Diagnostik kutaner Lymphome

Zusammenfassung

Die Diagnose eines primär kutanen Lymphoms kann bei passenden klinischen Befunden, passender Histologie, Immunhistologie und molekularbiologischen Veränderungen sowohl bei einem primär kutanen B‑Zell-Lymphom als auch einem primär kutanen T‑Zell-Lymphom sichergestellt werden. Bei vielen primär kutanen Lymphompatienten sind jedoch gerade zu einem frühen Zeitpunkt nicht alle Auffälligkeiten gegeben und stellen deshalb im klinischen Alltag immer wieder eine Herausforderung dar. Dies gilt insbesondere für das Sézary-Syndrom, das initial Schwierigkeiten bereiten kann in der Abgrenzung zu einer reaktiven Erythrodermie. Der Schwerpunkt dieser Übersichtsarbeit wird deshalb die Problematik der Diagnosestellung bei einem Sézary-Syndrom beschreiben. Es wird im Detail die klinische Heterogenität des Sézary-Syndroms beleuchtet, und dann werden die typischen histologischen und immunhistologischen Kriterien zur Diagnosestellung eines Sézary-Syndroms benannt. Hier werden auch aktuelle Ergebnisse von multizentrischen, internationalen Studien der Cutaneous Lymphoma Task Force der EORTC (European Organisation for Research and Treatment of Cancer) zu dermatopathologischen Veränderungen in der Haut sowie dem Nachweis von Sézary-Zellen im Blut erläutert. Der Nachweis von Sézary-Zellen im Blut stellt auch aktuell – trotz verbesserter molekularbiologischer und zytogenetischer Charakterisierungen der Tumorzellen – eine Herausforderung dar. Hier zeigten die neuen Studien, dass unterschiedliche Marker, die aktuell noch nicht zur Standarddiagnostik eines Sézary-Syndroms gehören (CD158k, MYC, MNT, DNM, TWIST1, EPHA4 und PLS3), vielversprechend sind in der Differenzierung zu einer reaktiven Erythrodermie. Die Zukunft wird zeigen, inwieweit diese neuen Erkenntnisse im klinischen Alltag implementiert werden.

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Effect of Radiofrequency on DNA Damage and Oxidative Status in Patients with Turbinate Hypertrophy

Abstract

The radiofrequency devices that are used generate radiofrequency in the frequency range of 1.5 and 2.5 MHz. This study aims to demonstrate whether systematic oxidative status and DNA are influenced in this frequency range. In study, 27 patients who received radiofrequency treatment on inferior turbinate as they were diagnosed with inferior turbinate hypertrophy. DNA damage was assessed by alkaline comet assay in peripheral lymphocyte cells. Plasma levels of total antioxidant status (TAS), total oxidative status (TOS) were determined by using an automated measurement method and oxidative stress index (OSI) was calculated (OSI was calculated as: OSI = (TOS/TAS) × 100). There were increased in the OSI and TOS values on days 1 and 15 as compared to the samples taken before the radiofrequency administration. Significant decreases were seen in TAS values on days 1 and 15. As for the DNA damage, no significant differences were found on day 15 compared to the preoperative values even though there was a statistically insignificant increase on day 1. Administration of radiofrequency radiation on inferior turbinates results in increased oxidative stress in the acute period and a decrease in the anti-oxidative system. Although this effect causes a slight increase in the DNA damage in the early post-operative period, the damage is restored to the pre-operative levels on day 15. Therefore, we believe that a more conservative approach should be selected for radiofrequency treatment instead of using it routinely.

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Complementary and Alternative Medicine and Their Effect on Global Health

By Nathan Douthit

According to the World Health Organization (WHO), the use of complementary and alternative medicine (CAM) is on the rise. The US National Institute of Health defines complementary medicine as non-mainstream, non-western practice used together with conventional medicine, whereas alternative medicine is defined as the same used instead of conventional medicine. The WHO also offers a definition of traditional medicine (TM) as

 

"the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness"

 

Globally, TM and CAM are much more accessible to patients than conventional medicine. Therefore the WHO strategy for TM and CAM revolves around research into these alternative techniques as well as education and training for their practice. However, recent years have seen a surge in popularity for CAM in western countries as well, with many being willing to pay out of pocket for these treatments. Integration of these practices into national health systems can allow them to be regulated and safely practiced along with conventional medicine for the best possible outcomes.

