Rays
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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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Degeneration of the intervertebral disk complex begins early in life and is a consequence of a variety of environmental factors as well as of normal aging. Degeneration of bone and soft tissue spinal elements is the most common cause of spinal stenosis. ⋯ Computed tomography and myelography have long been used for diagnosing the effects of degenerative diseases' of the lumbar spine. Despite the continuous improvement in magnetic resonance scanning for this purpose, computed tomography can provide excellent screening for disk herniation and spinal stenosis.
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The differentiation between normal sequelae and complications of any surgical treatment of the lumbar spine is of the utmost importance. Clinical and radiological diagnosis is often difficult. ⋯ For example, the frequent resort in vertebral surgery to metal implants which may limit or even prevent the interpretation of CT or MR images, should be kept in mind. The main types of surgical procedures involving the lumbar spine are briefly reviewed, focusing on CT and MRI appearance of normal sequelae of early or late complications and the recurrence of the lesion that necessitated the first procedure.
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Seventy-five years have elapsed since its introduction and a renewed interest has arisen in the vaccination with bacillus Calmette-Guerin (BCG) for the prevention of tuberculosis. This interest has been motivated by the increase in tuberculosis, especially in multidrug-resistant tuberculosis. The efficacy of BCG has been questioned for decades, however, new epidemiological studies have shown a protective effect in some populations and categories at risk. ⋯ The use of this vaccination is advised for specific populations based on the risk of infection and disease. However, BCG has a limited benefit. New agents produced with methods of molecular biology are supplying encouraging results in the animal model.