Vascular access device type for systemic anti-cancer therapies in cancer patients: A scoping review.

BACKGROUND: Patients with cancer can expect to receive numerous invasive vascular access procedures for intravenous therapy and clinical diagnostics. Due to the increased incidence and prevalence of cancer globally there will be significantly more people who require first-line intravenous chemotherapy over the next ten years. METHODS: Our objective was to determine the types of evidence that exist for the vascular access device (VAD) type for the delivery of systemic anti-cancer therapy (SACT) in cancer patients. We used JBI scoping review methodology to identify the types of VADs used for SACT and with a specific search strategy included articles from 2012-2022 published in the English language. We identify (i) type of VADs used for SACT delivery (ii) the type of insertion and post-insertion complications (iii) the geographical location and clinical environment (iv) and whether VAD choice impacts on quality of life (QOL). Findings were presented using the PAGER framework. MAIN FINDINGS: Our search strategy identified 10,390 titles, of these, 5318 duplicates were removed. The remaining 5072 sources were screened for eligibility, 240 articles met the inclusion criteria. The most common design include retrospective study designs (n = 91) followed by prospective study designs (n = 31). We found 28 interventional studies with 21 registered in a clinical trial registry and identified no core outcome sets papers specific to VAD for SACT. The most prevalent publications were those that featured two or more VAD types (n = 70), followed by tunnelled intravenous VADs (n = 67). Of 38 unique complications identified, the most frequent catheter related complication was catheter related thrombosis (n = 178, 74%), followed by infection (n = 170, 71%). The county where the most publications originated from was China (n = 62) with one randomized controlled multicenter study from a comprehensive cancer centre. Of the thirty three studies that included QOL we found 4 which reported on body image. No QOL measurement tools specific to the process of SACT administration via VAD are available INTERPRETATION: Our findings suggest a systematic review and meta-analysis of VAD use for intravenous SACT can be considered. However, the development of a core outcome set for SACT should be prioritised. Funding for high quality programs of research for VAD in cancer are needed. Comprehensive cancer centres should lead this research agenda.

Resigning oneself to a life of wound-related odour - A thematic analysis of patient experiences.

AIMS: To determine how patients with chronic wounds describe wound odour, identify what strategies they use to manage it and how effective these are. MATERIALS AND METHODS: Using a qualitative descriptive approach, semi-structured interviews were conducted between July and August 2021 with seven patients living with an odorous chronic wound at home. Data were analysed using Braun and Clarke's thematic analysis framework. RESULTS: The results were organised into two main themes: 1) becoming resigned to living with wound-related odour 2) strategies used to manage wound-related odour. Participants were sad, embarrassed and felt isolated but became resigned to living with this odour and accepting of it as a consequence of having a wound. Frequent dressing changes, household cleaning along with the use of sprays were the most frequently used tactics to manage odour none of which were deemed to be very effective. CONCLUSION: This study highlights the problem of odour management in clinical practice and how individuals develop strategies to overcome odour. Sadly, patients were resigned to living with wound odour and were accepting of it as part of daily life. This highlights the importance for healthcare professionals to recognise, assess for and ensure a better understanding of how people experience wound odour, the impact it can have on them personally. Frequent dressing changes can help manage wound odour from the patient's perspective.

Diagnostic difficulties in extraosseous Ewing's sarcoma: a proposal for diagnostic criteria.

Five cases diagnosed as extraosseous Ewing's sarcoma (EES) during a 15-year period, and the relevant literature, were reviewed. The diagnosis in these cases was difficult to confirm, mainly because the distinction between the osseous form of Ewing's sarcoma (OES) and either periosteal reactions or direct tumour invasion into adjacent bone by EES was often unclear. The literature suggests that other authors have also encountered difficulties. The authors believe that many cases reported as EES are likely to have been OES. This distinction has some importance, as the two conditions are usually treated in differing ways. The following criteria are proposed for the diagnosis of primary EES: (i) no evidence of bony involvement on magnetic resonance imaging; (ii) no evidence of increased uptake in bone or periosteum adjacent to the tumour on static isotope bone scan images; (iii) a small round cell tumour with no differentiating features on light microscopy, immunochemistry or electron microscopy; and (iv) demonstration of cytoplasmic glycogen.

Treatment of hepatic cavernous haemangioma with radiation therapy: case report and literature review.

Cavernous haemangiomas are the most common benign tumours of the liver, most of which are found incidentally during abdominal imaging, laparotomy or autopsy. A patient with a large, symptomatic lesion, which responded well to radiation therapy, is described. In view of the fact that a large proportion of these vascular malformations are unresectable and response to radiation therapy is well documented, the latter modality should be considered for symptomatic lesions.

