Clinical advances in hematology & oncology : H&O
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Clin Adv Hematol Oncol · Dec 2003
ReviewThe role of prophylactic cranial radiation in the treatment of non-small-cell lung cancer.
Patients with lung cancer face a substantial risk of developing brain metastases. Prophylactic cranial irradiation therapy has been demonstrated to significantly decrease the incidence of central nervous system metastasis and improve overall survival in patients with small-cell lung cancer. ⋯ However, the role of prophylactic cranial irradiation in patients with non-small-cell lung cancer is less well defined. As treatment modalities improve and patients live longer their risk of developing central nervous system recurrence increases, and methods to prevent this demand exploration.
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Antiphospholipid antibodies (APAs) have been associated with thromboembolic events. Since they were fi rst described in 1906, APAs have been the subject of multidisciplinary studies seeking to link them to potential pathophysiologic mechanisms. This review summarizes the different types of APAs, antigenic targets, clinical complications associated with APAs, and APA syndrome. In addition, the currently available methods for laboratory identification of lupus anticoagulants are discussed, as is the laboratory diagnosis of anticardiolipin antibodies.
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Clin Adv Hematol Oncol · Oct 2003
ReviewParticipation in cancer trials: recruitment of underserved populations.
One approach to address cancer health disparities is to focus on the under-representation by minority populations in cancer trials. Recruitment strategies include: 1) characterizing the target populations, 2) involve members of the population in planning, 3) take the message to the population, 4) give something back to the community, 5) enhance credibility with a community spokesperson, 6) identify and remove barriers, 7) improve staff sensitivity, and 8) educate the population about the trial. To recruit minorities to clinical trials, we have developed the Accrual to Clinical Trials (ACT) framework for understanding and enhancing the recruitment of participants to cancer trials.
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Clin Adv Hematol Oncol · Feb 2003
ReviewPotential role of recombinant factor VIIa as a hemostatic agent.
Recombinant factor VIIa (rFVIIa) has been shown to induce hemostasis in hemophilia patients with inhibitors against factor VIII or factor IX independent of factor VIII/factor IX. Factor VIIa binds to tissue factor (TF) exposed at the site of injury and generates, through factor X activation on the TF-bearing cells, enough thrombin to activate factors VIII, V, and XI, as well as platelets. The thrombin-activated platelets provided a perfect template for binding of activated factors VIII, IX, and V, further activation of factor X, and thrombin generation. ⋯ This also maintains hemostasis in the absence of factor VIII or factor IX. Pharmacologic doses of rFVIIa may accordingly be of benefit in producing hemostasis in situations other than hemophilia characterized by profuse bleeding and impaired thrombin generation. There is now clinical experience indicating a hemostatic effect in patients with thrombocytopenia and functional platelet defects. rFVIIa has also been successfully used in acute trauma patients with profuse bleedings and in other bleeding situations.