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Recent technological advances are having a profound impact on radiation treatment of cancer. New equipment and enhanced computer technologies foster the radiation oncologist’s ability to deliver radiation more precisely, increasing the dose to tumor targets and reducing the dose to normal tissues and critical structures. New treatment protocols have the potential to improve tumor control and cure rates with reduced complications. Some of the most significant technological developments of the past decade are highlighted in this article. It is the intent of the authors to elucidate some of these exciting areas of clinical radiotherapy such that practicing clinicians develop a greater comfort level when referring patients to a radiation oncologist.
- In: Cancer
- Tags: Cancer, innovation, radiation therapy, technological advances
This is a retrospective study and so is subjected to limitations of the design of such studies. It is, however, a good tool to use to review past activities and make amends as appropriate. It is economical, produces rapid results and has been found useful in many developing economies. The total number of deliveries and the ratio fulfilling the criteria for HTN disorders of pregnancy was relatively small, and this understandably detracts from the power of significance.
There were 2,393 deliveries between January 1997 and December 2002, with 127 (5.30%) patients fulfilling the criteria for hypertensive disorder of pregnancy. The yearly breakdown from 1997 to 2002 is as follows 16/438 (36.5 per 1,000), 13/402 (32.3 per 1,000), 13/194 (67.0 per 1,000), 19/940 (20.2 per 1,000), 25/443 (56.4 per 1,000) and 41/476 (86.1 per 1,000), respectively. Out of the 127 patients, full records were available for study for 122 patients.
Medical records of pregnant patients between January 1997 and December 2002 at the Olabisi Onabanjo University Teaching Hospital, Sagamu (in southwestern Nigeria) were retrieved and analyzed. The obstetrics department of the hospital had its full complement of specialist obstetricians about late 1996. Patients who were labeled as hypertensive and satisfied the inclusion criteria as stated below were identified.
INTRODUCTION
Hypertension (HTN) is the most common non-communicable disease in Nigeria. The crude prevalence rate for females is 11.2%, while the age-adjusted rate is 9.3%. HTN is also the most common medical disorder of pregnancy worldwide. It has been estimated that 5-10% of all pregnancies are complicated by HTN.
Angiosarcoma of the scalp is a rare and deadly malignant tumor classically found in elderly Caucasian males. It was first described by Livingston and Klemperer in 1926, when they reported a tumor of the scalp in a 38-year-old white male who later died from uncontrolled hemorrhage from the tumor. E. Wilson Jones, 38 years after the first case was published, described a series of nine cases occurring on the face and scalp of elderly patients.
- In: Cancer
- Tags: angiosarcoma cancer, head and neck, I black, scalp
CASE REPORT
A 50-year-old African-American man related a nine-month history of a scalp “knot” that measured about 1 cm x 0.5 cm. He scratched the lesion repeatedly, leaving him with an enlarging ulcer. Three weeks later, he presented to his primary care physician because of the foul smelling nature of the lesion. He was initially treated with antibiotics for seven days but with no resolution. He was again seen about two weeks later and was prescribed another regimen of antibiotics for 14 days. The lesion continued to increase in size associated with fluctuance and pruritus. The patient returned a third time and was given a 21-day course of antibiotics along with instruction to clean the lesion four times daily. By this time, the lesion had become an ulcerated mass. He was eventually referred to a dermatologist eight months after the lesion was first noticed. A biopsy of the lesion revealed atypical vascular proliferation that resembled granulation tissue but with focal atypical features including papillary formation and dissection in between the reticular collagen bundles. A few nonatypical mitotic figures were also noted associated with a marked mixed inflammation. Given the age and race of the patient in conjunction with the history, the dermatopathologist favored pyogenic granuloma as the top differential. Others on the differential included deep fungal infection, granulomatous inflammation, squamous cell carcinoma, and basal cell carcinoma. The patient was then referred for surgical evaluation. On physical exam, a fluctuant fungating and foul-smelling mass measuring 3.7 cm x 5.3 cm was noted in the right occipitoparietal area with purulent drainage. No cervical or posterior auricular lymph nodes were palpable, and the rest of the physical exam was otherwise unremarkable. Nine months after the patient first noticed the “knot”, the mass was excised with primary closure (Figure 1). The excised tissue was submitted for surgical pathology consultation.
- In: Cancer
- Tags: angiosarcoma cancer, head and neck, I black, scalp