Feasibility of image-guided radiotherapy for elderly patients with locally advanced rectal cancer.

PURPOSE: The study aims to assess the tolerance of elderly patients (70 years or older) with locally advanced rectal cancers to image-guided radiotherapy (IGRT). A retrospective review of 13 elderly patients with locally advanced rectal cancer who underwent preoperative chemoradiation using IGRT was performed. Grade 3-4 acute toxicities, survival, and long-term complications were compared to 17 younger patients (<70 years) with the same disease stage. RESULTS: Grade 3-4 hematologic toxicities occurred in 7.6% and 0% (p = 0.4) and gastrointestinal toxicities, and, in 15.2% and 5% (p = 0.5), of elderly and younger patients, respectively. Surgery was aborted in three patients, two in the elderly group and one in the younger group. One patient in the elderly group died after surgery from cardiac arrhythmia. After a median follow-up of 34 months, five patients had died, two in the elderly and three in the younger group. The 3-year survival was 90.9% and 87.5% (p = 0.7) for the elderly and younger group respectively. Two patients in the younger group developed ischemic colitis and fecal incontinence. There was no statistically significant difference in acute and late toxicities as well as survival between the two groups. CONCLUSIONS AND CLINICAL RELEVANCE: Elderly patients with locally advanced rectal cancers may tolerate preoperative chemoradiation with IGRT as well as younger patients. Further prospective studies should be performed to investigate the potential of IGRT for possible cure in elderly patients with locally advanced rectal cancer.

A protocol for the handling of tissue obtained by operative lung biopsy: recommendations of the chILD pathology co-operative group.

This is the first of a series on pediatric pulmonary disease that will appear as Perspectives in Pediatric Pathology over the coming months. The series will include practical issues, such as this protocol for handling lung biopsies and another on bronchoalveolar lavage in childhood, as well as reviews of advances in various areas in pediatric pulmonary pathology. It has been 11 years since the last Perspectives on pulmonary disease. Much has happened since then in this area, and this collection will highlight some emerging and rapidly advancing areas in pediatric lung disease. These will include a review of molecular mechanisms of lung development, and another of mechanisms of pulmonary vascular development. The surfactant system and its disorders, as well as recent advances in the biology of the pulmonary neuroendocrine system and mechanisms of respiratory viral disease, will be addressed. Articles on pulmonary hypertension, pulmonary neoplasia, and pediatric lung transplantation, with their implications for the pediatric pathologist, are also planned. The contributors to this series are a diverse group with special interests and expertise in these areas. As Dr. William Thurlbeck noted in his foreword to the previous volume, Pulmonary Disease, volume 18 of Perspectives in Pediatric Pathology, pediatric pathology had been largely concerned with phenomenology, rather than with mechanisms, model systems, and experimental investigation. I think he would have been pleased to see the changes that have occurred over the past 10 years in pediatric lung biology and pathology in particular, because these were particularly favored interests of his later years.

"It's always continuing": first-year medical students' perspectives on chronic illness and the care of chronically ill patients.

PURPOSE: Caring for patients with chronic health conditions is an important component of health care in the 21st century. This study uses qualitative research methods to take an in-depth look at the attitudes of first-year medical students toward chronic illness and the care of chronically ill patients. METHOD: In Spring 2000, 26 first-year medical students at the College of Human Medicine, Michigan State University, were invited to participate in interviews focused on their attitudes toward caring for patients with chronic illness. Transcripts of the interviews were analyzed to identify iterative themes. Concurrently, all 105 first-year students were given a questionnaire that asked about their attitudes toward various aspects of patient care. RESULTS: Nineteen students participated in the interviews. Students viewed chronic illness as incurable, long running, life altering, and often terminal. Most students had firsthand experience with chronic illness in family members; many had premedical work experience with chronically ill patients. Most students described themselves as comfortable with a partnership relationship with patients. Students acknowledged responsibility for caring for those with chronic illness but anticipated sadness and frustration in this work. One hundred and four students completed the questionnaire. Respondents' attitudes were consistent with those expressed in the interviews, suggesting that the interview findings represent the class as a whole. CONCLUSION: Students enter medical school with complex attitudes toward chronic illness, many of which are more negative than previously reported. Qualitative instruments constitute important methods for studying the intricacies of students' attitudes and outlooks.

Concepts of arthritis in India's medical traditions: Ayurvedic and Unani perspectives.

Anthropology and other social sciences have not given detailed attention to cultural constructions of arthritic disorders and their place in traditional medical systems. Humoral medicine and its numerous crosscultural variants offer an important perspective on the conceptualization and treatment of arthritis. The present paper provides a descriptive account of rheumatic disorders in India's Ayurvedic and Unani medical traditions. Data derive from anthropological fieldwork in the New Delhi metropolitan area and from Ayurvedic and Unani texts and secondary sources. The discussion explores these two traditions together as a polysynthetic field of ideas, practices, and materials, and it highlights their congruent concepts of arthritis and related somatic concepts, etiologies, and treatments. It reveals parallels in the clinical practices of Ayurvedic and Unani practitioners and identifies a broadly shared model of arthritis that circulates between these practitioners and their ethnically diverse patient-clienteles. The paper suggests that this South Asian humoral model provides a framework that may be useful in anthropological studies of arthritis in other humoral traditions.