RESUMO
INTRODUCTION: The multidisciplinary approach to cancer care has been established through a statewide videoconferencing network to discuss prospective patient management issues. To our knowledge this is the first report of a statewide community cancer center videoconferencing network in the USA. METHODS: Four of seven American College of Surgeons Commission on Cancer community hospitals in the state of Delaware agreed to participate in a statewide videoconferencing network. Through information technology all centers can communicate pathology and radiology results via visualization methodology. Information is shared on a weekly basis with discussion of treatment decisions and diagnostic procedures. The videoconferencing occurs over a 60-min period. RESULTS: All cases have been prospectively presented. The videoconferencing has led to an increase in National Cancer Institute (NCI) treatment and cancer control clinical trials accrual. American Society of Clinical Oncology (ASCO) guidelines and the National Comprehensive Cancer Center Network (NCCN) guidelines have been followed in 92% of case presentations as recommended by the videoconference participants. Physician and support personnel do not have to travel to any of the centers since technology allows communication amongst all participants through their own community cancer centers. CONCLUSION: A statewide community cancer center videoconferencing network has resulted in high compliance with ASCO and NCCN guidelines and improvement in accrual to NCI Clinical trials.
Assuntos
Institutos de Câncer/organização & administração , Serviços de Saúde Comunitária/organização & administração , Neoplasias/terapia , Comunicação por Videoconferência/estatística & dados numéricos , Humanos , National Cancer Institute (U.S.) , Neoplasias/prevenção & controle , Estudos Prospectivos , Estados UnidosRESUMO
BACKGROUND: Percutaneous stereotactic core biopsy has become an alternative to open surgical biopsy. STUDY: We report the initial 100 consecutive stereotactic core breast biopsies performed in a private breast center by three surgeons. RESULTS: Of the lesions biopsied, 89 were benign and 11 were malignant. Histological agreement was found in ten malignant and eight benign lesions that subsequently underwent open biopsy. In one patient with a lesion read as sclerosing papilloma on stereotactic core biopsy, a subsequent open biopsy undertaken at the pathologist's urging yielded a low-grade ductal carcinoma in situ. CONCLUSIONS: Stereotactic core breast biopsy is safe, accurate, cost-effective, and minimally invasive. It will, in all likelihood, become the breast biopsy method of choice.
Assuntos
Biópsia por Agulha/métodos , Neoplasias da Mama/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/economia , Análise Custo-Benefício , Feminino , Humanos , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
A case of phenytoin-isoniazid drug interaction is reported. Pharmacokinetic evaluation was performed on the basis of two different phenytoin serum concentrations obtained on two different dosage regimens. Whereas Vmax was found to be in the normal range, the patient's Km was increased five-fold. The literature regarding this interaction is reviewed. This case illustrates the usefulness of pharmacokinetic methods in the management of phenytoin-isoniazid interaction.