Replacement of daily load attenuates but does not prevent changes to the musculoskeletal system during bed rest.

The dose-response effects of exercise in reduced gravity on musculoskeletal health have not been well documented. It is not known whether or not individualized exercise prescriptions can be effective in preventing the substantial loss in bone mineral density and muscle function that have been observed in space flight and in bed rest. In this study, typical daily loads to the lower extremities were quantified in free-living subjects who were then randomly assigned to control or exercise groups.

A systematic review of the treatment of nausea and/or vomiting in cancer unrelated to chemotherapy or radiation.

Context: A systematic review of antiemetics for emesis in cancer unrelated to chemotherapy and radiation is an important step in establishing treatment recommendations and guiding future research. Therefore, a systematic review based on the question "What is the evidence that supports antiemetic choices in advanced cancer?" guided this review.

Objectives: To determine the level of evidence for antiemtrics in the management of nausea and vomiting in advanced cancer unrelated to chemotherapy and radiation, and to discover gaps in the evidence, which would provide important areas for future research.

Familial adenomatous polyposis in a patient with unexplained mental retardation.

Background: A 22-year-old woman was referred to a genomic medicine clinic for evaluation of suspected Prader-Willi syndrome (PWS) after normal DNA methylation studies on chromosome 15 were obtained. Features suggestive of PWS included mental retardation, short stature, obesity, hypotonia, and small hands and feet. The patient, however, lacked many PWS-defining behavioral features, including hyperphagia, compulsive skin picking, and food-seeking behaviors.

The business of palliative medicine - part 5: service utilization in a comprehensive integrated program.

The aim of palliative medicine is to provide multidisciplinary comprehensive care in advanced illness. Patient and family utilization of various product service lines offered by the Harry R Horvitz Center for Palliative Medicine at the Cleveland Clinic Foundation was studied. Newly referred patients were followed up prospectively until 85% had either died or been lost to follow-up.

A phase II trial of accelerated multimodality therapy for locoregionally advanced cancer of the esophagus and gastroesophageal junction: the impact of clinical heterogeneity.

Objectives: This is a report of mature results from a phase II trial of an accelerated multimodality treatment program for locoregionally advanced cancer of the esophagus and gastroesophageal junction with a focus on the impact of clinical heterogeneity on outcomes. A split course of pre- and postoperative hyperfractionated radiation therapy and concurrent chemotherapy was used in an effort to limit perioperative mortality.

Methods: Eligibility required a diagnosis of esophageal or gastroesophageal junction cancer and an esophageal ultrasound stage of at least T3, N1, or M1A.

Respiratory function during parenteral opioid titration for cancer pain.

Background: Respiratory depression is the most feared opioid-related side-effect yet research on the topic is sparse. We evaluated changes in respiratory parameters during parenteral opioid titration for cancer pain to determine if opioid titration was associated with evidence of hypoventilation. The primary outcome measure was to measure changes in end-tidal CO(2) (ET-CO(2)) during opioid titration to pain control.

Impact on quality of life of adjuvant therapy for breast cancer.

Late toxicities of adjuvant chemotherapy and side effects of endocrine therapy may cause long-term quality-of-life impairments for some individuals who have been treated for breast cancer. Chemotherapy has been associated with durable effects on cognitive function and fatigue and with the induction of menopause. Endocrine therapies can increase menopausal and sexual symptoms and can contribute to weight gain.

Radioimmunotherapy for non-Hodgkin's lymphoma: a review for radiation oncologists.

Purpose: The aim of this study was to review advances in radioimmunotherapy (RIT) for non-Hodgkin's lymphoma (NHL) and to discuss the role of the radiation oncologist in administering this important new form of biologically targeted radiotherapy.

Methods And Materials: A review of articles and abstracts on the clinical efficacy, safety, and radiation safety of yttrium Y 90 (90Y) ibritumomab tiuxetan (Zevalin) and iodine I 131 tositumomab (Bexxar) was performed.

Results: The clinical efficacy of RIT in NHL has been shown in numerous clinical trials of 90Y ibritumomab tiuxetan and 131I tositumomab.

The role of 111indium-octreotide brain scintigraphy in the diagnosis of cranial, dural-based meningiomas.

Objective: Meningiomas are common brain tumors with somatostatin receptors that bind octreotide. We report the use of (111)indium-octreotide brain scintigraphy (OBS) for the non-invasive differentiation of meningiomas from other cranial dural-based pathology.

