Miracle-dz/UniFAR-FTUs huggingface dataset:
Use of intralesional bleomycin as primary therapy in macrocystic lymphangiomas.

A prospective study was conducted to determine the efficacy and short term adverse effects of intralesional bleomycin sclerotherapy in children with lymphangioma. The diagnosis of lymphangioma was made on clinical examination and was supplemented with Doppler ultrasonography. Children with ultrasonographically proven, subcutaneous, macrocystic lymphangiomas with no/ minimal vascularity were included in the study. Before the procedure hemogram and baseline chest radiograph were performed. The procedure was performed after taking consent for the parents, under mild sedation (oral Triclofos) and aseptic conditions. A 20 G needle was used to perform the aspiration and attempt was always made to traverse the needle in subcutaneous plane initially and then puncture the lymphangioma in order to prevent egress of bleomycin from the puncture site at the end of the procedure. After complete aspiration of the lesion bleomycin was injected through the same needle. If the cyst could not be aspirated properly then injection under ultrasonographic guidance was performed. Bleomycin (1 mg/ml) was administered at dose of 0.6 mg/kg with a maximum dosage of 1 mg/ kg or 15 mg per session. A compression dressing, if feasible, was applied after the procedure. The parents were instructed to review with the child after 2 days in the outpatient department for removal of dressing and evaluation of any adverse effects. Patient was again examined at the end of 3 weeks and need for repeat injection assessed.
Synchronous and metachronous skeletal osteosarcomas: The Norwegian Radium Hospital experience

Background. The purpose of this work was to study clinical and histopathological tumor characteristics of patients treated for synchronous or metachronous skeletal osteosarcoma at The Norwegian Radium Hospital from January 1, 1980 to January 1, 2008. Patients and methods. The hospital sarcoma database and patient records were reviewed to identify cases with synchronous or metachronous skeletal osteosarcoma. Patients with more than one skeletal lesion in the absence of pulmonary or other soft tissue tumor manifestations were included in the study, and histopathological slides from these tumors were reviewed. Results. Among a total of 297 registered osteosarcoma patients, six with synchronous (2.0%) and 10 with metachronous (3.4%) skeletal osteosarcomas were identified. All tumors were of high-grade malignancy. Treatment at the time of the first osteosarcoma diagnosis was in most cases wide resections and multi-agent chemotherapy according to international protocols, whereas the treatment for metachronous tumors was individualized and in general much less intensive. One patient was diagnosed with Li-Fraumeni syndrome, two other individuals may be suspected to have the same syndrome, and yet another patient had previously been treated for a bilateral retinoblastoma. Thirteen patients are dead, 11 from metastatic osteosarcoma, one from myelodysplastic syndrome, and one from wound infection and methotrexate-related nephrotoxicity; whereas three patients are still alive with no evidence of osteosarcoma. Conclusions. The prognosis for patients with synchronous and metachronous skeletal osteosarcoma is poor. However, because long-term survival is seen, aggressive treatment to selected cases, e.g., patients with an osteosarcoma predisposing syndrome and/or late occurring metachronous tumours, is justified. Revealing a possible clonal relationship between these tumors, e.g., by karyotyping, may be of interest for estimating prognosis and guide therapy intensiveness.
Case studies showing clinical signs and management of cutaneous toxicity of the MEK1/2 inhibitor AZD6244 (ARRY-142886) in patients with solid tumours

