Hematology/oncology clinics of North America
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All of the third-generation chemotherapeutic agents reviewed in this article are independently active against NSCLC, although the agents differ significantly in their cellular and molecular mechanisms of cytotoxicity. All have also been shown to potentiate radiation effects, and thus are promising in exerting further cytotoxicity when used in combination chemoradiation therapy for locally advanced NSCLC. Although the toxicity to normal tissue varies among these agents when used alone, phase I/II clinical results consistently demonstrated higher risk and severity of esophagitis and pneumonitis when these agents were administered concurrently with thoracic radiation. ⋯ Although direct statistical comparison between the treatment arms was not valid for a phase II setting, such an analysis did indeed reveal similar overall response rates for these three arms. Chemoradiation using third-generation chemotherapeutic agents has improved local tumor response rates, with enhanced radiation toxicity such as esophagitis and pneumonitis. The challenge of targeting distant disease control for locally advanced NSCLC continues.
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The differential diagnosis of an elevated hematocrit and the criteria for the diagnosis of polycythemia vera present little or no problem; however, there is not a consensus on therapy. Spivak likened this to a conundrum--"an intricate and difficult problem." Nonetheless, it can be argued that on the basis of the following criteria--life expectancy, the absence of toxicity, and long remissions an average of 3.1 years or a median of 2 years--and with acute leukemia no more common than in other regimens except phlebotomy alone (a regimen that cannot be sustained), 32P should be the treatment of choice except in pregnant women. ⋯ Patients treated with phlebotomy alone were subjected to an unacceptably high incidence of early thrombotic events. Unavailability of pipobroman eliminates this choice.
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Hematol. Oncol. Clin. North Am. · Feb 2003
ReviewThromboprophylaxis and thrombosis in medical, surgical, trauma, and obstetric/gynecologic patients.
The International Consensus and the ACCP Sixth Consensus had a great impact on the clinical acceptance of LMWHs. These recommendations have been instrumental in initiating further clinical trial to answer key questions regarding thromboprophylaxis and in setting a new standard for patient care. ⋯ The simple defining of defects leading to unexplained thrombosis will add another 3,000,000.00 dollars in savings per 1000 patients with DVT and approximately 350,000.00 dollars per 100 patients with thrombotic stroke. In those with transient ischemic attacks, defining the defect and instituting appropriate antithrombotic therapy, thereby potentially saving approximately 30% from developing a thrombotic stroke, amounts to approximately 350,500.00 dollars (= 30% of 1,168,500.00 dollars) in savings per 100 patients.
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Hematol. Oncol. Clin. North Am. · Dec 2002
ReviewMedical information, confidentiality, and privacy.
State laws and accreditation requirements dictate the form, ownership, and substance of medical records, as well as requirements for storage, access, and confidentiality. There are limited exceptions to these requirements but they are highly circumscribed. Federal law also outlines requirements to ensure the privacy of patient-identifiable information. Thus, providers must be aware of these rules both to protect patient information from being abused and to understand the affirmative obligations they have so as to avoid the significant penalties associated with breach of these provisions.
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Understanding the legal definition of whole-brain death is imperative for hematologists and oncologists who deal with end-of-life patients on a regular basis. At present, only whole-brain death in which there is no function of the upper brain or brain stem is legally recognized as legal death. ⋯ Those advocating a more narrow definition of death typically fear being misdiagnosed or prefer the traditional cardiopulmonary definition for personal and religious reasons. As medical technology advances, offering new hope to both the critically injured patients who might be potential donors and to those patients in need of donated organs, the definition of death will continue to be a topic of passionate debate.