Harrison's Internal Medicine Chapter 81. Principles of Cancer Treatment
Principles of Cancer Treatment: Introduction The goal of cancer treatment is first to eradicate the cancer. If this primary goal cannot be accomplished, the goal of cancer treatment shifts to palliation, the amelioration of symptoms, and preservation of quality of life while striving to extend life. The dictum primum non nocere is not the guiding principle of cancer therapy. When cure of cancer is possible, cancer treatments may be undertaken despite the certainty of severe and perhaps life-threatening toxicities.
Rather than focusing on earlier treatments, based largely on the simplifications of geometrical acoustics, Physical Principles of Medical Ultrasonics examines concepts of wave acoustics, introducing them in the very first chapter. Practical implications of these concepts are explored, first the generation and nature of acoustic fields, and then their formal descriptions and measurement. Real tissues attenuate and scatter ultrasound in ways that have interesting relationships to their physical chemistry, and the book includes coverage of these topics.
The use of aeration in the wastewater treatment field has been in existence for over
a century. Each of the authors has been involved with the theory and application of
aeration systems for a little less than half a century. It was a daunting task to put
together what we considered the important principles underlying the mechanisms
involved in aeration and show how they are applied in practical applications.
This novel, timely and cost-competitive book on ‘Wetland Systems to Control
Urban Runoff’ covers water and environmental engineering aspects relevant for
the drainage and treatment of stormwater, wastewater and contaminated natural
watercourses from predominantly urban areas, providing a descriptive overview
of the complex ‘black box’ treatment systems and design issues involved.
The fundamental science and engineering principles of relevant water and
wastewater treatment units and processes are explained to address the student
as well as the professional market.
It is my privilege to introduce this Handbook on Advanced Cancer Care,
which belongs to a series of publications initiated by the European Society
for Medical Oncology (ESMO). There is a great need, especially for medical
oncologists, to have a comprehensive overview of the essential elements
needed for the care of patients with advanced cancer. This handbook fulfills
The Handbook on Advanced Cancer Care provides useful definitions and
surveys of treatment principles.
Approaches to Passive Immunization Passive immunization is generally used to provide temporary immunity in a person exposed to an infectious disease who has not been actively immunized; this situation can arise when active immunization is unavailable (e.g., for respiratory syncytial virus) or when active immunization simply has not been implemented before exposure (e.g., for rabies). Passive immunization is used in the treatment of certain illnesses associated with toxins (e.g.
Principles of Dose Selection The desired goal of therapy with any drug is to maximize the likelihood of a beneficial effect while minimizing the risk of adverse effects. Previous experience with the drug, in controlled clinical trials or in postmarketing use, defines the relationships between dose (or plasma concentration) and these dual effects and provides a starting point for initiation of drug therapy.
Figure 5-1 illustrates the relationships among dose, plasma concentrations, efficacy, and adverse effects and carries with it several important implications:
Diagnosis and Treatment of Adverse Drug Reactions The manifestations of drug-induced diseases frequently resemble those of other diseases, and a given set of manifestations may be produced by different and dissimilar drugs. Recognition of the role of a drug or drugs in an illness depends on appreciation of the possible adverse reactions to drugs in any disease, on identification of the temporal relationship between drug administration and development of the illness, and on familiarity with the common manifestations of the drugs.
Drug Interactions Not Mediated by Changes in Drug Disposition Drugs may act on separate components of a common process to generate effects greater than either has alone. Antithrombotic therapy with combinations of antiplatelet agents (glycoprotein IIb/IIIa inhibitors, aspirin, clopidogrel) and anticoagulants (warfarin, heparins) are often used in the treatment of vascular disease, although such combinations carry an increased risk of bleeding.
Principles of Chemotherapy Medical oncology is the subspecialty of internal medicine that cares for and designs treatment approaches to patients with cancer, in conjunction with surgical and radiation oncologists. The core skills of the medical oncologist include the use of drugs that may have a beneficial effect on the natural history of the patient's illness or favorably influence the patient's quality of life. In general, the curability of a tumor is inversely related to tumor volume and directly related to drug dose.
With an overall incidence of more than 800 cases per 1 million persons per year,
only motor vehicle accidents cause more accidental deaths than burns. Advances
in trauma and burn management over the past three decades have resulted in
improved survival and reduced morbidity from major burns. Twenty-five years
ago, the mortality rate of a 50% body surface area burn in a young adult was
about 50%, despite treatment. Today, that same burn results in less than 10%
mortality. Ten years ago, an 80 to 90% body surface area burn yielded 10%
survival. Today, over 50% of these patients survive....
Staging As noted in Chap. 77, an important component of patient management is defining the extent of disease. Radiographic and other imaging tests can be helpful in defining the clinical stage; however, pathologic staging requires defining the extent of involvement by documenting the histologic presence of tumor in tissue biopsies obtained through a surgical procedure.
Palliation Surgery is employed in a number of ways for supportive care: insertion of central venous catheters, control of pleural and pericardial effusions and ascites, caval interruption for recurrent pulmonary emboli, stabilization of cancerweakened weight-bearing bones, and control of hemorrhage, among others. Surgical bypass of gastrointestinal, urinary tract, or biliary tree obstruction can alleviate symptoms and prolong survival. Surgical procedures may provide relief of otherwise intractable pain or reverse neurologic dysfunction (cord decompression).
Application to Patients
Radiation therapy can be used alone or together with chemotherapy to produce cure of localized tumors and control of the primary site of disease in tumors that have disseminated. Therapy is planned based on the use of a simulator with the treatment field or fields designed to accommodate an individual patient's anatomic features. Individualized treatment planning employs lead shielding tailored to shape the field and limit the radiation exposure of normal tissue. Often the radiation is delivered from two or three different positions.
Karnofsky was among the first to champion the evaluation of a chemotherapeutic agent's benefit by carefully quantitating its effect on tumor size and using these measurements to objectively decide the basis for further treatment of a particular patient or further clinical evaluation of a drug's potential.
In the past 30 years, there have been significant changes to the Federal workforce (FW) and the broader labor market from which it draws -- the civilian labor force. As articulated in the merit system principles, the Fed. Govżt. is committed to the goals of a representative FW and to Fed. agencies which manage their employees fairly and develop and deploy their talents effectively. Therefore, it is important to assess the governmentżs progress towards achieving the stated ideals. This report examines changes in the composition of the FW and Fed.
Antibodies In general, antibodies are not very effective at killing cancer cells. Because the tumor seems to influence the host toward making antibodies rather than generating cellular immunity, it is inferred that antibodies are easier for the tumor to fend off. Many patients can be shown to have serum antibodies directed at their tumors, but these do not appear to influence disease progression. However, the ability to grow very large quantities of high-affinity antibody directed at a tumor by the hybridoma technique has led to the application of antibodies to the treatment of cancer.
What happens when physicians become ill? How easy or difficult is it for physicians
to relinquish the role of caretaker and to be cared for by others? What is
unique about the psychological makeup of physicians, as well as the culture of
medicine, that facilitates or impedes timely and comprehensive diagnosis and
treatment? When doctors behave badly or out of character at work, what factors
underlie such behavior, and what can be done about it? In assessing and treating
physicians, what strategies are useful to assure accuracy while simultaneously
diminishing morbidity and relieving sufferi...
(BQ) Part 1 book "Principles of addiction medicine the essentials" presents the following contents: Basic science and core concepts, pharmacology, diagnosis, assessment and early intervention, overview of addiction treatment, special issues in addiction medicine, management of intoxication and withdrawal, pharmacologic interventions.