Methods: A retrospective analysis of our experience with OBS for non-invasive identification of meningiomas was performed.

Systematic review of the treatment of cancer-associated anorexia and weight loss.

Purpose: We systematically assessed the efficacy and safety of appetite stimulants in the management of cancer-related anorexia. Literature databases were searched for randomized controlled trials of appetite stimulants in the treatment of cancer anorexia.

Materials And Methods: Studies were graded according to quality.

George W. Crile, Ohio's first neurosurgeon, and his relationship with Harvey Cushing.

Much has been written about Harvey Cushing, his contributions to neurosurgery, and his relationship with many of his contemporaries. Nevertheless, there is no independent report documenting his relationship with Ohio's first neurosurgeon, George W. Crile.

Opioid rotation in cancer patients: pros and cons.

Opioid rotation involves changing from one opioid to another using correct equianalgesic conversion techniques to achieve better analgesia and/or fewer side effects. The strategy appears to work because of significant interindividual variations in response to both analgesic activity and toxicity. Although there are many retrospective studies, few prospective controlled trials of opioid rotation have been published.

The modern brain tumor operating room: from standard essentials to current state-of-the-art.

It is just over a century since successful brain tumor resection. Since then the diagnosis, imaging, and management of brain tumors have improved, in large part due to technological advances. Similarly, the operating room (OR) for brain tumor surgery has increased in complexity and specificity with multiple forms of equipment now considered necessary as technical adjuncts.

The cancer anorexia-cachexia syndrome: a survey of the Prognostic Inflammatory and Nutritional Index (PINI) in advanced disease.

Other than weight loss, most traditional methods of nutritional assessment are not acceptable in advanced cancer patients because they are inaccurate, too expensive for routine use, or too difficult for a debilitated person to complete. The prognostic inflammatory and nutritional index (PINI) is a formula devised to evaluate nutritional status and prognosis in critically ill patients. It has been suggested that the PINI score can be used to follow most pathological conditions.

Autonomic nervous system dysfunction in advanced cancer.

The autonomic nervous system (ANS) innervates every organ in the body and is largely involuntary. There have been reports of autonomic dysfunction in cancer patients, but most are case reports. There are suggestions that this abnormality may be common in advanced cancer.

Can a soft diet prevent bowel obstruction in advanced pancreatic cancer?

Although many patients are advised to follow a high-fiber diet to avoid constipation, it seems that a soft diet such as that recommended after bowel surgery may well be more helpful in avoidance of intestinal obstruction.

Mitochondrial cytopathy in adults: what we know so far.

Mitochondrial cytopathies are a diverse group of inherited and acquired disorders that result in inadequate energy production. They can be caused by inheritable genetic mutations, acquired somatic mutations, exposure to toxins (including some prescription medications), and the aging process itself. In addition, a number of well-described diseases can decrease mitochondrial energy production; these include hyperthyroidism, hypothyroidism, and hyperlipidemia.

Modern management of the cancer anorexia-cachexia syndrome.

The cancer anorexia-cachexia syndrome is common, occurring in 80% of patients with advanced-stage cancer, and it is one of the most frequent causes of death in patients with cancer. It is a complex problem involving abnormalities in protein, carbohydrate, and fat metabolism. Tumors have both direct and indirect effects that result in anorexia and weight loss.

Modern management of the cancer anorexia-cachexia syndrome.

The cancer anorexia-cachexia syndrome is common, occurring in 80% of patients with advanced-stage cancer, and it is one of the most frequent causes of death in patients with cancer. It is a complex problem involving abnormalities in protein, carbohydrate, and fat metabolism. Tumors have both direct and indirect effects that result in anorexia and weight loss.

Phase II trial of liposomal doxorubicin (Doxil) in advanced soft tissue sarcomas.

Purpose: To assess the objective response rate, toxicity experienced, progression-free survival, and overall survival of patients with previously untreated advanced soft tissue sarcomas treated with a liposomal doxorubicin formulation (Doxil).

Methods: Patients with metastatic or recurrent soft tissue sarcoma who had received no prior chemotherapy for advanced disease were treated with liposomal doxorubicin (Doxil) according to a two stage accrual design. Doxil was administered at 50 mg/m2 every 4 weeks.