The development of therapies that selectively target specific molecules needed for tumour development, has introduced a new era in oncology. The intracellular Ras/Raf/MEK/ERK protein kinase signal cascade is a key pathway involved in cell proliferation and survival, which can be activated by a number of cell surface receptors, including epidermal growth factor receptor (EGFR) [1]. Mitogen-activated protein kinase kinases 1 and 2 (MEK1/2) are the central components of this pathway. Inhibition of MEK1/2 has the potential to block inappropriate signal transduction regardless of the upstream oncogenic aberration. Oral AZD6244 is a potent, selective, uncompetitive inhibitor of MEK1/2 by which signal transduction of multiple pathways, including the EGFR pathway, is inhibited. Clinical efficacy has been shown in phase I and II monotherapy studies in patients with advanced cancers [2–4]. AZD6244 is associated with cutaneous adverse events, which are similar to those experienced following targeted treatments that inhibit EGFR [5]. Here we report seven MEK1/2 inhibitor-related dermatological conditions; acneiform eruption, xerosis cutis, paronychia, exacerbation of psoriasis, anal fissure, hair abnormalities and palmar-plantar erythrodysaesthesia (PPE); and their management in three patients treated with AZD6244 in a phase I study [4].
Family Survivors of Homicide: I. Symptoms, Syndromes, and Reaction Patterns

As more and more mental health clinicians become involved in the criminal justice system, family therapists will see increasing numbers of crime victims in their caseloads, and some of these families will have lost loved ones to murder. Part I of this two-part article describes the common and atypical symptoms, syndromes, and reaction patterns shown by families who have experienced the murder of a loved one. Part II will present a practical model for treating family survivors of homicide that incorporates cognitive-behavioral, psychodynamic, family systems, and existential components. Throughout, the emphasis is on therapists being equipped with a sufficiently broad range of clinical tools to treat these survivors flexibly, effectively, competently, and compassionately.
New recommendation of doses in an ongoing phase II study of docetaxel, oxaliplatin and capecitabine as first line therapy in advanced gastro-oesophageal cancer

Recently we reported our results from a phase I study of docetaxel, oxaliplatin and capecitabine (TEX) as fi rst line therapy to patients with advanced gastrooesophageal cancer [1]. To establish the recommended dose (RD) for further therapy, a total of 23 patients were enrolled in cohorts of three at fi ve different dose levels. The TEX regimen was investigated in order to fi nd an easily administered, well tolerated three weeks regimen in the out-patient setting, maintaining the effi cacy of DCF (docetaxel 75 mg/m 2 , cisplatin 75 mg/m 2 and 5-FU 750 mg/m 2 /d day 1 – 5 every three weeks) seen in the V-325 trial [2]. At dose level V, two of four patients experienced dose limited toxicity (DLT) and therefore we included additional seven patients at dose level IV. Only one of seven patients experienced DLT but because of hematologic toxicity dose-intensity was reduced to 75% in four of seven patients after three courses of TEX. Overall eight patients (35%) had febrile neutropenia. Probably, the use of granulocyte colony-stimulating factor (G-CSF) might have minimized these problems, but since it is not recommended routinely in the palliative setting in Denmark, we decided to use dose level III as the RD for the ongoing phase II study. Our phase I trial was not designed to evaluate effi cacy but we found a promising response rate (RR) of 35%, progression free survival (PFS) of 9.4 months and overall survival (OS) of 12.5 months indicating high effi cacy of this three-drug combination. Due to a case of febrile neutropenia grade 5 in phase II we evaluated toxicity in all six patients who
Radical retropubic prostatectomy: A review of outcomes and side-effects

