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 160,383 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To select topics for quality assurance activities focusing on older patients, we convened a 14-member panel of physicians and experts in quality assurance. In two rounds of ratings, panelists rated 42 medical conditions (eg, pneumonia) in terms of their effects on patient outcomes, the availability of beneficial interventions, and the health benefits from improving current quality. They rated 27 health services (eg, adult day-care) on similar dimensions. The feasibility of doing quality assurance work on each condition and service also was rated. Using the ratings, the conditions selected for quality assurance work were congestive heart failure, hypertension, pneumonia, breast cancer, adverse effects of drugs, incontinence, and depression. Health care services selected were hospital discharge planning, acute inpatient care for the frail elderly, long-term-care facilities (intermediate-care facilities and skilled nursing facilities), home health care services, and case management.
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PMID:Assuring the quality of health care for older persons. An expert panel's priorities. 365

Bladder metastasis from breast cancer is rare. Patients with breast cancer, in particular patients with a lobular carcinoma subtype, who present with urinary symptoms including incontinence, hematuria, dysuria, and frequency should have the possibility of bladder metastases kept in mind and investigated with cystoscopy and imaging as necessary.
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PMID:Breast cancer presenting initially with urinary incontinence: a case of bladder metastasis from breast cancer. 1475 20

Cancer is a disease that most people fear. Nurses are required to provide information on how to avoid cancer, and, once the diagnosis is made, how to cope with it. Prevention and early detection of the cancers described in this article are in the very early stages of knowledge development, but general health promotion guidance can be offered on how to avoid most cancers (ie, no tobacco use, a high-fiber and low fat diet, exercise, and maintaining a normal weight). Nurses also can advise patients to be screened for colorectal cancer at the appropriate ages and time intervals and to be aware as new developments occur in the scientific base for screenings in the areas of prostate, penile, and testicular cancer. Finally, coping with these forms of cancer often requires the patient to make major lifestyle and psychological changes, especially if surgery in the genital area occurs. Decreased libido, incontinence, and impotence are major complications that can occur with these illnesses. The male cancers described vary tremendously in their prevalence, incidence, mortality, treatment, and survival rates. Within this group, there are remarkably positive outcomes and outcomes much in need of improvement. Penile and testicular cancers are the bright spots in this picture; both are uncommon, and both are eminently treatable. Prostate cancer, on the other hand, is quite common, difficult to screen, difficult to treat without major sexual problems, and yet receives relatively little funding from the NIH. Although as many men die from prostate cancer as women die from breast cancer, NIH funds breast cancer research at much higher levels than prostate cancer. According to the latest data available at the NIH Web site, during the 1990s, the amount of NIH funding varied from four times more for breast cancer (1993) to 2.9 times more in 1999. For fiscal year 2002, NIH is providing $522 million in funding for breast cancer and $278 million for prostate cancer. Private foundation funds for prostate cancer are much smaller than those available for breast cancer. Both types of cancer are extremely important to address, and both should receive adequate research attention. Nurses can advocate for more funding for prostate cancer, from basic science approaches to behavioral science strategies.
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PMID:Cancers of the prostate, penis, and testicles: epidemiology, prevention, and treatment. 1515 83

Lumpectomy to treat breast cancer has revolutionized the management of that disease. Lumpectomy showed that the quality of life of the individual patient can successfully be integrated into the equation of cancer treatment, without major loss of cancer treatment efficacy. Prostate cancer raises many of the same issues that breast cancer does in women. Impotence and incontinence, affects the male self image and psyche no less than the loss of a breast does a woman. Management of prostate cancer ranges from no treatment at all ("watchful waiting") to treatments in which the whole gland is destroyed (radiation therapy, cryosurgery) or removed (radical prostatectomy), with presently no treatment in between these extremes. Pathologic literature indicates, however, that 35% of prostate cancers are solitary and unilateral. In addition, long term studies have confirmed that cryoabltion for prostate cancer is an efficacious treatment. In this paper we will examine the rationale for a "male lumpectomy" using cryoablation and present preliminary data supporting it's role in prostate cancer management.
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PMID:The male lumpectomy: rationale for a cancer targeted approach for prostate cryoablation. A review. 1527 May 87

