. The pattern of in vivo deposition appears to arise from the rapid accumulation within the cortex and medulla, with little deposition evident in the cuticle. Neither phosphate buffer nor methanol washes affected the intensity of fluorescence in the hair. External loading of rhodamine into the hair resulted in staining of the junctions of cuticle scales. This pattern persisted even after 12 hr of solution exposure. Extraction with pH 6 phosphate buffer or methanol did not remove rhodamine. Fluoroscein followed a similar pattern, with maximum fluorescence when hair was loaded in pH 6 100mM phosphate buffer and nominal staining when loaded in pH 9 100 mM Tris buffer or methanol. Soaking the hair in pH 6 buffer, but not methanol, removed some fluorescein. These results demonstrate that compounds in the circulation can rapidly diffuse into the forming cortex and medulla, where rapid associations occur with elongating intermediate filaments specific to the medulla and cortex. These compounds can become significantly occluded within the mature matrix and are resistant to removal in aqueous or methanolic solutions.     

A clinical study on respiratory management using a respirator with nasal intubation in patients undergoing surgery for esophageal cancer

We analyzed a postoperative respiratory management using a respirator with nasal intubation in 55 patients who underwent subtotal esophagectomy through thoracic and abdominal approach between April 1984 and December 1989. In 21 cases (38%) the period using a respirator was within 3 days, in 24 cases (44%) during 4-7 days, and in 10 cases (18%) over 8 days. Postoperative pulmonary complications occurred in 20 cases (36%); pneumonia in 7 cases (13%), lung edema in 12 cases (22%), atelectasis in one case (2%). Two patient died after surgery, one from acute myocardial infarction, another from multiple organ failure after anastomotic leakage. The period using a respirator was positively correlated with the operative blood loss, transfusion and post-operative infusion, postoperative pulmonary complications positively correlated with the operative time, the anesthetic time, operative blood loss, transfusion and postoperative infusion as well as with preoperative complications and renal dysfunction too. In 120 cases before 1984, postoperative pneumonia occurred in 42 cases (36) and 19 cases (16%) of them died. These results suggest that our respiratory management using a respirator is effective in perioperative period of esophageal cancer.     

Stress and activity management: Group treatment for cancer patients and spouses.

51 ambulatory patients (aged 25–70 yrs) with commonly occurring cancers and 25 of their spouses participated in a study to evaluate a stress and activity management treatment program (SAM) conducted in a group. 26 patients participated in the SAM treatment condition, and 25 participated in the current available care (CAC) control condition. SAM patients and spouses were expected to improve more than the CAC patients and spouses in fund of information, psychosocial adjustment, and daily activities. Patients and spouses were evaluated at 4 times: pretreatment, posttreatment, 2-mo follow-up, and 4-mo follow-up. Interviews, questionnaires, and self-monitoring of behavior were designed to assess outcome variables. Measurement instruments included a functional performance scale, a cancer information test, and a psychological adjustment to illness scale. Results indicate some support for unique effects of the treatment intervention, but there was also support for improved psychosocial adjustment by all patients and spouses with the passage of time. SAM patients and spouses reported high satisfaction with the group program, used the techniques they learned in the group, and said that they would recommend it to other patients. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)