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Endoscopic Transoral Laser Resection For Radiotherapy Failure For Base Of Tongue Cancer
0Introduction
Carcinoma of the base of tongue usually presents at a relatively advanced stage due to the subtle non specific initial symptoms which can mimic various benign conditions. The presence of normal lymphoid tissue and the infiltrative nature of the disease make the diagnosis even more challenging. Once diagnosed, the usual treatment is radiotherapy with or without chemotherapy. Surgical resection is usually reserved for non responders as open resection of the tongue base is associated with severe morbidity in relation to speech and swallowing. However, conservative endoscopic laser can be used to salvage post radiotherapy recurrent or residual tumors with minimal morbidity for selective patients.
Case Report
A 75 year old gentleman presented to our OPD with complaints of dysphagia, odynophagia and pain in left ear for the last 3 months. On palpation, there was pain and induration over the left side of the base of tongue. Cervical lymph nodes were not palpable. CT scan showed an infiltrative growth involving left side of the base of tongue extending to the vallecula and the encroaching onto the lateral pharyngeal wall (cT3N0M0). No significant lymph nodes were evident on CT scan. Biopsy was confirmatory for a moderately differentiated squamous cell carcinoma.
The patient received IMRT (70 Gy in 35 fractions) over a period of 6 weeks. After the completion of radiotherapy, his symptoms regressed but did not disappear, after 3months rigid laryngoscopy with biopsy was done which confirmed the residual disease ,which was confirmed by biopsy. The CT scan of neck & thorax revealed lesion on the left BOT 2x2cm with no evidence of metastasis. The patient then underwent endoscopic trans oral laser resection of the lesion over the base of tongue which was margin negative on final histopathology. The patient is on regular follow up for six months post surgery. He has no evidence of disease at present. His morbidity is minimal with mild impairment in articulation and no difficulty in swallowing.
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Discussion
The base of the tongue is one of the most unfavorable sites for endoscopic laser surgeries. Firstly, it is extremely difficult to achieve adequate access to this region with sufficient exposure of all the areas that are involved by the tumor. Secondly, the differentiation between tumor and healthy tissue is particularly difficult due to the presence of lingual tonsils. For adequate exposure, the use of distending oropharyngoscopes is largely recommended. Continuous repositioning of the oropharyngoscope is required which demands a lot of patience and experience by the surgeon. An intermittent assessment of the wound should be performed by digital palpation and the use of a 30 degree or a 70 degree endoscope. Intraoperative frozen section can be a very handy tool in determining the margins of the resection.
Side effects of laser resection are significantly lower as compared to an open surgery. Post operative pain is surprisingly low. Hemorrhages can occur but is extremely low in experienced hands. Functional disturbances like impairment in swallowing and transient aspiration usually follow extensive resections. Finally the patient is spared of a temporary tracheotomy which is required in most open resections.
A study was conducted at Department of Otolaryngology,RushUniversityMedicalCenter,Chicago,USA. By Camp AA et al to determine survival and functional results in patients who underwent transoral laser excision of base of tongue squamous cell carcinoma. Of the 71 patients treated, one (1.4%), nine (12.7%), seven (9.9%), and 54 (76.1%) were stage I, II, III, and IV, respectively, at diagnosis. At 24 months, overall survival was 90 percent; disease-specific survival was 94 percent. Locoregional recurrence occurred in 10 percent. The study concluded transoral laser excision offers an acceptable treatment approach in terms of survival and quality of life for patients with base of tongue squamous cell carcinoma.
In a study conducted by Grant DG et al at the Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, USA to determine the oncologic and functional outcomes of transoral laser(TLM) microsurgery in the treatment of persistent, recurrent, and second primary squamous cell carcinoma of the tongue base, it was found to be a rational and effective treatment in appropriately selected patients with persistent, recurrent, or second primary tongue base cancer. The low morbidity and mortality and shortened duration of hospitalization associated with TLM make it an attractive therapeutic alternative.
Author on various topics for Cancer, Radiation Oncology, Allied Services, Healthcare, Hospitals and Health Subjects.
