سبد خرید

Diagnosis and Management of Epithelial Ovarian Cancer

Ovarian cancer is the fifth most common cancer among women after breast, bowel, lung, and endometrial and remains the leading cause of death due to gynecological malignancy (Cancer.org 2016). Epithelial ovarian cancer accounts for the vast majority of ovarian malignancies with figures of around 85 %. Due to its insidious nature of presentation, it is often not diagnosed until the later stages leading to a high mortality rate. Five-year survival is very much influenced by stage at diagnosis. Over the last 20 years, incidence and mortality have remained fairly static, and much research is being undertaken looking for aids to diagnosis,
possible screening methods, and improvement in treatment options, both surgical and medical. In this chapter we will discuss presentation, diagnostic tools, and possible management regimes for patients with epithelial ovarian cancer.

Practical Manual of Tricuspid Valve Diseases

Tricuspid valve (TV) dysfunction can result from morphological alterations in the valve or from functional aberrations of the myocardium. It can be classifed as primary and secondary. Primary TV disease with intrinsic structural abnormality is less common than diseases of the aortic and mitral valves. The slow progression of the disease leads to delayed appearance of symptoms. The physical signs are often less impressive. Hence, it may go undetected until advanced stage results in hepatomegaly, ascites, and leg edema. The secondary form of TV disease is far more common and is often the result of annular dilatation with incomplete valve closure. The functional abnormalities may be in the form of pure or predominant tricuspid stenosis (TS), pure or predominant tricuspid regurgitation (TR), or mixed.

Diagnosis and Management of Breast Tumors

Although the feld of radiology as a whole is subject to many levels of regulation and accreditation, breast imaging, and specifcally mammography, is a subspecialty subject to rigorous standards of care that are legally mandated in the United States. Two major entities collaboratively regulate breast imaging in the interests of quality and safety. Responding to issues and inconsistencies in matters pertaining to patient care and image quality, the American College of Radiology (ACR) developed the Mammography Accreditation Program in the late 1980’s as a means of periodic peer review and feedback from experts for improvement . Secondly, the Mammography Quality Standards Act (MQSA) was enacted by Congress in the 1990’s to set national quality standards through specifc regulatory requirements that were established by the Food and Drug Administration (FDA) for mammography . Under MQSA, all facilities that provide mammography services in the United States must be inspected by the FDA every year, earn accreditation by an FDA approved body (which includes the ACR, and the states of Arkansas, Iowa, and Texas) every 3 years, and be certifed by Health and Human Services every 3 years. Mammography facilities under the Department of Veterans Affairs, while not included in MQSA, undergo accreditation by the ACR to maintain the same standards of care.

Stroke Revisited: Diagnosis and Treatment of Ischemic Stroke

Although intravenous recombinant tissue-type plasminogen activator therapy was approved for treating acute ischemic stroke within 3 h of symptom onset in 1996, less than 5% of patients with acute stroke were receiving this treatment. To facilitate adequate care for acute stroke patients, the Brain Attack Coalition (BAC) discussed the need to establish primary stroke centers (PSCs) where patients can receive emergency stroke care from qualifed teams and developed recommendations with criteria for PSCs in 2000. A consensus statement from the BAC with extensive recommendations for comprehensive stroke centers (CSCs), a facility for stroke patients who require high-intensity medical and surgical care, was published in 2005. The Joint Commission began to certify PSCs in 2003 and CSCs in 2012. The “Get With The Guidelines®-Stroke” program, a popular database tool to record and track performance measures, was developed by the American Heart Association as a national quality improvement program. A third type of facility, the acute stroke-ready hospital (ASRH), is currently under development. An ASRH would have fewer capabilities than a PSC, but would be able to provide initial diagnostic services, stabilization, emergent care, and therapies to patients with acute stroke. This chapter introduces literature about stroke centers from the United States, Europe, and Japan and discusses the effectiveness and future challenges of stroke centers.

Nonunions Diagnosis, Evaluation and Management

Fracture healing is a very unique process in the human body. Bone is a unique tissue in that it can regenerate itself during the process of healing. This requires a very complex process which is regulated by various metabolic and hormonal factors to include various growth factors. These biological processes occur at the cellular level requiring recruitment proliferation and differentiation of many cells including endothelial cells, osteoprogenitor cells, platelets, macrophages, mesenchymal stem cells (MSCs) , and monocytes. These cells secrete various biologically active molecules at the site of injury to facilitate fracture repair. The bone morphogenetic proteins (BMPs) are osteoinductive agents which promote the proliferation and differentiation of undifferentiated cells to become either osteoprogenitor or chondroprogenitor cells. Although our bodies have the inherent capability to repair the fracture, the fracture healing process can be impaired for numerous reasons. When the fracture healing cascade stalls, a delayed union may develop, but the process may altogether cease. In a delayed union , both clinical evidence and radiographic evidence of healing do progress, but it lags behind what the normal healing time should be for a particular bone. There are however many factors to take into consideration such as the particular bone involved, the specific anatomic regions of the particular bone, the fracture pattern, as well as the method of treatment.

