Therapeutic Approach to Advanced Pancreatic Carcinoma

Pancreatic carcinoma, a chemoresistant disease, still remains a therapeutic challenge in oncology. A variety of cytotoxic agents have been tried with promising or disappointing results. Gemcitabine as a single agent or combined chemotherapy is the mainstay therapeutic approach in locally advanced or metastatic disease. Newer agents, such as tyrosine kinase inhibitors and monoclonal antibodies (bevacizumab, erbitux) are widely used nowadays in modern therapeutic algorithms with promising results. Key words: pancreatic carcinoma; gemcitabine; chemotherapy; monoclonal antibodies; kinase inhibitor

Primary choriocarcinoma of the renal pelvis presenting as intracerebral hemorrhage: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>A choriocarcinoma is a malignant neoplasm normally arising in the gestational trophoblast, gonads and, less frequently, the retroperitoneum, mediastinum and pineal gland. Primary choriocarcinomas of the renal pelvis are extremely rare.</p> <p>Case presentation</p> <p>We report a case of primary choriocarcinoma of the renal pelvis in a 38-year-old Greek woman of reproductive age, presenting with a sudden development of intracerebral hemorrhage due to metastatic lesions. The diagnosis was established with a renal biopsy, along with an elevated serum level of beta-human chorionic gonadotropin. An extensive diagnostic work up confirmed the origin of the choriocarcinoma to be the renal pelvis.</p> <p>Conclusion</p> <p>Extragonadal choriocarcinomas are rare neoplasms that require extensive laboratory and imaging studies to exclude a gonadal origin. Moreover, this is the first case of severe intracerebral hemorrhage as the initial presentation of primary choriocarcinoma of the renal pelvis. Nonetheless, choriocarcinomas should be considered in the differential diagnosis of women of reproductive age.</p

European Lung Cancer Working Party Clinical Practice Guidelines Non-small Cell Lung Cancer: II. Unresectable Non-metastatic Stages

The present guidelines on the management of unresectable non-metastatic non-small cell lung cancer (NSCLC) were formulated by the ELCWP in October 2005. They are designed to answer the following eight questions: 1) Is chest irradiation curative for NSCLC? 2) What are the contra-indications (anatomical or functional) to chest irradiation? 3) Does the addition of chemotherapy add an advantage to radiotherapy? 4) Does the addition of radiotherapy add an advantage to chemotherapy? 5) Is irradiation as effective as surgery for marginally resectable stage III? 6) How to best combine chemotherapy with radiotherapy: sequentially, concomitantly, as consolidation, as induction, as radiosensitiser? 7) In case of too advanced locoregional disease, is there a role for consolidation (salvage) local treatment (surgery or radiotherapy) after induction chemotherapy? 8) In 2005, what are the technical characteristics of an adequate radiotherapy

European Lung Cancer Working Party Clinical Practice Guidelines. Non-Small Cell Lung Cancer: III. Metastatic disease

The present guidelines on the management of advanced non-small cell lung cancer (NS CLC) were formulated by the ELCWP in October 2006. They are designed to answer the following twelve questions: 1) What benefits can be expected from chemotherapy and what are the treatment objectives? 2) What are the active chemotherapeutic drugs for which efficacy has been shown? 3) Which are the most effective platinum-based regimens? 4) Which is the indicated dosage of cisplatin? 5) Can carboplatin be substituted for cisplatin? 6) Which is the optimal number of cycles to be administered? 7) Can non-platinum based regimens be substituted for platinum based chemotherapy as first-line treatment? 8) Is there an indication for sequential chemotherapy? 9) What is the efficacy of salvage chemotherapy and which drugs should be used in that indication? 10) What is the place of targeted therapies? 11) What is the place of chemotherapy in the management of a patient with brain metastases? 12) Which specific drugs can be used for the patient with bone metastases

Dysregulation and containment in the psychoanalytic psychotherapy of a poorly controlled diabetic patient

Dysregulation, as a phenomenon of disruption in the psychotherapeutic setting, may be evidenced in the psychoanalytic psychotherapy of diabetic patients presenting poor metabolic and treatment control. In the case of a female patient, violations of the setting via acting out behaviors provided an opportunity for working through and understanding in depth the patient&apos;s unconscious attempts to activate traumatic childhood experiences and introduce loss and confusion into the relationship with the psychotherapist. Dysregulation was considered in connection with the patient&apos;s pathological containment function, in conflicting part self and object representations, and in relation to traumatic experiences of maternal desertion. Improvement of the patient was identified in her relationships with the psychotherapist, significant others, and the medical health providers, as well as in the overall management of her diabetic treatment. © 2008 The American Academy of Psychoanalysis and Dynamic Psychiatry

The efficacy of a psychiatric halfway house: A study of hospital recidivism and global outcome measure

The authors investigated the post-halfway house outcome of a sample of 41 former residents of the halfway house of the Department of Psychiatry, Athens University. Two criteria were used: hospital recidivism and global ratings of outcome (which was assessed on the basis of three parameters: rehospitalization, employment and independent living). Mean duration from the time of departure was 32 months (range: 8-52 months). Within this period good outcome and non-recidivism were related with compliance to pharmacotherapy. Most recidivists also had a shorter stay in the halfway house and cases with successful outcome tended to be evaluated higher on the ‘’Behaviour in Halfway House Scale” at the end of the residency

Coping strategies of women with breast cancer: A comparison of patients with healthy and benign controls

Background: Cancer has an enormous impact on the patient, triggering fears of suffering, disability and death. Still, little research has been published which investigates the coping strategies adopted by cancer patients, when attempting to deal with their serious health threat. Moreover, it is often not clarified whether the selected coping strategies are used exclusively by cancer patients, or whether other groups of women facing benign breast diseases or having health worries regarding their breasts share similar coping strategies. This study attempts to identify those coping strategies that distinguish breast cancer patients from non-malignant controls. Methods: A sample of 180 breast cancer patients was assessed on how it coped with health threats. The control group was composed of 268 women who were diagnosed as having either a benign disease or were disease free. The Ways of Coping Questionnaire was administered in order to record the frequency of the coping strategies used under the health conditions. Univariate analyses were conducted to compare mean scores in coping strategies among the diagnostic groups. Multivariate analyses were performed to identify those variables that distinguish one group from the other. Results: Compared with women with benign breast disease and those who were disease free, breast cancer patients significantly infrequently exhibited attributions of blame to self, whereas they did not differ from controls in other ways of coping such as self-isolation, passive acceptance, seeking social support, problem-focused coping, positive reappraisal, distancing, and wishful thinking. Conclusion: Our results may suggest that under the conditions of a cancer diagnosis, patients do not tend to assign responsibility on themselves and their character, since they possibly need to avoid guilt, low self-esteem, and social distance, and to maintain a potential to invest in the adjustment process. Copyright (C) 2004 S. Karger AG, Basel