Diversification and desynchronicity: An organizational portfolio perspective on corporate risk reduction

A longstanding objective of managers is to reduce risk to their businesses. The conventional strategy for risk reduction is diversification; however, evidence for the effectiveness of diversification remains inconclusive. According to Organizational Portfolio Analysis, firms are viewed as portfolios of business units, and the key to risk reduction is both diversification and synchronization compensation. This study introduces “desynchronicity”, a process that operationalizes synchronization compensation by assessing the degree of correlation between income streams of business units. Two samples of 737 and 332 firms (from COMPUSTAT) were used to empirically test the relationships between diversification and risk, and desynchronicity and risk. The results show that diversification alone will not always lead to a lower corporate risk. To reduce risk, firms also need to consider the desynchronicity of their business portfolios. Other practical implications include improved decisions on portfolio composition.</jats:p

Computed tomography of the sternum and its articulations

The chest wall presents diagnostic difficulties for both the clinician and the radiologist. Because of normal variations in anatomy and ossification, analysis of the sternal region can be particularly confusing. We reviewed the normal computed tomographic (CT) appearance of the sternum in 354 patients. Important normal sternal variants included cortical unsharpness along the posterior aspect of the manubrium, lateral surfaces of the body, and at the sternal fibrocartilaginous articulations; soft tissue prominence at the junction of the sternum and costochondral cartilage; and bony sclerosis at the transitions from manubrium to body and from body to xiphoid. In seven patients with clinically significant sternal abnormality, key CT features were abnormal soft tissue mass (7/7), destruction or irregularity of the cortical contour (7/7), and abnormal increased attenuation of bone (1/7). CT should be the radiologic study of choice in patients with suspected abnormality of the sternum and its articulations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46774/1/256_2004_Article_BF00349494.pd

Fentanyl nasal spray for the treatment of cancer pain

Introduction: Breakthrough pain, a transitory flare of pain in patients with otherwise controlled chronic pain, has been well characterized in cancer patients but despite medical awareness, sometimes remains underdiagnosed and therefore undertreated. Areas covered: Oral transmucosal fentanyl citrate (OTFC) and fentanyl buccal tablets are the first medications developed specifically for the treatment of breakthrough pain in opioid-tolerant patients. Since oral administration of fentanyl is not an option for many cancer patients, the development of intranasal fentanyl spray (INFS) emerged as a more effective method of administration. Intranasal administration of fentanyl has several advantages over the oral/gastrointestinal route and clinical trials have shown that it is superior to OTFC while being well tolerated and more acceptable by the majority of patients. Expert opinion: The aim of this review is to summarize the pharmacological characteristics and data obtained from clinical studies of INFS in the past few years, and present Fentanyl Pectin Nasal Spray (PecFent), which uses an innovative delivery system and is now approved in the EU. Finally, we discuss the impact that it may have in the future management of breakthrough pain in cancer patients, because an accurate diagnosis followed by the best treatment is crucial for effective pain alleviation. © Informa UK, Ltd

Optic nerve sonography: a new window for the non-invasive evaluation of intracranial pressure in brain injury

Enlargement of the optic nerve sheath has been described in patients with raised intracranial pressure (ICP), thereby serving as one of its indicators. Optic nerve sonography offers rapid bedside assessment of the optic nerve sheath diameter and has recently been introduced for the noninvasive detection of raised ICP, particularly in patients with severe brain injury. This review explains the pathophysiology of optic nerve sheath enlargement as a result of intracranial hypertension, describes the technique and clinical use of optic nerve sonography, and summarises the studies which have tested this modality in the non-invasive evaluation of ICP

Well-differentiated hand liposarcoma with bone metastases treated successfully with zoledronic acid

Background: Well-differentiated liposarcomas of the upper extremities, such as the hand or forearm, are extremely rare and are commonly misdiagnosed and considered benign. They are frequently reported as having low metastatic potential. Case Report: We report the case of a 58-year-old man with well-differentiated hand liposarcoma and diffuse bone metastases. The patient initially presented with a tumor of the thenar eminence and was treated with marginal surgical excision and external beam irradiation. 4 months after this treatment, soft tissue local recurrence and skeletal metastases were detected. Zoledronic acid treatment (4 mg per month) was initiated, and both the tumor and the metastases regressed. The patient remains cancer-free 3.5 years after diagnosis of the metastatic disease. Conclusion: Significant metastatic disease can develop in patients with well-differentiated liposarcomas. The beneficial effect of zoledronic acid observed in this case may be related to its anticancer properties, as described in phase III trials in various tumor types. © 2011 S. Karger AG, Basel

The mediation effect of anxiety between post-traumatic stress symptoms and preparatory grief in advanced cancer patients

Context: The relationship between anxiety and preparatory grief is complex and poorly understood. Objectives: To investigate the relationship between anxiety, post-traumatic stress symptoms, and preparatory grief in a sample of patients with advanced cancer. Methods: Ninety-four patients with advanced cancer completed the Greek version of the Impact of Events Scale-Revised (IES-R-Gr), the Anxiety subscale of the Greek Hospital Anxiety and Depression Scale, and the Preparatory Grief in Advanced Cancer Patients (PGAC) scale. Results: Statistically significant associations were found between IES-R-Gr subscales, anxiety (P &lt; 0.0005), and PGAC (P &lt; 0.0005). Conclusion: Some of the effect of post-traumatic stress symptoms on preparatory grief is mediated by anxiety. © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved

Retroperitoneal tumors: Do the satellite tumors mean something?

