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The role of role of calcium and mitochondrial oxidant stress in the loss of substantia nigra probiotic fora erectile dysfunction drugs muse order levitra oral jelly with amex. Fasano M erectile dysfunction doctors in louisville ky discount levitra oral jelly 20 mg overnight delivery, Bergamasco B causes of erectile dysfunction in your 20s purchase levitra oral jelly no prescription, Lopiano L (2007) the proteomic approach in host immune system impotence emotional causes purchase levitra oral jelly 20 mg fast delivery. Lotharius J, Brundin P (2002) Pathogenesis of Parkinson’s disease: dopamine, vesicles and alpha-synuclein. Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy. Sokol H, Seksik P (2010) the intestinal microbiota in infammatory bowel diseases: time to connect with the host. Box 509 Albany, New York 12201-0509 Third Edition 2007, Second Edition 1996, First Edition 1994 Requests for copies of this publication may be directed to: Blood and Tissue Resources Program New York State Department of Health Wadsworth Center Empire State Plaza P. Box 509 Albany, New York 12201-0509 Telephone: (518) 485-5341 Fax: (518) 485-5342 E-mail: btraxess@health. Director Director Transfusion Medicine and Cellular Therapy New York Blood Center Clinical Services New York Presbyterian Hospital White Plains, New York Weill Cornell Medical Center New York, New York Nadia Rajsz, M. Infusacare Medical Services (Ex-officio) Liverpool, New York Commissioner New York State Department of Health William Fricke, M. Rochester General Hospital Executive Secretary Rochester, New York Director, Blood and Tissue Resources New York State Department of Health Alicia E. Director Director Blood Bank Blood Bank Maimonides Medical Center Lenox Hill Hospital Brooklyn, New York New York, New York John Burch, M. Chief Medical Officer Director American Red Cross Blood Services Blood and Tissue Resources New York-Penn Region and New York State Department of Health Northeastern Pennsylvania Region Wadsworth Center West Henrietta, New York Albany, New York Debra Kessler, R. Despite the high degree of sophistication of current methods of blood donor screening, there exists a possibility of transmission of infectious diseases by transfusion or for the occurrence of other adverse reactions. Transmission of infectious diseases may occur because the donation took place within the "window period" of detection for the pertinent infectious disease marker; no test is available for the agent that causes the disease; or other factors, including clerical and/or laboratory error. Other adverse reactions may occur because of unexpected interactions between donor and recipient blood. A donor is “involved” with a transfusion-transmitted event if a donated component was transfused to the affected patient during an interval plausible for acquisition. An involved donor is “implicated” in a transfusion-transmitted event if the donor’s component is determined to be the likely cause. The major benefit of reporting transfusion-associated disease to collection facilities is the potential for: 1. It is important that any communication to the donor that the donation may have transmitted a disease to a recipient be preceded by careful evaluation of the recipient, in order to eliminate clearly from consideration any conditions not associated with transfusion. Only donations from donors who fulfill all required criteria are distributed for transfusion. Although currently all blood collected in New York State for transfusion purposes is donated by volunteer donors, blood may be collected from paid donors if it is appropriately labeled as such. Collecting facilities provide donors with educational materials regarding both donor and recipient safety issues. In the course of the medical history interview, donors are asked about prior exposure to infectious diseases, medications, and risks for infectious diseases. Provisions should be made to enable donors to self-exclude confidentially, at the time of donation or via a call-back system, donations that may be unsuitable. The names of blood donors are compared to names in a local, regional, or nationwide donor deferral registry to identify those currently disqualified because of infectious disease risk (previous medical/behavioral risk history and/or test results). Donors are subjected to an evaluation that includes temperature, pulse, blood pressure, screening for hemoglobin concentration or hematocrit, and examination of the antecubital areas to identify skin infections or evidence of illegal drug use. Blood samples from each donor are subjected to a number of tests, including assays for blood group, antibodies to red blood cell antigens, and infectious disease markers. Testing of donor samples is also performed under strict rules and oversight by regulatory agencies. Most cases are acquired by sexual contact, injected drug use, or other contact with blood or other body fluids. Transmitted most commonly by sexual contact, injected drug use, needle sticks, or maternofetal transmission. Transfusion-associated cases should be reported to the collecting facility and the Blood and Tissue Resources Program. Most cases are associated with contact with another person’s blood through injected drug use. Some cases occur through maternofetal transmission or needlesticks in healthcare workers. Pathogen reduction of human-derived clotting factor concentrates makes transmission unlikely. A source listing, by county, New York State county