Irregular uterine bleeding is a common symptom among women in the menopausal transition. Women commonly transition from having regular cycles to having irregular cycles before the final menstrual period. In late perimenopause, anovulation becomes more common, leading to skipped menstrual cycles. Low-dose oral contraceptive pills are effective in decreasing the amount of menstrual blood loss and improving menstrual cycle regularity. It is unclear whether menorrhagia is associated with normal perimenopausal hormonal changes. Studies to date have failed to correlate menorrhagia with hormonal levels and pathology within the uterus. Because of the common association between uterine pathology and menorrhagia, this is an important area for future studies. Vaginal dryness is a common symptom, particularly in late perimenopause. The association between vaginal dryness and low estrogen levels is clear. Estrogen-based hormone replacement therapy is effective in treating this symptom. Locally released estrogen therapy may be preferred over systemic therapy because of lower systemic estradiol levels, reduced side effects, and high efficacy. The long-term safety of these products, particularly in women with a history of breast cancer, requires more study. The prevalence of incontinence increases as women age, but it is unclear whether the menopausal transition is an independent risk factor. Incontinence is a frequent complaint among women in the menopausal transition. In postmenopausal women, hormone therapy (HT) appears to be ineffective in preventing or improving the symptoms of incontinence. Further study of HT, including locally applied estrogens for the common symptom of incontinence, are needed in women in the menopausal transition.
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PMID:Genitourinary symptoms in the menopausal transition. 1641 26

The big three, breast cancer (BC), prostate cancer (PC) and colorectal carcinoma are the most frequent malignancies world wide and also typical tumors of advanced age. Therefore the question to screen and how to screen for these tumors in the elderly is the main question for reduction of the total cancer burden and mortality in all western countries. BREAST CANCER (BC): The age related risk of BC increases from 1 : 2,500 at age 30+ to > 1 : 10 at age 80. Nevertheless, most of the national BC-Screening-Programs stop at age 60 or earlier. Therefore the majority of all advanced i. e. T (4) stages of BC are found in women age > 60. Frequently it is suggested that age related comorbidity should eliminate the benefit of treatment. Recently two longitudinal studies have clearly shown that correct standard treatment is as effective in elderly as in younger individuals. Mammography (MG) has been shown to reduce mortality of BC significantly with best results for specificity and sensitivity at age 70+. PROSTATE CANCER (PC): The screening situation of PC is quite different to BC, because risk profiles are poorly defined and the benefit of radical prostatectomy is not clearly demonstrated in the early non symptomatic stages of PC. At the other side watchful waiting leads to an elevated frequency of incontinence and enuresis as well. Two studies are now under progress and may possibly change the situation; but the final results are expected 2005-2008 at the earliest. Therefore an assisted individual decision making is the only recommendation at this time. COLORECTAL CANCER (CC): Risk groups are clearly defined. Risk of the elderly (> 60) is the average risk. The incidence increases from < 50/10 (5) to more than 500 at age 75+(male) and 500 (female). When to start and when to stop screening? Experts give the advice to begin at age 50 and to end at age 80; but this is not really evidence based. There are several unanswered questions and open problems: we are not exactly informed about complication rates of colonoscopy during the screening programs. There is a lack of data according accuracy of barium enema, virtual colonoscopy and genetic stool test in comparison to colonoscopy in combination with fecal occult blood test (FOBT). And adherence to screening is not well documented among informed patients. However, effectiveness of CC-screening (FOBT alone or in combination with colonoscopy) has been documented in three high randomised trials which have shown a disease specific mortality reduction of 15-33 % over a period of 8-13 years. But it must be clear that the economic resources must be mobilised individually or by insurance: offering the testing of only FOBT for ten years to one thousand persons can save one life.
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PMID:[Chances and risks of prevention in elderly people for the three major cancers: breast-, prostate- and colorectal cancers]. 1675 77

Over the last ten years, progress in evidence-based medicine coupled with technological and surgical breakthroughs have deeply changed the management of our patients. Uterine bleeding is the first cause of gynaecological consultation and the intrauterine progestin delivery system as well as new hysteroscopic procedures have optimized the therapeutic approach to this problem. Introduction of magnetic resonance imaging and interventional procedures have improved breast disease diagnosis and management; likewise sentinel node localization, introduction of aromatase and growth factors inhibitors, new radiotherapy procedures and pharmacogenomics, have helped to ameliorate breast cancer treatment. Pelvic surgery has been switching more and more towards laparoscopic procedures not only in the field of benign lesions (eg endometriosis), of surgery of prolapse and incontinence with new prosthetic materials, but also for an improved management of gynaecological cancers.
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PMID:[Therapeutic progress in gynecology: organic diseases]. 1772 16