Keratoconus Recent Advances in Diagnosis and Treatment

Keratoconus is today a classic topic in ophthalmology . Its history is associated to a background of a corneal disease with a blinding potential and no hope for treatment. It is only since the late 1950s that contact lenses have become a partial solution for the visual loss for some cases of keratoconus while other approaches were nonexisting. Those patients diagnosed with keratoconus had the same category as any corneal dystrophy with no potential treatment and no therapeutic recommendations to perform. The patients had no hope for the future and could not do anything about preventing its progress or being informed about the potential long-term complications or any consistent and reliable therapeutic approach. Since those historical and recent “black days” until now there has been a tremendous evolution. At this moment in 2016, there is a completely different approach for the diagnosis and treatment of keratoconus. The study and diagnosis of keratoconus has radically changed since the early seventeenth century when the Jesuit Priest Christoph Scheiner experienced and reported that glasses of different shapes reflect light in different ways, until nowadays, corneal diagnostic technology has taken a huge step forward. Scheiner used the optical phenomenon he described to assess the curvature of the human cornea. In doing it, he was able to compare the light reflections of different shapes and he even described some pathologies that were evident cases of keratoconus.

Primary Immunodeficiency Diseases Definition, Diagnosis, and Management

The immune system is a complex network of cells and organs which cooperate to protect individual against infectious microorganisms, as well as internally-derived threats such as cancers. The immune system specializes in identifying danger, containing and ultimately eradicating it. It is composed of highly specialized cells, proteins, tissues, and organs. B- and T- lymphocytes, phagocytic cells and soluble factors such as complement are some of the major components of the immune system, and have specific critical functions in immune defense. When part of the immune system is missing or does not work correctly, immunodeficiency occurs; it may be either congenital (primary) or acquired (secondary). Secondary immunodeficiency diseases are caused by environmental factors such as infection with HIV, chemotherapy, irradiation, malnutrition, and others; while primary immunodeficiency diseases (PIDs) are hereditary disorders, caused by mutations of specific genes. Primary immunodeficiency diseases are a heterogeneous group of inherited disorders with defects in one or more components of the immune system. These diseases have a wide spectrum of clinical manifestations and laboratory findings; however, in the vast majority of cases, they result in an unusually increased susceptibility to infections and a predisposition to autoimmune diseases and malignancies . Primary immunodeficiencies constitute a large group of diseases, including more than conservatively defined hereditary disorders affecting development of the immune system, its function, or both .

Neuroblastoma: The Clinical Aspects

Neuroblastoma is a predominantly pediatric cancer, arising from the primordial neural crest cells that form the sympathetic nervous system. The prognosis for patients with neuroblastoma can vary from uniform survival in low risk patients to fatality in patients with high risk disease. This chapter gives a brief overview of the epidemiology, genetics, clinical presentation, diagnosis, and discussion of the various staging systems and risk classifcations of neuroblastoma. We also briefly describe our understanding of the conventional and novel treatment modalities available and their effects on the current prognosis of patients with neuroblastoma. The purpose of this chapter is to serve as a brief overview of the clinical aspects of neuroblastoma, to serve as a foundation of knowledge for scientists aspiring to develop new therapeutic modalities for this dreadful pediatric disease.

Imaging and Diagnosis in Pediatric Brain Tumor Studies

Pediatric brain tumors, especially embryonal and other high-grade tumor types, have the propensity to disseminate along the cerebrospinal fluid (CSF) pathway ,while spread outside the central nervous system (CNS) at diagnosis is very rare. The management of pediatric brain tumors has evolved over the last three decades as a result of prospective multicentric clinical trials. Multimodal treatment including surgical resection, radiotherapy, and chemotherapy has led to improved outcomes in many entities. However, treatment- related toxicity often has a major impact on long-term quality of survival. In order to reduce sequelae, the concept of stratification into risk groups according to clinical variables (e.g., age, presence of metastases detected by imaging or cytological evaluation of CSF, and postoperative residual tumor status) has been developed in the last decades, adjusting the intensity of therapy to the risk of relapse. While the principal treatment strategies have not significantly changed over the past few years, enormous progress has been made in understanding of tumor biology, which has led and most likely will continue to lead to further refinements of risk stratification and to the development of novel therapy approaches using targeted drugs in a personalized way.

Evidence-Based Physical Diagnosis

The purpose of this book is to explore the origins, pathophysiology, and diagnostic accuracy of many of the physical signs currently used in adult patients. We have a wonderfully rich tradition of physical diagnosis, and my hope is that this book will help to square this tradition, now almost two centuries old, with the realities of modern diagnosis, which often rely more on technologic tests, such as clinical imaging and laboratory testing. The tension between physical diagnosis and technologic tests has never been greater. Having taught physical diagnosis for 20 years, I frequently observe medical students purchasing textbooks of physical diagnosis during their preclinical years, to study and master traditional physical signs, but then neglecting or even discarding this knowledge during their clinical years, after observing that modern diagnosis often takes place at a distance from the bedside. One can hardly fault a student who, caring for a patient with pneumonia, does not talk seriously about crackles and diminished breath sounds when all of his teachers are focused on the subtleties of the patient’s chest radiograph. Disregard for physical diagnosis also pervades our residency programs, most of which have formal x-ray rounds, pathology rounds, microbiology rounds, and clinical conferences addressing the nuances of laboratory tests. Very few have formal physical diagnosis rounds.

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