health department contact information is provided in Appendix C. Most cases are acquired through breast milk, sexual contact (primarily male to female), or injected drug use. Transmission has not been reported in association with frozen plasma or with red blood cell components stored for at least 28 days. No transfusion-transmitted case of syphilis has been reported in the United States in more than 40 years. The absence of disease transmission may be due to the low frequency of the disease in the blood donor population and a relatively small period of asymptomatic spirochetemia in infected persons. Studies have suggested, although not proven 4 conclusively, that storage conditions of both red blood cells and platelets are not compatible with extended survival of the organism. Counseling messages for donors with confirmed positive screening test results should reflect the low likelihood of actual acute infection. Suspected or confirmed clinical cases and positive laboratory test results for syphilis are reportable to the local health department, based on the patient’s or donor’s county of residence. Health department programs that can assist in investigations or receive reports can be found in Appendix C. A rare, acute “malaria-like” infection caused in the northeastern United States by Babesia microti. Endemic areas in the eastern United States include eastern Long Island, Connecticut, and Massachusetts. Usually produces no disease or mild disease in immunocompetent humans, but can cause severe illness in those who are splenectomized, elderly, or otherwise immunosuppressed. An asymptomatic carrier state has been demonstrated in infected blood donors for periods exceeding a year. Suspected or confirmed clinical cases and positive laboratory test results for Babesia infection are reportable to the local health department, based on the patient’s or donor’s county of residence. Current laboratory reporting guidance is available from the sources given in Appendix B. Caused by the protozoan Trypanosoma cruzi, transmitted by insects of the Reduviidae family (kissing bugs); also transmissible by blood transfusion and organ transplantation, and may be transmissible by tissues containing intact cells. Highly prevalent in areas of Mexico, and Central and South America; confirmed cases are uncommon in the United States. A limited number of cases have been reported in association with blood transfusion and organ transplantation in North America during the last 25 years, almost exclusively in immunocompromised patients. Infected individuals may be identified by observation of the protozoan in peripheral blood smears and biopsy specimens (in a few acute cases), and by detection of antibodies by enzyme immunoassay or indirect immunofluorescence. Chronically infected persons likely have intermittent parasitemia, and about 50 percent of recipients of blood donated by chronically infected individuals acquire the infection. Thought to be currently the most frequent infectious disease risk of blood transfusion. Most commonly associated with contamination during blood collection (skin or environmental bacteria) or, less frequently, during manipulation of components. Risk of transfusion-transmitted bacterial infection is higher for platelets because room temperature storage conditions facilitate bacterial proliferation. Typical reaction is characterized by chills, high fever, rigors and shock in the first few minutes of transfusion; transfusion must be immediately discontinued.
The sellar cavity is single-layer dural substitute for protection filled with pieces of collagen sponge erectile dysfunction injections australia buy 20 mg levitra oral jelly with mastercard. Different techniques are used (intra and/or extradural closure of the sella erectile dysfunction treatment saudi arabia buy generic levitra oral jelly 20 mg online, and packing of the sella with or without packing of the sphenoid sinus) erectile dysfunction treatment bangladesh generic levitra oral jelly 20 mg free shipping, depending on the size of the osteo-dural defect and of the “dead space” inside the sella impotence lab tests buy levitra oral jelly australia. A small amount of fbrin glue is injected though the arachnoid defect and, if possible, the redundant arachnoid is used to cover the defect. Different layers of collagen sponge are then placed over the cisternal surface, whilst autologous abdominal fat or fbrin glue is used to fll the sellar cavity. Thereafter, the sellar foor is closed intra or better extradurally with a dural substitute, and other layers of collagen sponge are positioned to cover the posterior wall of the sphenoid sinus. Whichever approach is used, reconstruction proceeds in the same way as for Grade 2 up to the closure of the sellar foor, which in this case is performed with a single large layer of dural substitute in the extradural space. In addition, a sheet of resorbable solid material, tailored to conform to the size and grade of the defect, is then placed over the dural substitute and embedded in the extradural space dragging the dural substitute into overlay position (Fig. The dural substitute is positioned and the bone substitute is embedded in the extradural space dragging the dural substitute. Eventually, a vascularized nasoseptal fap according to Hadad-Bassagasteguy’s technique can be used. Once sellar reconstruction has been fnished, the surgical procedure is com pleted by medializing the middle turbinate previously displaced to avoid maxillary sinusitis. Endoscopic Pituitary