For more information you can visit Cancer Hospital
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Adenosine Drug (medication) Information
0How to Take Adenosine
Take Adenosine exactly as prescribed by health care provider. Adenosine is generally available in market in the form of Injection 3 mg/mL . Drug may produce short-lasting heart block. Patients in whom high-level heart block (eg, third-degree) develops after one dose of Adenosine should not receive repeat doses.
Dosage Instructions for Adenosine Drug
Conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PSVT), including that associated with Wolff-Parkinson-White syndrome.
Contraindications for Adenosine Drug
Second- or third-degree AV block or sick sinus syndrome (except in patients with functioning artificial pacemaker); atrial flutter; atrial fibrillation; ventricular tachycardia.
Interactions of Adenosine with other drugs
Caffeine, theophylline: Antagonize effects of adenosine; larger doses of adenosine may be needed.
Carbamazepine: May produce higher degrees of heart block.
Dipyridamole: Potentiates effects of adenosine; smaller doses may be adequate.
What are the Side Effects of Adenosine –
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Like other medicines, Adenosine can cause side effects. Some of the more common side effects of Adenosine include
* Facial flushing; headache; chest pain; hypotension.
* Lightheadedness, dizziness, tingling in arms; numbness.
* Nausea.
* Dyspnea; shortness of breath; chest pressure.
Warnings and precautions before taking Adenosine :
* Inform patient before using Adenosine to report the following symptoms to health care provider: facial flushing, headache, shortness of breath, chest pressure, lightheadedness, dizziness, tingling in arms, numbness or nausea.
* The safety and efficay of Adenosine medicine have not been studied in children and adolescents.
* Warn patient to avoid unnecessary exposure to sun and sun lamps while using this medication. Advise patient to use sunscreens and protective clothing over treated areas when exposure cannot be avoided.
* Advise women before using Adenosine to inform health care provider if pregnant, planning to become pregnant, or breastfeeding while taking Adenosine. Insulin is recommended to maintain blood glucose levels during pregnancy. Prolonged severe neonatal hypoglycemia can occur if sulfonylureas are administered at time of delivery.
What if Overdose of Adenosine ?
If you think you or anyone else taken overdose of Adenosine , immediately telephone your doctor or contact your local or regional Poisons Information Centre Seek medical attention immediately. You may need urgent medical attention. Erythema; scaling; dryness; pruritus, skin discomfort, burning, stinging, and irritation; sunburn; acne flares are may be the overdose symptoms of Adenosine.
What if Missed Dose of Adenosine ?
If you miss a dose of Adenosine medicine and you remember within an hour or so, take the dose immediately. If you do not remember until later, skip the dose you missed and go back to your regular schedule. Do not double doses.
Storage Conditions for Adenosine :
Store Adenosine at room temperature. Do not refrigerate Adenosine because crystallization may occur. If crystallization has occurred, dissolve crystals by warming to room temperature.
By: ashu
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The solution to cancer
0From experience after experience, I understood that the raison d’ètre of these alternative movements was the inability of conventional medicine to solve the problems of patients who seemed, instead, to get greater benefits from those therapies which evaluated them and treated them as a whole being and not only with limited symptomatological remedies.
It is when I was implementing a naturopathic set-up for my career that I had the idea that cancer could be caused by fungus. As I was treating a patient affected by psoriasis with corrosive salts, I understood that the salts worked because they were destroying something –and that something were fungi.
Psoriasis
From that realization my mind followed a syllogistic path that was to give me the solution I had been waiting for so long: if psoriasis, an incurable disease, is caused by a fungus, then it is possible that cancer, another incurable disease, could be caused by a fungus. That link was what started all the experiences, the experiments, the verifications and the results, through relentless and “underground” work that brought great professional satisfaction to me and that allowed me to perfect a therapy that is very efficacious against neoplastic masses, that is, against fungin colonies.
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Sodium Bicarbonate
Once the causal role of fungi in neoplastic proliferation was hypothesized the problem of how to attack them in the intimacy of the tissues arose, since in those areas it was not possible to use salts that were too strong. It then came to my mind that in the oro-pharyngeal candidosis of breast-fed babies, sodium bicarbonate was a quick and powerful weapon capable of eliminating the disease in three of four days. I thought that if I could administer high concentrations orally or intravenously I might be able to obtain the same result. So I started my tests and my experiments, which provided me immediately with tangible results.
