Особенности деонтологии в сексологической практике

Описаны основные принципы врачебной этики в сексологической практике. Рассмотрены особенности взаимоотношений врача−сексолога и пациента. Подчеркивается, что выполнение врачом деонтологических принципов будет способствовать гармонизации семейно−сексуальных отношений.Basic principles of medical ethics in sexological practice are presented. The peculiarities of mutual relations of the doctor sexologist and the patient are discussed. It is emphasized that adherence of the doctor−sexologist of ethical principles will promote harmonization of family sexual relations

Opereren zonder snijden

De toekomst van kankerbehandeling ligt in 'opereren zonder snijden'. Dat zegt hoogleraar Interventieradiologie Maurice van den Bosch van het UMC Utrecht. Hij spreekt op 21 november zijn oratie uit bij de Universiteit Utrecht. Nieuwe technologie verandert de behandeling van kanker in razend tempo. In het UMC Utrecht werken Van den Bosch en collega's aan drie nieuwe aanpakken. Het wegbranden van tumoren; lokale afgifte van chemotherapie; en tijdens bestralen real-time kijken waar de tumor zich precies bevindt. Beeldgestuurde interventie "Alle technieken hebben één ding gemeen", stelt Van den Bosch. "Met beelden kijken we waar de tumor precies in het lichaam zit. Daarna behandelen we alleen de tumor en sparen we het gezonde weefsel rondom de tumor. Hierdoor heeft de patiënt minder complicaties, ligt hij korter in het ziekenhuis en blijft de kwaliteit van leven groter." Het wegbranden van de tumoren gebeurt via ultrageluid. Door geluidsgolven te bundelen is het mogelijk om van buitenaf weefsel of tumoren in het lichaam weg te branden. Het is dan niet meer nodig om het lichaam open te maken. Het UMC Utrecht behandelt op deze manier al goedaardige tumoren in de baarmoeder en is een onderzoek gestart naar de behandeling van borstkanker. In de tweede onderzoekslijn proberen wetenschappers van het UMC Utrecht chemotherapie alleen aan de tumor toe te dienen en niet aan het hele lichaam. Bijwerkingen zoals misselijkheid, vermoeidheid en haaruitval zijn daardoor veel minder. Gestuurd via temperatuur geven bolletjes geladen met medicijnen bijvoorbeeld alleen in de lever hun lading af. Als laatste omvat beeldgestuurde radiotherapie onder meer de bouw van een apparaat waarmee tumoren bestraald kunnen worden terwijl de patiënt in een MRI-scanner ligt. Onder deze benadering vallen ook radioactieve bolletjes waarmee het mogelijk is om levertumoren van binnen uit te bestralen

Image-guided focused ultrasound ablation of breast cancer: current status, challenges, and future directions

Image-guided focussed ultrasound (FUS) ablation is a noninvasive procedure that has been used for treatment of benign or malignant breast tumours. Image-guidance during ablation is achieved either by using real-time ultrasound (US) or magnetic resonance imaging (MRI). The past decade phase I studies have proven MRI-guided and US-guided FUS ablation of breast cancer to be technically feasible and safe. We provide an overview of studies assessing the efficacy of FUS for breast tumour ablation as measured by percentages of complete tumour necrosis. Successful ablation ranged from 20% to 100%, depending on FUS system type, imaging technique, ablation protocol, and patient selection. Specific issues related to FUS ablation of breast cancer, such as increased treatment time for larger tumours, size of ablation margins, methods used for margin assessment and residual tumour detection after FUS ablation, and impact of FUS ablation on sentinel node procedure are presented. Finally, potential future applications of FUS for breast cancer treatment such as FUS-induced anti-tumour immune response, FUS-mediated gene transfer, and enhanced drug delivery are discussed. Currently, breastconserving surgery remains the gold standard for breast cancer treatment

Effectiveness of Reirradiation for Painful Bone Metastases: A Systematic Review and Meta-Analysis

Clinical Oncolog

Accuracy of contrast-enhanced breast ultrasound for pre-operative tumor size assessment in patients diagnosed with invasive ductal carcinoma of the breast

Our aim was to assess the feasibility and accuracy of contrast-enhanced ultrasound (CEUS) of the breast with SonoVue microbubbles for pre-operative size measurement of invasive breast carcinomas. Seven patients diagnosed with nine invasive breast carcinomas prospectively underwent gray-scale ultrasound and CEUS of the breast according to a standardized protocol. CEUS of the breast was performed by a Philips iU22 scanner equipped with a 4–8 MHz linear array transducer. We used a single dose of 2.4 ml SonoVue as contrast agent. Breast lesion morphology was scored according to the sonographic BI-RADS lexicon criteria and classified accordingly. The greatest tumor dimensions on gray-scale ultrasound and CEUS of the breast were finally compared with the greatest histopathologic tumor sizes. Gray-scale ultrasound underestimated the histopathologic tumor size in 6/9 cases (67%), whereas CEUS of the breast underestimated tumor size in only 3/9 (33%) cases. CEUS of the breast was significantly more accurate for tumor size assessment. Greatest tumor dimension as measured with gray-scale ultrasound of the breast was within 2 mm of the pathologic tumor size in only 2/9 cases (22%), whereas CEUS of the breast accurately assessed tumor size within 2 mm of pathologic tumor size in 6/9 (67%) of the cases (P<0.05). CEUS of the breast proved to be a feasible and safe procedure. It is more accurate than gray-scale ultrasound of the breast for pre-operative size assessment of invasive ductal breast carcinomas

Prediction of positive resection margins in patients with non-palpable breast cancer

10.1016/j.ejso.2014.08.474European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology411106-11

Liver perfusion in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) : comparison of enhancement in Gd-BT-DO3A and Gd-EOB-DTPA in normal liver parenchyma

Purpose: Within-patient comparison of the enhancement patterns of normal liver parenchyma after gadobutrol and gadoxetate disodium, with emphasis on the start of hepatocytic uptake of gadoxetate disodium. Materials and methods: Twenty-one patients (12 female, 9 male) without chronic liver disease underwent 1.5-T contrast-enhanced MRI twice, once with an extracellular contrast agent (gadobutrol) and once with a hepatospecific agent (gadoxetate disodium), using a T1-weighted keyhole sequence. Fifteen whole-liver datasets were acquired up to 5 min for both contrast agents and two additional datasets, up to 20 min, for gadoxetate. Signal intensities (SI) of the parenchyma, aorta and portal vein were measured and analysed relative to pre-contrast parenchymal SI. Results: After gadoxetate, in 29 % of the patients the parenchymal SI decreased by =5 % after the initial vascular-phase-induced peak, while in the other 71 % the parenchymal SI remained stable or gradually increased until up to 20 min after the initial peak. The hepatocytic gadoxetate uptake started at a mean of 37.8 s (SD 14.7 s) and not later than 76 s after left ventricle enhancement. Conclusion: Parenchymal enhancement due to hepatocytic uptake of gadoxetate can start as early as in the late arterial phase. This may confound the assessment of lesion appearance as compared to extracellular contrast such as gadobutrol. Key Points: • Gadoxetate-enhanced liver MRI results in early enhancement of normal parenchyma in patients • The start of the hepatobiliary phase coincides with the late arterial phase • This may confound the assessment of lesion appearance compared to extracellular contrast • Different parenchymal enhancement patterns after gadoxetate were found for normal parenchyma. © 2014 European Society of Radiology