 

Unfortunately, the case report "Consequences of delivery at home in a woman without prenatal care" by Kumar et al reveals the danger associated with lack of education, training and regulation. We are told,

 

"The patient denied having any allopathic prenatal care during the current pregnancy. She denied having gestational diabetes testing, blood work or detailed ultrasonography, but she stated that she had undergone regular Doppler and bedside ultrasound scans by her midwife."

 

Despite having had three prior caesarean sections, the woman chose a direct entry midwife, defined as follows.

 

"Direct entry midwives are defined as independent practitioners educated in midwifery through self-study, apprenticeship, a mid- wifery school or a university-based programme…. In the USA, licensure and training varies per state, with ∼50% of states not requiring licensure for direct entry midwives. Most patients are unaware of the difference between [direct entry and certified nurse midwives] and may not receive the necessary guidance to choose the appropriate provider for their needs."

 

This patient's past medical history puts her at increased risk, and her poor outcome is the result of lack of education, regulation and information in this alternative delivery.

 

BMJ Case Reports invites authors to publish cases regarding the effects both positive and negative of complementary and alternative medicine. Global health case reports can emphasize:

-Successful integration of CAM into national health systems

-Research on CAM that has proved useful in patient care

-Partnerships between practitioners of CAM and practitioners of conventional medicine that have improved patient outcomes

-Use of CAM causing delays in care, inappropriate care or worsening of patient outcomes.

Manuscripts may be submitted by students, physicians, nurses or other medical professionals to BMJ Case Reports. For more information, review the blog on how to write a global health case report.

Read more about CAM at BMJCR:

–Factors affecting illness in the developing world: chronic disease, mental health and traditional medicine cures

–Why tuberculosis control programmes fail? Role of micro level and macro level factors: an analysis from India

–Delayed diagnosis of pulmonary tuberculosis in a 13 year old Malawian boy

Selected References on CAM from other sources:

1. World Health Organization. WHO traditional medicine strategy: 2014–2023. [Internet] WHO; 2016 (cited 07 July 2017). Available from: http://ift.tt/2ws7foX strategy14_23/en/
2. Complementary, Alternative, or Integrative Health: What's In a Name? [Internet]. National Center for Complementary and Integrative Health. U.S. Department of Health and Human Services; 2016 [cited 07 July 2017]. Available from: http://ift.tt/2vzN5x4
3. Abdullahi AA. Trends and challenges of traditional medicine in Africa. Afr J Tradit Complement Altern Med 2011;8(Suppl 5):115–23.
4. Lee CAL. Alternative Medicine and Global Health [Internet]. Franklin Humanities Institute. Duke University; 2011 [cited 07 July 2017]. Available from: http://ift.tt/2wsh7PC

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Local protocol variations for Image-Guided Radiotherapy in the multicenter Dutch hypofractionation (HYPRO) trial: impact of rectal balloon and MRI delineation on anorectal dose and gastrointestinal toxicity levels

Publication date: Available online 3 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): R.C. Wortel, W.D. Heemsbergen, R.J. Smeenk, M.G. Witte, A.D.G. Krol, F.J. Pos, L. Incrocci
PurposeThe phase 3 XXX trial randomized intermediate to high-risk localized prostate cancer patients to conventionally fractionated (78Gy/39fr) or hypofractionated radiotherapy (64.6Gy/19fr). Differences in techniques and treatment protocols were present between participating centers. This study aimed to compare dose parameters and patient-reported gastrointestinal symptoms between these centers.Methods and MaterialsFrom the trial population we selected patients (n=572) from four treatment centers who received image-guided-IMRT (IG-IMRT). Center A (n=242) applied planning target volume (PTV) margins of 5-6mm and was considered the reference center. In center B (n=170, 7mm margins), magnetic resonance imaging (MRI) was integrated in treatment planning. An endorectal balloon (ERB) was applied in center C (n=85, 7mm margins). Center D (n=75) applied the largest PTV-margins of 8mm. The study protocol provided identical anorectal dose constraints and local protocols were applied for further treatment optimization. Anorectal dose-surface histograms were compared applying t-tests. Rectal complaints during follow-up (6 months-4 years) were compared in a generalized linear model, adjusting for age, follow-up, treatment arm, and hormone therapy.ResultsFavorable anorectal dose distributions were found for center B (MRI delineation) and C (ERB application) as compared to center A and D. This was associated with significantly lower incidences of patient-reported complaints of rectal incontinence, use of incontinence pads, and rectal discomfort in these centers. Furthermore, lower incidences of increased stool frequency (≥4/day) and mucous loss were observed for center C.ConclusionsDespite comparable IG-IMRT techniques and predefined dose constraints, pronounced differences in dose distributions and toxicity rates were observed. MRI delineation and ERB application were associated with favorable rectal dose parameters and toxicity profiles, whereas a 2-3mm difference in PTV-margins did not translate into observed differences. We conclude that choices for treatment optimization of IG-IMRT are important and clinically relevant for patients since these affect symptoms experienced in daily life.