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The cause of cancer, is a common fungus, Candida albicans, and it can be treated with a powerful antifungal agent that can’t be patented.
The book “Cancer is a fungus” describes how a fungous infection always forms the basis of every neoplastic formation, and this formation tries to spread within the whole organism without stopping.
The book cancer is a fungus has been published in english, italian, dutch and french.
if you want to get more news,tips, help on cancer visit
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Plendil medication
0Plendil
Plendil generic Felodipine is a drug known as calcium channel blocker. Calcium channel blockers are the natural chemicals that affect the cell of the body such as heart muscle, smooth muscle of the vessels. The purpose of the chemical is to reduce the pressure of the blood or hypertension. These medications relax, expand, or open the blood vessels such as veins or arteries that make possible for the heart to pump easily and thus decrease its work pressure.
How should I take this medication?
Swallow Felodipine medication whole, do not crush, chew or break the medication. Take this medication after having food or before having food. This medication should be used as per the dosage and the frequency suggested by the doctor. As this medicine is used to treat multiple disorders, do not use it without consulting your doctor first. The patient should go for regular check –ups in order to see whether or not the medication is performing well. Do not skip the medication, make a regular timing for taking this medicine and if you forget to take this medication, take it immediately if there is time for your regular schedule. The patient should brush the teeth after taking this medication so as to prevent the infection of the gums. Keep Plendil in favorable temperature away from heat, light and moisture.
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What are the possible side effects of using this drug?
Plendil medication may cause side effects like swelling of hand, swelling of feet, unusual heart beat rate, lack of feeling, pricking or stinging feeling, unconsciousness, pain at the chest, contraction of chest, severe pain of arms and shoulders and often feeling of sickness. The patient may also experience head-ache, feel dizzy, sleeplessness or wakefulness, insomnia, anxious, worried, nausea disorder, pain while eliminating body waste due to hard stool, bloody stool, stomach-ache, pain in the joint or muscles disorder, feeling of warm, itchy feeling in the skin, formation of rashes, sensation of burning, frequently urination, feeling cold and formation of patches or sore in the throat. Besides this Plendil drug may also cause allergic reactions such as hives, breathing problem, swollen tongue or throat, swollen face or lips, hives,searing or cracking skin and burning sensation.
What precautions do I need to follow while using Plendil?
If you are using this medication tell your doctor whether or not you are using any prescribed or un-prescribed, herbal k, any supplementary diet as there might a need of adjustment in the dosage. Patient having a problem of liver or congestive heart failure should consult the doctor before taking this medication.Make sure you also let your doctor know if you are pregnant, planning to become pregnant or a lactating mother as it is not known whether or not it harm the unborn child or passes in to the milk of the breast.
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Cancer Treatment Coaching
0Once you have read my ”Cancer-Free(Second or Third Edition)”book, I am available for additional coaching. I have learned two lessons after five and one half years of coaching like this:
First, only telephone coaching works. There is too much gained from interaction with the cancer patient or his/her loved one. E-mails just don’t work. Here’s an example from a lady in Curacao in the Netherlands Antilles:
“Dear Bill,
Many thanks for spending the time the other day – I felt it was extremely valuable. Having read your book so long ago, it was also a good refresher to get me back on track. . I have chased the suppliers of the vitamins and will also purchase the Cellect. Thereby, I will be taking all the vitamins you recommend, plus the FO/CC, Cellect and apricot kernels. I will make an appointment next week for the panoramic x-ray of my teeth and send it off. I will order “The Emotion Code.” I am seriously thinking of declining chemotherapy if it is offered to me.
What I felt was most valuable to me with your coaching call was that it gave me hope to carry on with the alternative treatment. I was starting to doubt it after the last progression of my disease. I can see some of the things I have been doing wrong and plan to correct them.
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You provide a fantastic service Bill and give us all hope! I believe in your therapy and hope to be one of the long term survivors. I will keep in touch.
Very best regards and I wish you a terrific 2009.
Mandy
(Yvonne Sherwin – Ruyssenaers)”
Second, the first call usually lasts about 90 minutes. Almost always, additional calls when questions come up are needed by the “coachee.” Often these are “time-sensitive.”