The introduction of breast-sparing surgery (ie, "lumpectomy") revolutionized the management of breast cancer. The use of lumpectomy showed that quality of life could be optimized without compromising treatment efficacy. Complications of prostate cancer treatment, including impotence and incontinence, adversely alter the male self-image similarly to the way the loss of a breast does for a woman. Traditional thinking holds that prostate cancer is multifocal and therefore is not amenable to focal treatment. However, histopathologic findings from published data have indicated that up to 25% of prostate cancers are solitary and unilateral. Furthermore, the significance of minute secondary cancers might be minimal. These observations raise the question of whether certain patients can be identified and treated with a limited "lumpectomy." In this study, focal cryoablation has been used to ablate the area of known cancer as determined by staging biopsies. The serum prostate-specific antigen (PSA) concentration was obtained every 3 months for 2 years and every 6 months thereafter. American Society for Therapeutic Radiology Oncology (ASTRO) criteria for PSA recurrence were used. A total of 55 patients with > or = 1 year of follow-up had undergone focal cryoablation. Follow-up ranged from 1 to 10 years (mean, 3.6 years). At the original transrectal ultrasound biopsy, the mean and median numbers of cores taken were 9.9 and 10 (SD, +/- 3.5), respectively. Mean and median numbers of positive cores were 1.8 and 1 (SD, +/- 1.3), respectively. Of the 55 study patients, 52 (95%) had stable PSA levels with no evidence of cancer despite a medium to high risk for recurrence in 29 patients. All biopsy findings were negative among the 26 patients with a stable PSA level who had undergone routine biopsy at 1 year. No local recurrence was noted in treated areas. Potency was maintained in 44 (86%) of 51 patients. Of the 54 patients without previous prostate surgery or radiotherapy, all were continent. These preliminary results indicate that "male lumpectomy"--in which the prostate tumor region itself is destroyed--preserves potency in most patients and limits other complications (particularly incontinence) without compromising cancer control. Additional studies and long-term follow-up are needed to confirm that this treatment approach could have a profound effect on prostate cancer management.
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PMID:"Male lumpectomy": focal therapy for prostate cancer using cryoablation. 1819 6

Leptomeningeal carcinomatosis represents a rare manifestation of metastatic breast cancer (MBC). We herewith report on a patient suffering from HER2 overexpressing MBC who received intrathecal methotrexate and trastuzumab for meningeal carcinomatosis. A 48-year-old woman was diagnosed with breast cancer in December 2002. Following surgery, six cycles of adjuvant FE100C plus irradiation and, subsequently for 1 year, trastuzumab were given. As a result of disseminated metastatic spread in October 2005, the patient received whole-brain radiotherapy for symptomatic central nervous system involvement, and was put on several trastuzumab-based combination regimens (capecitabine, vinorelbine, paclitaxel). In June 2006, the patient developed clinical signs of terminal cone involvement with overflow incontinence and paraparesis of the legs. Immediate radiation led to partial relief from clinical symptoms. Subsequently, the patient was put on the tyrosine kinase inhibitor lapatinib and capecitabine (August to October 2007), but on November 6th the patient suffered again from overflow incontinence and weakness of the legs. Failing to respond to lapatinib, the patient received gemcitabine/cisplatin and, additionally, was recommenced on intravenous trastuzumab. Owing to progressive leptomeningeal disease, the patient received repeated doses of intrathecal methotrexate and trastuzumab. Within 2 weeks and four intrathecal treatments, cerebrospinal fluid cytology showed the absence of tumor cells. Moreover, a striking clinical improvement with resolution of the paraparesis of the legs and overflow incontinence was observed. This case report gives details regarding the clinical course of a breast cancer patient who received intrathecal trastuzumab and methotrexate via lumbar puncture for meningeal carcinomatosis of HER2-overexpressing MBC.
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PMID:Intrathecal trastuzumab (Herceptin) and methotrexate for meningeal carcinomatosis in HER2-overexpressing metastatic breast cancer: a case report. 1869 96

Gastrointestinal disturbances (particularly diarrhea) are often induced in response to cancer treatments such as chemotherapy or radiation. Oral chemotherapeutic agents can induce diarrhea by damaging the intestinal lining. Two common oral drugs used in cancer treatment that are known to have gastrointestinal side effects are capecitabine and lapatinib. In this brief communication, the authors discuss a case study of a stage IV breast cancer patient whose chemotherapy-induced diarrhea was treated successfully with a multispecies combination of probiotics. This is a unique study in which grade 3 chemotherapy-induced diarrhea (characterized by 7-9 stools per day and associated with incontinence and abdominal cramping) was treated with only a multispecies combination of probiotics. Probiotics have been used to treat diarrhea in patients with irritable bowel syndrome, ulcerative colitis, pouchitis, and Crohn's disease. More recently, probiotics have been used to treat chemotherapy-induced diarrhea in colon cancer patients. This case study demonstrates that the probiotics can also be used to treat severe cases of chemotherapy-induced diarrhea in breast cancer patients. The use of different probiotics in gastrointestinal diseases is an increasingly important area of study, and more research into this area is needed. This study demonstrates that probiotics should be considered for advanced breast cancer patients with chemotherapy-induced diarrhea.
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PMID:Use of probiotics in the management of chemotherapy-induced diarrhea: a case study. 1955 10


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