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《Journal of Medical Imaging and Radiation Sciences》2015,46(4):442-449
The purpose of this literature review is to investigate clinical treatment methods of total body irradiation within the context of a clinical department adopting a paediatric cohort with no existing technique. An extensive review of the literature was conducted using PubMed, Science Direct, Google Scholar, and Clinicians Knowledge Network. Articles were limited to nonhelical tomotherapy, nonparticle therapies, and those using hyperfractionated regimes. Total marrow irradiation was excluded because of national treatment and trial limitations. Of the numerous patient positioning methods present within the literature, the most comfortable and reproducible positioning methods for total body irradiation include both supine and the supine and/or prone combination. These positions increased stability and patient comfort during treatment, while also facilitating computed tomography data acquisition at the simulation stage. Ideally, dose calculations should be performed using a three-dimensional treatment planning system and quality assurance procedures that include in vivo dosimetry measurements. The available literature also suggests inhomogeneity correction factors and intensity modulation are superior to conventional open field techniques and should be implemented within developing protocols. Dynamic machine dose modulation is suggested to reduce department impact, removing the need for tissue compensators and accessory shielding devices, while providing significant improvements to treatment time and dose accuracy. Further long-term survival and intensity modulation studies are warranted, including direct comparisons of both dose modulation and treatment efficiency. 相似文献
4.
Fur-Hsing Wen Jen-Shi Chen Wen-Chi Chou Wen-Cheng Chang Wen Chi Shen Chia-Hsun Hsieh Siew Tzuh Tang 《Journal of pain and symptom management》2019,57(1):64-72
Context
Family caregivers constitute a critical component of the end-of-life care system with considerable cost to themselves. However, the joint association of terminally ill cancer patients' symptom distress and functional impairment with caregivers' subjective caregiving burden, quality of life (QOL), and depressive symptoms remains unknown.Objectives/Methods
We used multivariate hierarchical linear modeling to simultaneously evaluate associations between five distinct patterns of conjoint symptom distress and functional impairment (symptom-functional states) and subjective caregiving burden, QOL, and depressive symptoms in a convenience sample of 215 family caregiver–patient dyads. Data were collected every 2 to 4 weeks over patients' last 6 months.Results
Caregivers of patients in the worst symptom-functional states (States 3–5) reported worse subjective caregiving burden and depressive symptoms than those in the best two states, but the three outcomes did not differ between caregivers of patients in State 3 and States 4–5. Caregivers of patients in State 5 endured worse subjective caregiving burden and QOL than those in State 4. Caregivers of patients in State 4 suffered worse subjective caregiving burden and depressive symptoms but comparable QOL to those in State 2.Conclusion
Patients' five distinct, conjoint symptom-functional states were significantly and differentially associated with their caregivers' worse subjective caregiving burden, QOL, and depressive symptoms while caring for patients over their last 6 months. 相似文献5.
Hand-assisted laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma. 总被引:1,自引:0,他引:1
Jay D Raman Michael A Palese Casey K Ng Stephen A Boorjian Douglas S Scherr Joseph J Del Pizzo R Ernest Sosa 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2006,10(4):432-438
OBJECTIVE: We report our experience with hand-assisted laparoscopic nephroureterectomy (HALN) for upper urinary tract transitional cell carcinoma and compare our results with a contemporary series of open nephroureterectomy (ON) performed at our institution. METHODS: Between August 1996 and May 2003, 90 patients underwent nephroureterectomy for upper-tract transitional cell carcinoma (TCC). Thirty-eight patients underwent HALN, while 52 had an ON. End-points of comparison included operative time, estimated blood loss (EBL), intraoperative and postoperative complications, length of hospital stay, pathologic grade and stage of tumor, and tumor recurrence. RESULTS: The mean patient age was 72.3 and 70.6 years in the ON and HALN groups, respectively. Mean operative duration was 243 minutes (ON) and 244 minutes (HALN), with an EBL of 478mL in the open group versus 191 mL in the hand-assisted group (P<0.001). No intraoperative complications occurred, but postoperative complications occurred in 4% and 11% of the ON and HALN groups, respectively (P=0.21). The mean hospital duration was 7.1 days (ON) versus 4.6 days (HALN) (P<0.01). No difference existed in the pathologic grade or stage distribution of urothelial tumors between the 2 groups. The mean follow-up was 51.0 months in the ON group and 31.7 months in the HALN group. Recurrence of urothelial carcinoma occurred in 50% of patients who underwent ON and 40% treated by HALN (P=0.38) at a median interval of 9.1 and 7.7 months, respectively, after surgery. CONCLUSION: Hand-assisted laparoscopic nephroureterectomy is an effective modality for the treatment of upper urinary tract urothelial carcinoma. Patients benefited from less intraoperative blood loss and a shorter hospitalization with an equivalent intermediate-term oncologic outcome compared with that of the open approach. 相似文献
6.
