The Medical clinics of North America
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Infections in the immunosuppressed cancer patient are caused by a wide variety of bacteria, viruses, fungi, and protozoa; many of these in the normal individual are saprophytes but will cause disease in the immunosuppressed patient, often with treatment failure. Patterns of infection are recognized, and this should enable the physician to plan a meaningful course of action when infection occurs in the compromised host. Obviously, it would be much better to prevent rather than have to treat infection in these immunosuppressed patients. Ideally, in the future, it is hoped that drugs which have less suppressive effect on defense mechanisms will provide a partial solution to the problem of infection in the immunosuppressed patient.
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While pain can be a most useful symptom, it becomes a problem requiring attention when it causes or increases the patient's anxiety, prevents sleep, or starts the patient on a vicious cycle of increasing doses of narcotics with concomitant depression, anorexia, and lethargy. Various surgical modalities and their indications are discussed.
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Melanoma currently offers challenges to the medical profession. Opportunities for early detection, development of rational immunotherapy, and gains in curability are unparalled because of the recently defined aspects of early recognition, its cutaneous location, the long periods of superficial lateral growth, the increasing incidence, and the many fascinating immunologic aspects of melanoma.