Background and Objectives: Primary retroperitoneal tumors constitute a rather uncommon disease with an incidence of 2 in 100,000. Local recurrence after surgical resection is reported between 60% and 90% at 10 yr. The aim of this study was to present the problem of satellite tumors around the main tumor mass and their possible relation to local recurrence. Methods: Twenty- nine patients with retroperitoneal tumors underwent surgical resection in our department during an 8-yr period. We reviewed their records including their preoperative computed tomography (CT) scans. Results: Twenty patients had &apos;complete&apos; resections requiring seven nephrectomies, four colectomies, two splenectomies, and one appendectomy. In nine cases the resection was incomplete because of tumor invasion to vital structures. Histopathology revealed that the resected tumors were: liposarcomas (12), leiomyosarcomas (4), paragangliomas (5), malignant fibrous histiocytomas (3), other sarcomas (3), schwannoma (1), myelolipoma (1), and the malignancy grade was I in 6, grade II in 11, and grade III in 12 cases. Two patients died within 30 d of the operation. The I year recurrence rate was 41.4% (12/29) and the total recurrence rate 55.2% (16/29). Survival at 5 yr was 31% (9/29), whereas the disease-free survival was 20.7% (6/29). Four patients required reoperations. In seven cases (24.1%) preoperative CT scans revealed small nodular lesions around the main tumor that were removed en bloc and were of the same histopathological type as the main tumor. We called these &apos;satellite&apos; tumors. All seven patients had local recurrence within 1 yr. Conclusions: There seems to be a close relationship between the finding of satellite tumors and the recurrence of the disease. The existence of satellite tumors on the preoperative CT scan may be used as a guide for the extent of the resection, and further investigations are necessary before they are used as a prognostic sign

Retroperitoneal tumors: Do the satellite tumors mean something?

Background and Objectives: Primary retroperitoneal tumors constitute a rather uncommon disease with an incidence of 2 in 100,000. Local recurrence after surgical resection is reported between 60% and 90% at 10 yr. The aim of this study was to present the problem of satellite tumors around the main tumor mass and their possible relation to local recurrence. Methods: Twenty-nine patients with retroperitoneal tumors underwent surgical resection in our department during an 8-yr period. We reviewed their records including their preoperative computed tomography (CT) scans. Results: Twenty patients had “complete” resections requiring seven nephrectomies, four colectomies, two splenectomies, and one appendectomy. In nine cases the resection was incomplete because of tumor invasion to vital structures. Histopathology revealed that the resected tumors were: liposarcomas (12), leiomyosarcomas (4), paragangliomas (5), malignant fibrous histiocytomas (3), other sarcomas (3), schwannoma (1), myelolipoma (1), and the malignancy grade was I in 6, grade II in 11, and grade III in 12 cases. Two patients died within 30 d of the operation. The 1 year recurrence rate was 41.4% (12/29) and the total recurrence rate 55.2% (16/29). Survival at 5 yr was 31% (9/29), whereas the disease-free survival was 20.7% (6/29). Four patients required reoperations. In seven cases (24,1%) preoperative CT scans revealed small nodular lesions around the main tumor that were removed en bloc and were of the same histopathological type as the main tumor. We called these “satellite” tumors. All seven patients had local recurrence within 1 yr. Conclusions: There seems to be a close relationship between the finding of satellite tumors and the recurrence of the disease. The existence of satellite tumors on the preoperative CT scan may be used as a guide for the extent of the resection, and further investigations are necessary before they are used as a prognostic sign. (C) 1998 Wiley-Liss, Inc

Caregivers&apos; anxiety and self-efficacy in palliative care

MYSTAKIDOU K., PARPA E., PANAGIOTOU I., TSILIKA E., GALANOS A. &amp; GOULIAMOS A. (2012) European Journal of Cancer Care22, 188-195 Caregivers&apos; anxiety and self-efficacy in palliative care This study examined the relationship between caregivers&apos; anxiety supporting a patient with advanced cancer and self-efficacy and their socio-demographic characteristics, and then whether these variables could influence their self-efficacy. One hundred and seven caregivers of advanced cancer patients participated in the study and completed the Greek versions of the State-Trait Anxiety Inventory (STAI) and the General Perceived Self-efficacy Scale (GSE). Significant comparisons were found between State anxiety and female gender (P= 0.009), cohabitation (P= 0.002) and relationship with the patient (P= 0.004); statistically significant associations were found between State, Trait anxiety and self-efficacy scores of caregivers (P &lt; 0.0005 respectively). A multiple regression model (enter method) showed women (P= 0.005), spouses (P= 0.01) and self-efficacy (P= 0.02) as the significant predictors of State anxiety. Furthermore, self-efficacy seemed to be the strongest contributor of trait anxiety (P &lt; 0.0005). Female caregivers and spouses of advanced cancer patients experience more state anxiety levels than men and other caregivers respectively. In addition, caregivers with low self-efficacy are more likely to have elevated anxiety scores than self-efficacious caregivers. These findings can help healthcare professionals focus on some problems common to caregivers of cancer patients and plan appropriate interventions. Copyright © 2013 Blackwell Publishing Ltd 22 2 March 2013 10.1111/ecc.12012 Original Articles Original Article © 2012 Blackwell Publishing Ltd