Abstract Background. Radical prostatectomy (RP) is worldwide probably the most common procedure to treat localized prostate cancer (PC). Due to a more widespread use of Prostate-Specific Antigen (PSA) testing, patients operated today are often younger and have organ confined disease justifying a more preservative surgery. At the same time, surgical technique has improved resulting in lower risk of permanent side-effects. This paper aims to give an overview of results from modern surgery regarding cancer control and side-effects. A brief overview of the history is given. Material and Methods. A literature research identified recently published papers focusing on outcome and side-effects after RP. Results. One large randomized study (SPCG-4) compared RP and watchful waiting (WW). The study showed that RP was superior to WW in preventing local progression (RR = 0.36), distant metastasis (RR = 0.65) and death from PC (RR = 0.65). Observational studies also show a better outcome for men treated with RP compared to WW. Peri-operative mortality after RP is low in most material around 0.1%. The risk of stricture of the vesico-urethral anastomosis has decreased with improved technique from historically 10–20% to a low incidence of around 2–9% today. Also the risk of incontinence has declined with improved technique. However, while the rates of severe incontinence is usually very low, as many as 30% still report light incontinence after long-term follow-up. Erectile dysfunction (ED) is still a frequent side-effect after RP. This risk is dependent on age, pre-operative sexual function, surgical technique and other risk factors for ED such as smoking, diabetes, etc. In selected subgroups the risk of ED is low. Inguinal hernia is a more recently described complication after open retropubic RP with a postoperative incidence of 15–20% within three years of surgery. Conclusion. RP is an effective method to achieve cancer control in selected patients. With modern technique it is a safe procedure with a low risk of permanent side-effects except for ED.
Depression as a risk factor for early and late morbidity after coronary artery bypass surgery

Objective: To assess presence of depression symptoms in the preoperative period, immediate postoperative period (IPP) and in the late postoperative period (LPP) in patients with coronary artery disease undergoing bypass surgery and its impact on early and late postoperative morbidity. Method: Fifty-eight inpatients waiting to undergo a bypass elective surgery completed the Beck Depression Inventory (BDI) before surgery (period I), after surgery just before hospital discharge (period II) and three months later (period III). Patients mean age was 61.2 (34 to 78 years; SD: 10.1), 34 (58.6%) were male, 31 (55.4%) had a history of infarction, 35 (62.5%) had ejection fraction >40%, 19 (33.0%) had diabetes. Results: Depression symptoms were identified in 12 (20.7%) patients on period I, 13 (23.6%) on period II e 4 (9.8%) on period III. Eighteen (31.0%) patients had complications on the IPP, 17 (34.0%) on the LPP. IPP complications were more frequent for older patients (more than 65 years; p=0.003), with at least three grafts (p=0.001) and depression on period I (p=0.011). When those variables were associated with complications on the LPP, there was a significant difference for females (p=0.006) and depression on period II (p=0.008). Female patients had more depression symptoms while staying in hospital (p=0.04). Conclusion: More than 65 years, females, three or more grafts and depression symptoms on the postoperative period were associated with more complications after bypass surgery. Patients undergoing bypass surgery should be carefully monitored for depression and treated if necessary since it may be associated with complications after surgery. Descriptors: Coronary disease. Depression. Myocardial revascularization.
Robotic renal surgery: The future or a passing curiosity?

The development, advancement and clinical integration of robotic technology in surgery continue at a staggering pace. In no other discipline has this rapid evolution occurred to a greater degree than in urology. Although radical prostatectomy has grown to become the prototypical application for the robot, the role of the robot in renal surgery remains controversial. Herein we review the literature on robotic renal surgery. A comprehensive PubMed literature search was performed to identify all published reports relating to robotic renal surgery. All clinically related articles involving human participants were critically appraised in this review. Fifty-one clinical articles were included, encompassing robot-assisted pyeloplasty, nephrectomy, nephroureterectomy, living-donor nephrectomy and partial nephrectomy. Feasibility has been shown for each of these procedures. Robot-assisted techniques have been described for almost all renal-related procedures. However, the intersect between feasibility and necessity as it pertains to robotic renal surgery has yet to be defined. Also, the high cost of surgical robotic technology mandates critical appraisal before adoption, especially in a publicly funded health care system, such as the one present in Canada.
Fluence correction factors and stopping power ratios for clinical ion beams