L. M. Ramondetta G. Tortolero-Luna D. C. Bodurka D. Sills† K. Basen-Engquist‡ J. Gano & C. Levenback 《International journal of gynecological cancer》2004,14(4):580-588
We sought to explore the Society of Gynecologic Oncologists (SGO) members' opinions and decisions about end-of-life issues and incurable conditions. A survey was mailed to members of the SGO. Their responses were recorded on a Likert scale and entered into a database. The survey explored opinions, experiences, and decisions in managing terminally ill gynecologic oncology patients. Of 900 surveys, 327 were returned (response rate, 36%). Seventy-three percent were men, 89% were white, and 72% were of Christian denomination. Respondents believed that 97% of patients who are dying realize that they are dying but stated only 40% of these patients initiate conversations about end-of-life issues. In contrast, 92% of respondents stated that they initiate end-of-life discussions with patients. Ninety-two percent of respondents thought that the patients should be allowed to make end-of-life choices independently after the facts are given to them. However, 44% thought that it is important to influence the way information is presented, and 54% believe that the gynecologic oncologist (GO) controls the outcome of end-of-life discussions. Although the physicians' sex, race, religion, and age did not correlate with their treatment decisions, religion did correlate with less fear of death (P = 0.011) and less discomfort when talking with patients about death (P = 0.005). Fifty-four percent of respondents believed that the GO controls the outcome of end-of-life discussions, and 40% believe that their actions prolong the process of dying. Expanding our understanding of what motivates GOs to recommend continued treatment over palliation is important for preserving informed patient-motivated end-of-life decisions. 相似文献
7.
James A. Wdlff 《Pediatric hematology and oncology》1991,8(2):89-91
Pediatric oncology emerged as a subspecialty in the United States of America following the observations in 1948 of Farber and his associates of the benefits of chemotherapy for acute leukemia. The establishment of national cooperative chemotherapy groups furthered its development. More recently, the subspecialty has been recognized by the American Board of Pediatrics. Even more recently, training programs for the subspecialty have been given accreditation. Parallel to development of the specialty in the United States has been a similar evolution of pediatric oncology in Europe. 相似文献
8.
Katsunobu Kawahara Shinji Akamine Takao Takahashi Akihiro Nakamura Hiroyuki Kusano Tohru Nakagoe Takayuki Nakazaki Hiroyoshi Ayabe Masao Tomita 《Surgery today》1994,24(12):1101-1103
We report herein the case of a 75-year-old man who developed anal canal metastasis from squamous cell carcinoma of the lung. Initially, he underwent a right middle and lower lobectomy combined with left atrial wall resection under cardiopulmonary bypass. He presented 3 months later with an anal polyp which had prolapsed and bled, for which he underwent a transanal polypectomy. Histologically, the polyp was classified as squamous cell carcinoma and considered to be a metastasis from the primary lung cancer. He is presently well with no signs of recurrence 9 months after his initial operation. To our knowledge, there has been no other case of anal metastasis from lung cancer ever reported. 相似文献
9.
John F. Boggess 《Journal of robotic surgery》2007,1(1):31-37
Robotic surgical platforms were first developed with telesurgery in mind. Conceptualized by NASA and the military to provide
surgical expertise to remote locations, some telesurgical success has been documented, but progress has been held back by
communication bandwidth limitations. Telepresence surgery, where the surgeon is in proximity to the patient but is provided
with an ergonomic console equipped with three-dimensional vision and autonomous control of wristed laparoscopic surgical instruments
and energy sources, has shown efficacy first in cardiac and then urologic cancer surgery. Interest is currently focused on
the application of this technology in the field of gynecology, with techniques being described to perform simple hysterectomy,
myomectomy, tubal anastomosis, and pelvic reconstruction procedures. This article will review the application of robotic-
and computer-assisted surgery in the specialty of gynecologic oncology. 相似文献
10.
Impact of a Summer Camp Experience on Daily Activity and Family Interactions Among Children with Cancer 总被引:1,自引:0,他引:1
Smith Karen E.; Gotlieb Sharon; Gurwitch Robin H.; Blotcky Alan D. 《Journal of pediatric psychology》1987,12(4):533-542
Eighteen pediatric cancer patients and their families participatedin a longitudinal study to assess the effects of a camp experienceon daily activity and family interactions. Based on maternalreport, changes were found in the amount of time these childrenspent in social, physical, and self-engaged activities. Mothersand a sibling closest in age to the patient also noted changesin their own frequency of activities spent with the family andwith others. These changes were evident when comparing measuresobtained 2 weeks prior to and 2 weeks after camp. Many changeswere still present 1 month after attending camp. These datasupport the use of a camp experience as an intervention to facilitatea return to more normal, healthy functioning by pediatric cancerpatients and their families. 相似文献