In short, a lot of my time is required to do an adequate job of explaining to you, the cancer patient, or your loved one exactly “what I would do if I were you.”
Understand that as a mere “reporter,” I can’t give individual recommendations to the people I talk to in this way. I am not a medical professional. I can simply answer questions about the regimen recommended in my book and discuss the probable causes of the cancer based on the patterns I’ve seen in talking like this to about 3,000 cancer patients.
If that appeals to you, please click below to pay the 0 fee for this service. This fee can be paid by either credit card, PayPal or check. Your statement will show a charge by “ClickBank.” I receive immediate notification of your purchase from ClickBank.
This fee covers unlimited calls to me and my return calls to you at any time during your cancer experience. Once you have paid the fee, you will be told how to contact me. There will be an “800″ number for those of you in the U.S. For those outside the U.S., there will be another number for you to call. I am in the Pacific Time Zone of the U.S. (GMT minus 8 hours.)
If you contact me by e-mail and give me a phone number and time to call you, be sure to use the password you will be given in the “Subject” line of your e-mail and tell me what time zone you are in.
I want to help you recover complete health. Please feel free to use this service whenever you have questions about any of the information in my book.
if you want to get more news,tips, help on cancer visit
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Influence of Health Store in your life
0What can we see inside the health store? Obviously, most of us have been to one. There are different types of people who visit the health store. A few of them are those who religiously take health supplements for body maintenance while others are just browsing of what they can get. We can never imagine how we can really benefit once we visit one. We need to protect ourselves to diseases that may strike us. So be cautious and know what suits you. World Health Organization (WHO) defines health as a condition of absolute physical, mental, and social well-being and not simply the lack of disease or infirmity.
Health is also a lifestyle. The great influence in our life is the surrounding that we are in. Like in Singapore, this country is noted for its cleanliness, so hygiene is a concern of every individual. Majority of its people are health conscious, so they are perfect examples who engage themselves into healthy lifestyle. It is a great factor to be healthy and guard you from contacting diseases. However, too much of something is not good. So if we overdo something, it won’t benefit us
Health stores provide us a wide range of health supplements to develop and improve our immune system. It’s time to differentiate a drug store from a health store. Simply, drug stores provides cure to our sickness while health stores help us to prevent to have sickness. So health stores are our shield or protector from sickness or disease
If you have the time, you will have no problem in finding a health store because these stores can be seen just around the corner. Almost all countries have their store for health, the United States, parts of Asia, Europe and Australia. The only thing that you will need when buying health products is a smile on the face and some cash at hand. But once again, reality dictates that not everyone has some time to spare. Not everyone has the luxury to turn at the corner and stop at the store. Furthermore, not all of the countries in the world have such stores available. If they happen to have them, the products are not that effective and satisfying. Here is the good news, with the technology and communication that we have today the problems stated about can be solved and addressed. On the online community there are available health stores that are able to provide their services to the world. Products can be receive by any customer in the world, has long has that customer has an address. A health store can provide a customer from around the world with solutions to unhealthy skin and nails, and solutions to the very scary heart diseases.
It is very simple to look for online health store, just by the click of a mouse you can find one. But be careful and be smart in selecting your online store because some of the online health stores are not tested. It is best to have a target country to be sure, let us take Australia as an example. It is a country that is tried and tested to be of high quality when it comes to a health store.
Health is also a lifestyle. Health stores are there to boost your health shield. To give your immune system an additional power to prevent sickness.
Article from articlesbase.com
IMRT In Prostate Cancer
0Carcinoma Prostate is the 4th commonest cancer inIndia, with a median age of 72 years at diagnosis. The incidence inU.S. is 265,000 new cases per year with 36,000 deaths every year. Radiation treatment and radio curability in prostate cancer depends upon the dose of radiation given to prostate. In a meta analysis of 22 trials covering 11927 patients, it was seen that radiation dose of more than 70 Gy yields better response. Increasing the dose beyond this increases the rates of clinical, pathological and biochemical response.