Teaser

The effects of differences in techniques and treatment protocols on patient-reported rectal toxicity were compared between treatment centers participating in the prospective prostate XXX trial. All included centers applied image-guided-IMRT using identical anorectal dose constraints. As compared to reference center A (5-6mm PTV margins), favorable anorectal dose distributions were found for center B (MRI delineation, 7mm margins) and center C (endorectal balloon application, 7mm margins). This translated into significantly lower incidences of rectal complaints within both centers.


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Hypofractionated nodal radiation therapy for breast cancer was not associated with increased patient-reported arm or brachial plexopathy symptoms

Publication date: Available online 3 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Nelson Leong, Pauline T. Truong, Keith Tankel, Winkle Kwan, Lorna Weir, Ivo A. Olivotto
PurposeTo determine whether nodal radiation therapy (RT) for breast cancer using modest hypofractionation (HF) with 2.25-2.5 Gy/fraction (fx) was associated with increased patient-reported arm symptoms, compared with conventional fractionation (CF) ≤2 Gy/fx.Materials and MethodsTwo cancer registries were used to identify subjects who received CT-planned, nodal RT for pT1-3, pN0-2, M0 breast cancer from 2007-2010 at two cancer institutions. Following ethics approval, patients were mailed an explanatory letter and the Self-reported Arm Symptom Scale (SASS), a validated instrument with 8 questions about arm symptoms and 5 related to activities of daily living (ADL). Clinico-pathologic characteristics and SASS scores were compared between HF/CF cohorts using non-parametric analysis, chi-squared analysis and multivariate ordinal regression.Results800/1759 patients returned a completed survey (45.5%). 708 eligible cases formed the study cohort. 406 (57%) received HFRT (40 Gy/16fx, 45 Gy/20fx), and 302 (43%) received CFRT (45-50 Gy/25fx, 50.4 Gy/28fx). Median time interval post-RT was 5.7 years. 43% and 75% of patients received breast conserving surgery and chemotherapy respectively. 22% received breast boost RT, independent of fractionation. Median age at diagnosis was 59 years (HF) and 53 years (CF) (p<0.001). The mean numbers of excised (n=12) and involved (n=3) nodes were similar between fractionation cohorts (p=0.44), as were the mean sums of responses in arm symptoms (p=0.17) and ADL (p=0.85). HF patients reported lower rates of shoulder stiffness (p=0.04), trouble moving the arm (p=0.02), and ability to reach overhead (p<0.01) compared to the CF cohort. There was no difference in self-reported arm swelling or symptoms related to brachial plexopathy.ConclusionsNodal RT with hypofractionation was not associated with increased patient-reported arm symptoms or functional deficits compared to CF. Subjects treated with CF reported more disability in certain aspects of arm/shoulder function. These data support shorter fractionation utilization when regional nodes are within the therapeutic target.

Teaser

Among 708 women treated with CT-planned regional nodal radiation therapy (RT) for breast cancer, self-reported arm symptoms were similar or less debilitating following modestly hypofractionated (2.25-2.5 Gy/day) versus conventionally fractionated (≤ 2 Gy/day) RT at a median of 5.7 years after treatment.


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Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives.

The Keeping Children Safe programme produced extensive new evidence on preventing falls, poisonings and thermal injuries in the under-fives, including that an injury prevention briefing did not increase the proportion of families with a fire escape plan, but did improve some secondary outcomes.

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Clinical Evaluation of the OncAlert RAPID in Subjects Presenting for Evaluation and/or Initial Biopsy; Impact on Decision-Making

Conditions:   Palatal Neoplasms;   Lip Neoplasm;   Gingival Neoplasms;   Leukoplakia, Oral;   Tongue Neoplasms;   Oropharyngeal Neoplasms;   Oral Ulcer
Intervention:   Device: OncAlert
Sponsors:   Vigilant Biosciences, Inc.;   Pearl Pathways
Recruiting - verified May 2017

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