Rays
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Based on a review of the literature on resectable lung cancer, pulmonary risk factors before, during and after surgery are discussed. The role of preoperative evaluation in order to determine the patient ability to withstand radical resection is considered. Spirometric indexes as forced expired volume (FEV1) and diffusing lung carbon monoxide capacity (DLCO) should be measured first. ⋯ However, if FEV1 and DLCO are <60% of predicted, further evaluation with a quantitative lung scan is required. If predicted postoperative values for FEV1 and DLCO are >40%, patients can undergo lung resection, otherwise exercise testing is necessary. If the latter shows maximal oxygen uptake (VO2max) of > 15ml/Kg, surgery can be performed; if VO2max is <15 ml/Kg, patients are inoperable.
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Review
Preoperative assessment and risk factors in the surgical treatment of lung cancer: the role of age.
The incidence of lung cancer in the elderly is increasing in Western countries. This disease represents the second leading cause of cancer death in this age group and it is also responsible for a substantial increment in morbidity and health care costs. ⋯ Therefore, a careful preoperative assessment of these factors, with particular regard to comorbid conditions (such as cardiovascular and pulmonary diseases or secondary malignancy) is necessary in older adults. In consideration of the need of a multidisciplinary assessment to identify comorbidities and operative risk a close collaboration between pneumologists, radiologists, oncologists, thoracic surgeons, anesthesiologists, cardiologists, geriatric specialists, physical therapists is highly recommended.
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Three-dimensional conformal radiation therapy (3-D CRT) or intensity-modulated radiation therapy (IMRT) have been increasingly used as an alternative to radical prostatectomy in patients with localized carcinoma of the prostate and in patients at high risk, in combination with hormonal therapy. To better understand the implications of dose-time and fractionation in prostate cancer, it is important to be familiar with some laboratory investigations dealing with the cell kinetics characteristics of this tumor. Biological and clinical considerations of dose fractionation, total dose of irradiation and local tumor control, elapsed overall treatment time and sequelae of irradiation are illustrated, based on an exhaustive review of the literature.
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The university with the fragmentation of knowledge in the disciplines required by an in-depth study and by research had to reconsider over and over the doctor's curriculum in order to make professionalism able to concretely and consistently address health needs. The main points of this new process of medical education and training are presented as an analytical list illustrated in its single aspects. These subjects tackle only some of the main problems that substantiate the renewal of medical education for the development, in a harmonious sysnthesis, of cognitive competences (knowledge), psychomotor competences (know how to do) and psychoemotional competences (know how to be).