Abstract Background. In radiation therapy, the principal dosimetric quantity of interest is the absorbed dose to water. Therefore, a dose conversion to dose to water is required for dose deposited by ion beams in other media. This is in particular necessary for dose measurements in plastic phantoms for increased positioning accuracy, graphite calorimetry being developed as a primary standard for dose to water dosimetry, but also for the comparison of dose distributions from Monte Carlo simulations with those of pencil beam algorithms. Material and methods. In the conversion of absorbed dose to phantom material to absorbed dose to water the water-to-material stopping power ratios (STPR) and the fluence correction factors (FCF) for the full charged particle spectra are needed. We determined STPR as well as FCF for water to graphite, bone (compact), and PMMA as a function of water equivalent depth, zw, with the Monte Carlo code SHIELD-HIT10A. Simulations considering all secondary ions were performed for primary protons as well as carbon, nitrogen and oxygen ions with a total range of 3 cm, 14.5 cm and 27 cm as well as for two spread-out Bragg-peaks (SOBP). STPR as a function of depth are also compared to a recently proposed analytical formula. Results. The STPR are of the order of 1.022, 1.070, and 1.112 for PMMA, bone, and graphite, respectively. STPR vary only little with depth except close to the total range of the ion and they can be accurately approximated with an analytical formula. The amplitude of the FCF depends on the non-elastic nuclear interactions and it is unity if these interactions are turned off in the simulation. Fluence corrections are of the order of a percent becoming more pronounced for larger depths resulting in dose difference of the order of 5% around 25 cm. The same order of magnitude is observed for SOBP. Conclusions. We conclude that for ions with small total range (zw-eq ≤3 cm) dosimetry without applying FCF could in principle be performed in phantoms of materials other than water without a significant loss of accuracy. However, in clinical high-energy ion beams with penetration depths zw-eq ≥3 cm, where accurate positioning in water is not an issue, absorbed dose measurements should be directly performed in water or accurate values of FCF need to be established.
Tracking latency in image-based dynamic MLC tracking with direct image access

Abstract Purpose. Target tracking is a promising method for motion compensation in radiotherapy. For image-based dynamic multileaf collimator (DMLC) tracking, latency has been shown to be the main contributor to geometrical errors in tracking of respiratory motion, specifically due to slow transfer of image data from the image acquisition system to the tracking system via image file storage on a hard disk. The purpose of the current study was to integrate direct image access with a DMLC tracking system and to quantify the tracking latency of the integrated system for both kV and MV image-based tracking. Method. A DMLC tracking system integrated with a linear accelerator was used for tracking of a motion phantom with an embedded tungsten marker. Real-time target localization was based on x-ray images acquired either with a portal imager or a kV imager mounted orthogonal to the treatment beam. Images were processed directly without intermediate disk access. Continuous portal images and system log files were stored during treatment delivery for detailed offline analysis of the tracking latency. Results. The mean tracking system latency for kV and MV image-based tracking as function of the imaging interval ΔTimage increased linearly with ΔTimage as 148 ms + 0.58 * ΔTimage (kV) and 162 ms + 1.1 * ΔTimage (MV). The latency contribution from image acquisition and image transfer for kV image-based tracking was independent on ΔTimage at 103 ± 14 ms. For MV-based tracking, it increased with ΔTimage as 124 ms + 0.44 * ΔTimage. For ΔTimage = 200 ms (5 Hz imaging), the total latency was reduced from 550 ms to 264 ms for kV image-based tracking and from 500 ms to 382 ms for MV image-based tracking as compared to the previously used indirect image transfer via image file storage on a hard disk. Conclusion. kV and MV image-based DMLC tracking was successfully integrated with direct image access. It resulted in substantial tracking latency reductions compared with image-based tracking without direct image access.
Albumin: friend or foe?

In the absence of red blood cells or any other colloid, human albumin has saved thousands of lives since its first use in 1941. However, for general volume expansion purposes including trauma resuscitation, published evidence suggests that albumin has now been superseded by synthetic colloids, which are more effective volume expanders, have vascular protective effects and are cheaper.
Outcome of dexamethasone-cyclophosphamide pulse therapy in pemphigus: a case series.

