The lancet oncology
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The lancet oncology · Feb 2003
ReviewCancer/testis tumour-associated antigens: immunohistochemical detection with monoclonal antibodies.
Cancer/testis tumour-associated antigens (C/T TAA) were the first human tumour-associated antigens to be characterised at the molecular level. Specific genes are expressed in the testis and in tumours of varying histological origin. The tissue expression pattern supports the notion that these antigens could be targets for active specific immunotherapy. ⋯ The emerging picture is consistent with a mostly heterogeneous expression in human cancers. These findings support the concept of multiantigenic tumour vaccine preparations. Moreover, the wide range of tumours in which C/T TAA have been detected urges further efforts to develop effective specific immunotherapeutic procedures.
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The lancet oncology · Oct 2002
ReviewBeyond futility: to what extent is the concept of futility useful in clinical decision-making about CPR?
The concept of futility has often been invoked to justify abstention from treatment and decisions such as 'do not attempt resuscitation' (DNAR). In this capacity, futility has played an important part in the development of several sets of official clinical guidelines. ⋯ Although the concept of futility promises simplicity, it cannot stand alone as a satisfactory framework for clinical decision-making. Practitioners and policy makers should be cautious about their use of the concept.
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Dyspnoea, defined as a sensation of an uncomfortable awareness of breathing, is one of the most frightening and distressing symptoms for patients with cancer. It is very common in cancer patients with and without direct lung involvement. The gold standard of diagnosis and assessment is the patient's self-report. ⋯ Opioids are the first line of therapy for such relief. Medical management can be directed at the underlying cause when the potential benefits outweigh the burdens of such treatment. In rare cases for which symptomatic treatment does not control dyspnoea to the patient's satisfaction, sedation is an effective, ethical option.
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The accuracy of the dinical diagnosis of cutaneous melanoma with the unaided eye is only about 60%. Dermoscopy, a non-invasive, in vivo technique for the microscopic examination of pigmented skin lesions, has the potential to improve the diagnostic accuracy. Our objectives were to review previous publications, to compare the accuracy of melanoma diagnosis with and without dermoscopy, and to assess the influence of study characteristics on the diagnostic accuracy. ⋯ A comparison of various diagnostic algorithms for dermoscopy showed no significant differences in their diagnostic performance. A thorough appraisal of the study characteristics showed that most of the studies were potentially influenced by verification bias. In conclusion, dermoscopy improves the diagnostic accuracy for melanoma in comparison with inspection by the unaided eye, but only for experienced examiners.