Current opinion in oncology
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Patients with neoplastic diseases are predisposed to develop invasive fungal infections as the result of impairments of host defense mechanisms due principally to pharmacologic immunosuppression resulting from intensive cytotoxic chemotherapy, ablative radiation therapy, and corticosteroids. Candida species, Aspergillus species, and emerging opportunistic fungal pathogens comprise the principal etiologic agents of opportunistic mycoses in cancer patients. This paper reviews the recent progress, particularly during the year of 1991, in management of invasive fungal infections and the current problems of invasive mycosis, which confront patients with neoplastic diseases.
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Intensive care has been important in the treatment of cancer patients during the last decade. The main indications for admission to the intensive care unit are postoperative recovery, critical complications of cancer and its treatment, intensive anticancer treatment administration monitoring, and acute disease unrelated to the neoplastic disease or its treatment. Management of such cases must take into account the patient's fragility resulting from the presence of a severe chronic underlying disease with systemic effects. In the future, intensive care may play an important role in the development of oncology not only as supportive care for patients but also in the active development of new anticancer therapies.
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Clinically significant thyroid malignancies are relatively uncommon, although their prevalence in autopsy series ranges up to 11%. New data confirm an increased incidence of carcinoma in solitary thyroid nodules in younger patients and a greater likelihood for younger patients to present with metastatic disease. ⋯ Prophylactic neck dissection does not improve survival or lessen recurrence in differentiated thyroid cancers and may increase morbidity. It should, therefore, be reserved for the patient with clinically enlarged cervical nodes.