and Skull Base Surgery – Anatomy and Surgery of the Endoscopic Endonasal Approach 25 Fig. Anatomical Structures Involved in Extended Endonasal Approaches to 6 the Skull Base In order to achieve a wider working space that facilitates maneuvering of instru ments while exploring areas around the sella, or even in selected sellar lesions, the basic rules for extended approaches to the skull base (Figs. The following basic steps are therefore required: unilateral removal of the middle turbinate; lateralization of the middle turbinate in the other nostril; removal of the posterior portion of the nasal septum; removal of the superior turbinate and of the posterior ethmoid air cells (on the same side where the middle turbinate has been removed). Endoscopic Anatomy of the Planum Sphenoidale Immediately above the sellar foor, the angle formed by the convergence of the sphenoid planum with the sellar foor, represented by the tuberculum sellae, can be observed. The sphenoid planum is slightly anterior to it, bounded on both sides by the protuberances of the optic nerves, that diverge towards the apices of the orbits (Fig. The broken line demarcates the boundary of bone removal to gain access to the suprasellar area; the pointers indicate the medial opto-carotid recess. After the bone has been removed, the dura over the sellar foor, the tuberculum sella and planum sphenoidale is opened gaining access to the main suprasellar neurovascular structures (Figs. The entire suprasellar region can be divided into four areas by two ideal planes, one passing through the inferior surface of the chiasm and mammillary bodies, and another passing through the posterior margin of the chiasm and dorsum sellae: the suprachiasmatic, subchiasmatic, retrosellar and intraventricular area (Fig. In the suprachiasmatic area, the anterior margin of the chiasm, the medial portion of both optic nerves, the anterior portion of the circle of Willis, and the gyri recti of the frontal lobes are exposed (Figs. They can be divided into four areas: suprachiasmatic (1); subchiasmatic (2); retrosellar (3); intraventricular (4). In the retrosellar area, above the dorsum sellae, the upper third of the basilar artery, the pons, the superior cerebellar arteries, the oculomotor nerves, the posterior cerebral arteries and, lastly, the mammillary bodies and the foor of the third ventricle are visualized (Figs. Opening the foor of the third ventricle at the level of tuber cinereum, a panoramic view of the intraventricular area is obtained (Figs. Endoscopic Anatomy of the Olfactory Groove In order to gain access to this area of the skull base, middle turbinates of both nostrils, anterior and posterior ethmoid cells and the superior half of the nasal septum are completely removed. When explored through the endonasal route, the olfactory groove is a rectangular area of the cranial base demarcated by the lamina papyracea (orbital walls) laterally, the planum sphenoidale posteriorly, and the frontal sinus anteriorly. Such an area is composed of two symmetrical parts divided by the perpendicular plate of the ethmoid, the lamina cribrosa medially and the ethmoidal labyrinth laterally (Figs. The anterior and posterior ethmoidal arteries, which both are branches of the ophthalmic artery, reach the cribriform plate emerging from the anterior and Fig. Anterior and posterior ethmoidectomy have posterior ethmoidal canals respectively (Fig. Once the anterior skull base has been exposed in the area between the orbits and the dura opening has been completed, the intracranial contents become visible (Fig. The superior part of the nasal septum has been removed, thus allowing a bilateral median exposure. Endoscopic Pituitary and Skull Base Surgery – Anatomy and Surgery of the Endoscopic Endonasal Approach 29 6. Endoscopic Anatomy of the Clivus the clivus is divided by the inferior wall (foor) of the sphenoid sinus in two portions, the upper, i. Therefore, the vomer and the foor of the sphenoid sinus have to be completely removed to allow exposure of both parts of the clivus. The lateral boundary is the vidian nerve, which can be identifed at the exit from its canal, lateral to the vomer-sphenoid junction (Fig. It also represents a key landmark to unlock the lateral aspect of the middle junction and identification of the vidian nerve. The lateral boundary of the sphenoid portion of the clivus is demarcated by the paraclival tracts of the intracavernous carotid arteries (Fig. Nevertheless, one should bear in mind that particular attention must be paid when extending the bone removal laterally. As a matter of fact, the abducent nerve enters the cavernous sinus by traversing the basilar sinus in close proximity to the paraclival tract of the intracavernous carotid artery. Once the dura mater has been opened, the basilar artery and its branches, as well as the upper cranial nerves, are well visualized along their courses in the posterior cranial fossa (Figs. The removal of the inferior part of the clival bone exposes the anterior surface of the craniovertebral junction. As a matter of fact, the articular surface of the condyles lies on its lateral portion. Therefore, removal of the inner surface of the anterior third of the condyles can be performed without affecting the functional integrity of the joints. Upon dural opening, the vertebral arteries can be explored up to the basilar artery (see Fig. Endoscopic Anatomy of the Craniovertebral Junction level of the hypoglossal canals. Dissection of the muscular structures together with