Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: If you don't believe it, it won't help you": use of bush medicine in treating cancer among Aboriginal people in Western Australia...
This book is unique among its peers as it offers a broad international perspective and
discusses practice approaches from around the globe. In addition, key elements of
emergency medicine practice are covered for the reader discussing historical and
cutting edge approaches and their scientific basis. The chapters that make up this
textbook should be of interest to any reader who treats or is interested in the treatment
of the emergency patient whether the patient is located in the pre-hospital, emergency
department or in-hospital settings....
Head and Neck Cancer: Treatment Patients with head and neck cancer can be categorized into three clinical groups: those with localized disease, those with locally or regionally advanced disease, and those with recurrent and/or metastatic disease. Comorbidities associated with tobacco and alcohol abuse can affect treatment outcome and define long-term risks for patients who are cured of their disease.
Nearly one-third of patients have localized disease; that is, T1 or T2 (stage I or stage II) lesions without detectable lymph node involvement or distant metastases.
Until recently, surgical resection was considered the only option for treatment of kidney
cancer, especially renal cell carcinoma. The disease is relatively resistant to both radiotherapy
and chemotherapy, and although alternative systemic therapies such as interleukin-
2 immunotherapy and interferon have shown promise, objective response rates are
still quite low. Minimally invasive therapies have piqued the interest of researchers by
showing significant improvements in treatment and management of kidney cancer.
Estrogen receptors (ERs) and androgen receptors, members of the steroid hormone family of nuclear receptors, are targets of inhibition by drugs used to treat breast and prostate cancers, respectively. Tamoxifen, a partial agonist and antagonist of ER function, can mediate tumor regression in metastatic breast cancer and can prevent disease recurrence in the adjuvant setting, saving thousands of lives each year. Tamoxifen binds to the ER and modulates its transcriptional activity, inhibiting activity in the breast but promoting activity in bone and uterine epithelium.
The level of suspicion of infections with certain organisms should depend on the type of cancer diagnosed (Table 82-3). Diagnosis of multiple myeloma or CLL should alert the clinician to the possibility of hypogammaglobulinemia. While immunoglobulin replacement therapy can be effective, in most cases prophylactic antibiotics are a cheaper, more convenient method of eliminating bacterial infections in CLL patients with hypogammaglobulinemia.
More common than tunnel infections are exit-site infections, often with erythema around the area where the line penetrates the skin. Most authorities (Chap. 129) recommend treatment (usually with vancomycin) for an exit-site infection caused by a coagulase-negative Staphylococcus. Treatment of coagulasepositive staphylococcal infection is associated with a poorer outcome, and it is advisable to remove the catheter if possible. Similarly, many clinicians remove catheters associated with infections due to P.
Pancreatic Cancer: Treatment Symptoms and the associated impaired performance status are significant issues in the management of patients with pancreatic cancer, as they can have a marked negative impact on the ability to safely deliver chemotherapy or perform curative surgery. For example, patients with malabsorption secondary to pancreatic insufficiency may be treated with pancreatic enzyme supplementation. Indeed effective symptom management is as important a therapeutic goal as survival prolongation.
Several general principles have arisen from these studies. Bevacizumab appears to potentiate the effects of many different types of active chemotherapeutic regimens used to treat a variety of different tumor types. No phase III trials have demonstrated single-agent activity for bevacizumab; colon and lung cancer trials have demonstrated a lack of activity when used alone. An exception may be renal cell cancer (RCC), a tumor that is specifically dependent upon VEGF as the result of deletion of the VHL tumor suppressor and activation of the HIF-1α transcription factor (see above).
Mitomycin C undergoes reduction of its quinone function to generate a bifunctional DNA alkylating agent. It is a broadly active antineoplastic agent with a number of unpredictable toxicities, including delayed bronchospasm 12–14 h after dosing and a chronic pulmonary fibrosis syndrome more frequent at doses of 50–60 mg/m2. Cardiomyopathy has been described, particularly in a setting of prior radiation therapy. A hemolytic/uremic syndrome carries an ultimate mortality rate of 25–50% and is poorly treated by conventional component support and exchange transfusion.
Stages I and II Seminoma Inguinal orchiectomy followed by retroperitoneal radiation therapy cures ~98% of patients with stage I seminoma. The dose of radiation therapy (2500– 3000 cGy) is low and well tolerated, and the in-field recurrence rate is negligible. About 2% of patients relapse with supradiaphragmatic or systemic disease. Surveillance has been proposed as an option, and studies have shown that about 15% of patients relapse. The median time to relapse is 12–15 months, and late relapses (5 years) may be more frequent than with nonseminoma.
The Palpable Breast Mass Women should be strongly encouraged to examine their breasts monthly. A potentially flawed study from China has suggested that BSE does not alter survival, but given its safety, the procedure should still be encouraged. At worst, this practice increases the likelihood of detecting a mass at a smaller size when it can be treated with more limited surgery. Breast examination by the physician should be performed in good light so as to see retractions and other skin changes.
Chemotherapy Unlike many other epithelial malignancies, breast cancer responds to multiple chemotherapeutic agents, including anthracyclines, alkylating agents, taxanes, and antimetabolites. Multiple combinations of these agents have been found to improve response rates somewhat, but they have had little effect on duration of response or survival. The choice among multidrug combinations frequently depends on whether adjuvant chemotherapy was administered and, if so, what type.
The idea of this book grew out of the awareness of the need for a better answer to the frequent query: "Where can I learn about the psychological problems of cancer patients and how to treat them?" . . . There were many books and journals that an interested reader could turn to, but no summary of the broad range of issues that one needed to know to be informed was available. We began to conceive of a small book that would serve as an introduction to this emerging area of oncology. Using a developmental model, we sought to understand...
The pervasiveness of different modalities of TM and CAM
varies greatly from country to country. For example, in China,
where traditional Chinese medicine is well integrated into the
health system,many different modalities may be used to treat a
given condition. In the United States, by contrast, CAM pro-
grams are slowly being integrated with conventional medicine.
Several medical schools have nascent CAM programs and have
integrated them into medical school curricula to differing
In the last part of the 20th century scientists discovered drugs that made the brain
more resistant to ischemia, to such an extent that cerebral tissue treated with them was
only little damaged, or was not damaged at all, by an ischemic insult that badly
damaged control, untreated tissue. It was the beginning of a very exciting era in
neuroscience research, a period when academic and industrial scientists all pursued
the research of a “neuroprotectant” that could defend the ischemic brain from
In most cases, the cause of cancer is multifactorial. About 75% of cancers are due to environmental factors, some of which are within the control of the individual, e.g. tobacco smoking, exposure to sunlight. Growing understanding of cancer genetics and inherited disease suggests that fewer than 10% of cancers are familial.The different systemic modalities used to treat cancer patients are discussed. Immunosuppressive drugs are described here as they share many characteristics with cytotoxics. ...