Curēus
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The abscopal effect is a phenomenon observed in the treatment of metastatic cancer where localized irradiation of a particular tumor site causes a response in a site distant to the irradiated volume. The mechanisms of the abscopal effect are speculated to be of several origins, including distant effects on p53, elaboration of inflammatory agents including cytokines, and, most recently, secondary to immune mechanisms. In this case report, we present a rare report of a patient with hepatocellular carcinoma with lung metastases who, after receiving radiation treatment to the liver, had a treatment response in the liver and a complete response in the lung. Recent advances in the understanding of the primary role of immune-modulated cytotoxicity, especially with the success of immune checkpoint inhibitors, have the potential to turn the abscopal effect from a rare phenomenon into a tool to guide antineoplastic therapy and provide a new line of research.
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A 77-year-old man presented to the hospital for non-ambulation of 48 hours prior to admission. He was found to have a metastatic spinal cord compression (MSCC), a PSA exceeding 27,000, and biopsy-confirmed prostate cancer. After palliative radiation (RT) to the spine and medical treatment, the patient recovered his functions fully and survived for more than 7.5 years, far beyond what would be expected based on current published literature. A systematic review of the literature of MSCC in patients with prostate cancer was carried out. ⋯ Positive predictive factors of local control included single level of metastasis, time of development of motor deficits of more than 14 days, no prior androgen-deprivation therapy (ADT), age under 65, and longer course of RT (10 fractions of 2 Gy). Absence of prior ADT, pre-treatment ambulation, a single site of metastasis, and haemoglobin of less than 12g/L were positive predictors for survival.
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As adult learners, junior clerks on core rotations in emergency medicine (EM) are expected to "own" their patients and follow them from presentation to disposition in the Emergency Department (ED). Traditionally, we teach clerks to present an exhaustive linear list of symptoms and signs to their preceptors. ⋯ Mnemonics have been developed to teach clerks how to present succinctly and cohesively. To address the need for continual patient reassessment throughout the patient's journey in the ED, we propose a complimentary approach called SPIRAL.