Cancer of distant primary site relapsing in the nasopharynx: a report of two cases and review of the literature.

Cancers metastatic to the nasopharynx are rarities. We present here two more such tumors. Although the clinical features of primary and secondary tumors in the nasopharynx are indistinguishable, a past history of treatment for malignant disease is an obvious clue to the correct diagnosis.

Formation of a vitamin B-12-serum complex on heating at alkaline pH.

The binding of vitamin B-12 to serum proteins during heating at alkaline pH was investigated by gel filtration of serum supplemented with cyano[57Co]-cobalamin. Heating for 5 min at 100 degrees C destroyed most of the vitamin B-12 binding activity of serum but, with further heating, the vitamin B-12 became incorporated into a complex that did not correspond in molecular size to the original vitamin B-12 binding proteins. Radioassay of vitamin B-12 in heated serum showed correspondingly first an increase then a progressive decrease in the apparent vitamin B-12 level suggesting that, on heating, vitamin B-12 was initially released then subsequently complexed by the serum. The formation of complexed vitamin B-12 was abolished by the presence of the reducing agent dithiothreitol during the heating step.

Effect of premenopausal castration and incremental dosages of conjugated equine estrogens on plasma follicle-stimulating hormone, luteinizing hormone, and estradiol.

Plasma levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) were measured serially in 11 premenopausal patients before and after hysterectomy with bilateral salpingo-oophorectomy. One week after operation an incremental dosage regimen of conjugated estrogens (CEE) in tablet form was commenced on a basis of two weeks with therapy (0.3, 0.625, 1.25, and finally 2.5 mg.), with each dose interspersed by two weeks without therapy. FSH, LH and E2 levels were measured at the end of each period with and without therapy. E2 levels fell within 24 hours of operation while FSH and LH levels rose gradually. CEE therapy produced an elevation of E2, but circulating concentrations comparable to the premenopausal values were only maintained during the dosage periods of 0.625 and 1.25 mg. of CEE. In only one instance did CEE succeed in reducing FSH to premenopausal levels, and that was at a dosage of 2.5 mg., in which instance the E2 level was higher than the premenopausal value. LH was never reduced to a premenopausal level. Thus, the data indicate that CEE alone in dosages up to 2.5 mg. per day was unable to reproduce in postmenopausal women the gonadotropin and E2 blood serum levels shown to exist prior to oophorectomy. Usual CEE treatment after menopause, therefore, in itself does not represent physiologic "hormone replacement therapy," if defined as the dosage required to maintain premenopausal circulating concentrations of reproductive hormones.

Hormonal effects of wedge resection of polycystic ovaries.

Plasma FSH, LH, estradiol, testosterone, and progesterone were measured serially before, during, and after bilateral ovarian wedge resection in 2 patients with polycystic ovaries. Preoperatively both were anovulatory with persistently elevated plasma LH values and 1 patient had high testosterone concentrations. Plasma FSH, estradiol, and progesterone were within the normal midfollicular phase range. The LH:FSH ratio was increased and no cyclic gonadotropic activity occurred. During surgery progesterone levels rose while estradiol concentrations fell. In both patients, the initial reduction in estradiol secretion was observed after unilateral wedge resection but testosterone concentrations only declined 6-24 hours postoperatively. During the first postoperative week the LH:FSH ratio fell significantly and cyclic gonadotropic activity, in the form of sporadic LH and FSH spurts, was noted. In the second week after surgery, and estradiol surge occurred followed by preovulatory LH and FSH peaks, ovulation, and a normal luteal phase. Spontaneous menstruation occurred by the end of the first postoperative month and both patients conceived within 4 months of surgery.

A simple radioimmunoassay for plasma cortisol: comparison with the fluorimetric method of determination.

A quick and simple method for the radioimmunoassay of plasma cortisol is described. The mean morning plasma cortisol concentration in 43 normal subjects was 9.8 +/- 3.1 (S.D.) microgram/100 ml with a range of 5.0-19.5 microgram/100 ml. Mean midnight concentration in 24 normal subjects was 4.3 +/- 2.3 (S.D.) microgram/100 ml with a range of 1.4-9.6 microgram/100 ml. When compared with the fluorimetric method the mean results by radioimmunoassay of 154 routine specimens were 23% lower. In samples from unstimulated patients, regression analysis of results obtained by the two methods gave a correlation coefficient (r) of 0.93, regression line slope of 1.1, and intercept of 1.4 microgram. Mean radioimmunoassay results were 15% lower. When plasma cortisol concentration was above the normal range (greater than 30 microgram/100 ml) the regression line slope was 0.87, the intercept 17.9 microgram, r = 0.87 and mean radio immunoassay results were 37% lower. Plasma cortisol concentration in patients after insulin or Synacthen stimulation exhibited similar responses when measured by either method. Plasma cortisol concentration in normal subjects given metyrapone was lower when measured by radioimmunoassay (mean +/- S.D. = 8.7 +/- 2.7 microgram/100 ml) than when measured by fluorimetry (18.5 +/- 10.8 microgram/100 ml). The diagnostic usefulness of the two methods, ease of assay, and costs are compared.