removal of the anterior arch of the atlas are required to visualize the dens (Fig. The dens is then thinned, separated from the apical and alar ligaments, dissected from the transverse ligament, and fnally removed. Once the dura mater has been opened, all the neurovascular structures running through the anterior part of the foramen magnum can be visualized; particularly, the intradural tract of the vertebral artery and the C1 and C2 ventral rootlets should be clearly visible (Fig. Cavernous Sinus Approach – Endoscopic Anatomy this approach involves removal of the bone that covers the intracavernous carotid artery (carotid protuberance) and allows both the medial and lateral compartments of the cavernous sinus to be exposed. Viewing the intracavernous carotid artery within the sphenoid sinus, resembling a shrimp, permits to identify Fig. Therefore, we are able to distinguish a parasellar and a paraclival atlantooccipital membrane (aom); anterior segment. The latter forms the shape of a “C” with medial concavity and can be part of the foramen magnum (dotted line); subdivided into three segments: upper horizontal, vertical and inferior horizontal. Endoscopic Pituitary and Skull Base Surgery – Anatomy and Surgery of the Endoscopic Endonasal Approach 31 By lateralizing the intracavernous carotid, it is possible to view, behind the latter and the pituitary gland, the meningohypophyseal trunk and its branches, the dorsal meningeal, inferior hypophyseal and tentorial arteries (Fig. On the other hand, passing laterally to the carotid artery, the inferolateral trunk, i. Furthermore, the oculomotor, abducent and maxillary nerves can be visualized lying on a closer plane as compared to that occupied by the trochlear and the ophthalmic nerves (Figs. As visualized through the endoscope from below, the oculomotor nerve superiorly and the abducent inferiorly defne a triangular area, the base of which is formed by the lateral loop of the carotid artery. The outer surface of this area contains the fourth cranial nerve and a portion of the V1 branch of the trigeminal nerve. The abducent nerve superiorly and V2 inferiorly enclose a quadrangular area, laterally demarcated by the bone surface of the lateral sphenoid sinus wall, Fig. The ophthalmic branch of the trigeminal nerve and arteries intracavernous carotid artery and exposure of the right inferior hypophyseal artery . Removal of the lateral sphenoid wall and exposure of the neurovascular structures of the right cavernous sinus. Medialization of the carotid artery and exposure of the neurovascular structures of the right cavernous sinus. Operating Room Set-up the use of some additional tools has been shown to make the endoscopic endonasal trans-sphenoidal procedures safer and more effective, particularly in case of extended approaches. Image-guided surgery systems (neuronavigation) are very useful for intra operative identifcation of the boundaries of the lesion providing relevant information concerning the midline and trajectory, and offering enhanced precision in defning the bony delineations and neurovascular spatial relation ships.
An infant responds to erectile dysfunction new treatments discount levitra oral jelly 20mg with visa abdominal pain by flailing the extremities; the child responds by guarding the abdomen erectile dysfunction treatment options in india buy 20mg levitra oral jelly with amex. Chapter 4 Health Promotion for the Developing Child Answer as either true (T) or false (F) erectile dysfunction causes weed buy cheap levitra oral jelly online. Environmental factors influence growth and development prenatally and after birth erectile dysfunction shake drink cheap levitra oral jelly 20mg with mastercard. Standard growth curves are appropriate for assessing children regardless of racial or ethnic background. Theories of Growth and Development Match each stage of Piaget’s theory with the example that is characteristic of that stage. Formal operations Identify which of Freud’s stages of psychosexual development is represented by each of the following. Child typically prefers same-sex friends: Fill in the blanks in the following statements to complete the developmental tasks of Erikson through adolescence. Postconventional morality 20 Chapter 4 Health Promotion for the Developing Child Copyright © 2013, 2007, 2002 by Saunders, an imprint of Elsevier Inc. List three interventions that nurses might use when working with families with genetic abnormalities. Results from interaction between genetic susceptibility and environmental factors during the prenatal period 66. X-linked recessive disorder 21 Copyright © 2013, 2007, 2002 by Saunders, an imprint of Elsevier Inc. Why are the child’s height, weight, and head circumference plotted on standardized growth charts at every well child checkup What are questions that the nurse should ask during the initial interview for a 4-year-old during a well-child check up Because all states require immunizations for children attending school, obtaining parental informed consent before immunization is not necessary. The preferred site for intramuscular injections for infants and toddlers is the deltoid muscle. Acetaminophen can be given to relieve the discomfort associated with vaccine administration. When administering more than one injection, the nurse should give the vaccines with separate syringes. An otherwise healthy child with a low-grade fever should not be immunized at this time. Vitamins/minerals 23 Copyright © 2013, 2007, 2002 by Saunders, an imprint of Elsevier