Kupelian etal (IJROBP, 61, 415-9, 2005) published data of 1325 patients from 9 institutions with T1 and T2 lesions of the prostate. The 8 years PSA disease Free Survival (PSADFS) was 62% and a dose of 72 Gy was an independent predictor of outcome. The dose response curves for conformal Radiotherapy are sigmoid curves which mean that a higher dose has to be delivered to get higher cure rates. If we look at the PSA nadir i.e. a serum PSA level of less than 1.oo ng/ml, these are seen in 90% of the patients who get more than 75 Gy. A positive biopsy rate after 5 years in patients receiving 80 Gy is only 4%. Thus dose escalation in prostate carcinoma by 3D CRT leads to an intermediate and high risk benefit after 70 Gy in response and as well as toxicity. Zietman Al etal, in 2005 published a comparison between conventional versus high dose 3D- CRT, in 393 patients randomized between conventional (n=197) and 3d CRT (n=196). The study concluded that the 5 year Disease Free Survival (DFS) was 80.4% with 3d CRT versus 61.45 in patients who received 70 Gy. There is level I evidence which shows that with 3D CRT without increase in dose reduces gastrointestinal complications and increasing the dose of radiation from 70-78/79.2 Gy decreases the failure rate.
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According to the RTOG trial published by Ryu Jk etal (IJROBP 54, 1036-46) irradiation of prostate ad seminal vesicles does not increase the late gastrointestinal or gastrourinary morbidity. At the PD Hinduja National Hospital, 51 patients have been treated from 1997 to 2002 with the median dose of 72 Gy, the acute rectal toxicity has been seen to be grade 0(4 patients), grade 1(31 patients), and Grade 2 (16 patients) while late toxicity has seen to be Grade 0 (41 patients), grade 1(3 patients), and Grade 2 (2 patients). Thus the level evidence is that increase in dose of radiation over 70 Gy increases the rectal morbidity.
IMRT in prostate cancer implies alterations in the intensity in beamlets within a radiation field. It also includes high levels of target structure dose conformality, automated beam selection – inverse treatment planning and concept of cross field homogeneity. Therefore with IMRT one is able to increase the dose of radiation without increasing the side effects which may improve local control of disease. However, it must be kept in mind that with increased volume exposure to modest doses of radiation an increase in radiation induced cancers may occur in the long run.
Prior to starting intensity Modulated Radiotherapy for carcinoma prostate the following basic steps are required (i) preparation of the pelvicst (immobilization device), (ii) CECT of the affected part at 5 mm slices (iii) demarcation of the target volume and tissues at risk (iv) evaluation of dose distribution (v) development of DRRs( Digital Reconstructed radiographs) (vi) generation of portal imaging. The Clinical Target Volume (CTV) for prostate carcinoma includes prostate and seminal vesicles. Seminal Vesicles can be removed from CTV after 50 Gy if probability of their involvement is less than 10%. Planning Treatment Volume (PTV0 is taken as CTV +10 mm margin in the cranio- caudal direction and 7 mm in other directions. The treatment position is supine with knees fixed and a rectal suppository is inserted 15 minutes before RT. The patient takes 750 ml of water 1 hour before start of RT and 300 ml immediately before RT. Frequent portal images are taken to correct the patient’s position. A 18 MV photon beam is used with the gantry at 116 and 224 degrees with step and shoot method. The daily treatment time is less than 8 minutes and usually 285 monitor units are delivered. The maximum rectal dose has to be kept below 60 Gy.
Hypofractionated IMRT is when the number of fractions is reduced to 28 and yet the total dose delivered is 70 Gy. It is seen that the rectal and bladder complications are less in hypo- fractioned IMRT but results of long term follow up are not available.
To conclude IMRT in carcinoma prostate is a well established treatment modality. It helps us to escalate the amount of radiation delivered to tumor and ensure lower dose reaching the normal structures.
Author on various topics for Cancer, Radiation Oncology, Allied Services, Healthcare, Hospitals and Health Subjects.
For more information you can visit Cancer Hospital
Article from articlesbase.com
TTPlayer17
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1 month ago
Raaaaaaaaaampage
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1 month ago
mizisreally
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1 month ago
assaprince
@wweHardy222 Die ersten Dinge, die Ausländer mit Deutschland in Verbindung bringen, sind: Sauerkraut, Hitler, die Autobahn und Bier. Der […]
1 month ago
charliebrown937
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1 month ago