Pituitary-gonadal function in men with alcoholic cirrhosis of the liver.

Fourteen adult males with alcoholic cirrhosis were studied. Gonadotrophin responses to luteinizing hormone-releasing hormone (LRH) and testosterone (T) responses to human chorionic gonadotrophin (HCG) were determined and basal 17 beta oestradiol (E2) levels were measured in each case. The mean basal luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels, and the mean LH and FSH responses to LRH were not significantly different from a group of age-matched male controls. However, the five men with testicular atrophy all had an elevated basal FSH level and an exaggerated FSH response to LRH. The mean serum T of the cirrhotic men was significantly lower than that of the controls (P less than 0.05), while the mean E2 level was not significantly different. However, the mean E2 level in the eight patients with gynaecomastia was significantly higher than in those without gynaecomastic (P less than 0.05). All patients had a T response to HCG, including those 5 with low basal T levels. A significant negative correlation was found between the maximum rise in T after HCG (delta T) and the maximum LH response to LRH (delta LH), suggesting a mediating effect of T reserve on the LH response to LRH. These findings tend to exclude a suppressive effect of alcohol on the pituitary gland as a cause for the hypogonadism found in men with alcoholic cirrhosis. Furthermore, the evidence of some testicular T reserve despite low basal T levels, and the presence of normal basal LH levels, suggests that the low T production is not primarily due to leydig cell dysfunction.

Abnormal luteinizing hormone response patterns to synthetic gonadotrophin releasing hormone in patients with polycystic ovarian syndrome.

Basal gonadotrophin and sex steroid levels and responses to an intravenous injection of 100 mug gonadotrophin releasing hormone (Gn-RH) have been studied in 15 patients with polycystic ovaries. Mean basal LH concentration was raised and an excessive, exaggerated and prolonged response was observed after Gn-RH treatment, but patients could further be subdivided into two functional groups on the basis of their basal LH values and LH response patterns. Evidence was also produced which suggested a breakdown in the negative feedback mechanism in these patients.

Plasma gonadotropin and gonadotropin-releasing hormone levels after intranasal administration of gonadotropin releasing hormone.

Intranasal administration of gonadotropin hormone (GnRH) in doses ranging from 2-4 mg produced a consistently prolonged LH response in patients with secondary amenorrhea. In 4 cases, a delayed secondary rise occurred. A similarly prolonged FSH response was observed in the majority of patients. Six hours after intranasal GnRH, FSH and LH values were well above basal levels and were higher than those observed at a similar interval after intravenous GnRH. Plasma GnRH levels after intranasal administration failed to achieve the high peaks found after the intravenous route but maintained elevated levels for at least an hour and often longer. Despite the much lower plasma GnRH levels, intranasal GnRH produced a sustained effect on LH and FSH secretion, greater than GnRH given by the intravenous route.

Endocrine changes in male sexual deviants after treatment with anti-androgens, oestrogens or tranquillizers.

The endocrine effects of drugs on two groups of 12 male sexual offenders in a special hospital were studied. In the first study benperidol, chlorpromazine and placebo were compared and in the second ethynyl oestradiol and cyproterone acetate were compared with no treatment. In the first study there was no difference between the three drugs in their effects on plasma testosterone or luteinizing hormone (LH). In the second study cyproterone acetate produced a reduction in plasma testosterone, LH and follicle-stimulating hormone (FSH). Ethynyl oestradiol produced a rise in plasma testosterone and LH, and no change in FSH. Neither drug changed total plasma oestrogen levels. The unexpected effects of ethynyl oestradiol were attributed to an increase in sex hormone-binding globulin (SHBG) leading to a rise in bound, inactive testosterone. Direct measurement showed a two- to threefold increase in SHBG with ethynyl oestradiol treatment and no change in SHBG with cyproterone acetate treatment. In spite of these contrasting endocrine effects, ethynyl oestradiol, cyproterone acetate and benperidol produced similar behavioural changes.