BACKGROUND Pemphigus disorders are a group of serious and potentially life-threatening diseases affecting skin and/or mucus membranes. Dexamethasone-cyclophosphamide pulse (DCP) therapy has shown promising results in the management of these diseases. AIMS The objective of the study was to assess the outcome of DCP therapy in pemphigus. METHODS Pemphigus patients who had been treated with DCP therapy from 2001 to 2008 were prospectively and retrospectively analyzed. RESULTS A total of 65 pemphigus patients were enrolled. Male to female ratio was 1 : 1.82. Mean age of patients was 44.65 +/- 11.85 years with a range of 14 to 73 years. Thirty two patients completed phase I, of which 28 (9 in phase II, 7 in phase III and 12 in phase III) were maintaining remission and four patients relapsed. Relapse was observed only in patients who discontinued or took irregular treatment. Six patients were declared cured of disease. Five patients died during phase I. Dexamethasone-cyclophosphamide pulse therapy is not absolutely free from adverse effects. Most of the immediate side effects were expected, tolerable and did not pose any problem in continuing treatment. There was a slight increased incidence of weight gain, hypertension, diabetes mellitus, cataract and Cushingoid habitus, since most of our patients also received additional daily oral steroids. Also, there was a high incidence of secondary pyogenic infections of skin lesions and oral candidiasis during phase I. Staphylococcus aureus was the commonest bacteria isolated from the pus of skin lesions. Most of the alterations in laboratory parameters were transitory or correctable, and did not pose a problem in continuing therapy. CONCLUSIONS DCP therapy was found to be effective in inducing and maintaining remission in pemphigus, provided the patients receive regular and complete treatment.
Knowledge and Attitudes of Pharmacists in Missouri Regarding Natural Products

Objectives. The purpose of this descriptive investigation was to determine the perceived knowledge of and attitudes toward natural products by pharmacists in Missouri. Methods. A questionnaire was mailed to 2921 licensed pharmacists. Assessments were conducted regarding the venues and specific resources these pharmacists utilized in order to gain knowledge in the area of natural products. Results. Over half (56.9%) of those surveyed indicated that they received natural product questions on a weekly basis, but only a minority (2.4%) felt they could “always answer natural product questions. ” The most commonly used means for education was printed continuing education (70.2%). Only 12.5% of pharmacists indicated that they had gained knowledge about natural products from their didactic pharmacy education. Conclusions. These results confirm the need to provide pharmacists with additional education on natural products. Ideas for integrating education on natural products into pharmacy school curricula are presented.
The influence of training on the recognition of gross features of dermoscopy images.

BACKGROUND In a dermoscopic examination, besides structural components, inexperienced clinicians should also be able to recognize the gross features of the images. AIM The aim of this study is, whether or not an inexperienced clinician has problems in the recognition of gross features of the images on dermoscopic examination. METHODS Two dermatologists, of whom one was experienced in the field of dermoscopy and the other was not, examined 161 dermoscopic images of melanocytic lesions in the gross features of their borders. Inner and outer borders were defined for each lesion. Both dermatologists separately evaluated the borders of the lesions for irregularity, asymmetry, and wideness of fading. For subjective image analysis they scored each lesion by using the four-point ordinal scale. For computerized image analysis they manually marked borders with dots, by using a computer program. We used quadratic-weighted kappa for interobserver reliability assessments for subjective scores and intraclass correlation coefficients (ICC) for automatically calculated scores. RESULTS In a subjective evaluation the inexperienced observer used a higher score than the experienced observer and the kappa values were between 0.241-0.286. ICC for the automatically calculated scores were between 0.357 and 0.522. According to both the outer and the inner borders, the concordance between experienced and inexperienced observers was almost perfect in measurements of diameter, perimeter, and area (ICC scores were between 0.948 and 0.990). CONCLUSIONS An inexperienced person, in comparison with an experienced person, sees lesions in the same sizes, but in different shapes on dermoscopy. Therefore, it is advisable that making learners familiar with the borders of lesions should be included in the training on dermoscopy.