Inc. Chart the height, weight, and head circumference of at least three children (an infant, a young child, and a school age child or adolescent) on a standardized growth chart. They tell you they are concerned because Amy is not as tall as her brother was at 12 months and because she cannot walk yet. You plot her height, weight, and head circumference and find that these measurements fall within the same growth channel as on her previous visits. From a dietary history, you learn that she is drinking low-fat (2%) milk from a cup. How would you determine whether the parents’ concerns about Amy’s growth and development are alleviated An infant responds to an injection by crying and flailing the extremities, whereas a preschooler responds by rubbing the injection site. Parents of a preschooler are concerned because she wants “to marry” her father and told her mother to “go outside and get hit by a car. An adolescent who has been losing weight will record everything he eats for 3 days. When children play board games, they learn that taking turns is rewarded and that cheating is not rewarded. Which pair of anthropometric data reflect an 18-month-old’s current nutritional status A 12-month-old child’s immunization record indicates that only one set of immunizations was given at 2 months. Which statement made by the adolescent indicates an understanding of the teaching A 21-year-old adult develops generativity by developing a mutual relationship with another person. Formal operations with analysis of situations 26 Chapter 4 Health Promotion for the Developing Child Copyright © 2013, 2007, 2002 by Saunders, an imprint of Elsevier Inc. Trust Growth and Development of the Infant Next to each activity, write the age at which the behavior generally first appears. Can stand alone 27 Copyright © 2013, 2007, 2002 by Saunders, an imprint of Elsevier Inc. Parents can use a tiny bit of toothpaste on a washcloth to clean their infant’s teeth. All infants require fluoride supplements to promote the development of healthy teeth. Gates at the top and bottom of stairs should be in place when the child starts to. What does the American Academy of Pediatrics recommend for preventing sudden infant death Assess fine and gross motor skills, language patterns, and psy chosocial interactions. Jamal, an 8-month-old, is being hospitalized for 2 weeks to receive antibiotic therapy. According to Piaget, an infant who intentionally shakes a rattle to hear the sound is in what substage Coordination of secondary schemata 30 Chapter 5 Health Promotion for the Infant Copyright © 2013, 2007, 2002 by Saunders, an imprint of Elsevier Inc. An 11-month-old enjoys picking up Cheerios one by one with the thumb and index finger and throwing them on the floor. The parents of a 3-month-old with colic explain that, because their child does not sleep through the night, they feel very frustrated. Which statement suggests that the parent needs more information about infant nutrition The 6-month-old whose out-of-town cousin has lead toxicity 31 Copyright © 2013, 2007, 2002 by Saunders, an imprint of Elsevier Inc. The nurse is teaching new parents about the care of their recently circumcised infant. Which statement made by the parents would indicate a correct understanding of the instruction The nurse is teaching a class on growth and development to a group of pregnant mothers. An 8-month-old generally has more regular patterns of bowel and bladder elimination and may reach for toys. A 12-month-old should have tripled his or her birth weight and can feed himself or herself with a spoon. The nurse is teaching a group of newly graduated nurses who will be working on a pediatric unit about nutrition for infants. Which statement made by one of the new nurses would indicate a need for additional instruction Disorders in the rhythm of speech in which child knows what to say but is unable to do so 7. Transductive reasoning Growth and Development during Early Childhood Fill in the blanks. Chapter 6 Health Promotion during Early Childhood For each of the following, write T if the behavior first occurs during toddlerhood or P if it first occurs during the preschool years. Magic thinking is common Match each characteristic of preoperational thinking with its example. Magical thought Health Promotion for the Toddler or Preschooler and Family Answer as either true (T) or false (F). An appropriate serving size for solid food for the young child is 1 tablespoon of solid food per year of age.
- Lupus nephritis
- Subungual and periungual warts - appear under and around the fingernails or toenails.
- Not urinating often enough during the day
- Time it was swallowed
- Magnetic resonance imaging (MRI) of the head
- Levels of vitamins and minerals in the body
Positron emission tomography for target volume definition in the treatment of non-small cell lung cancer erectile dysfunction in diabetes management order levitra oral jelly 20 mg with visa. Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials yohimbine treatment erectile dysfunction levitra oral jelly 20mg on line. Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline erectile dysfunction treatment urologist purchase 20mg levitra oral jelly free shipping. Twice daily compared to erectile dysfunction pump pictures levitra oral jelly 20 mg free shipping once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. Respiratory gating techniques and image guidance techniques may be appropriate to minimize the amount of critical tissue (such as lung) that is exposed to the full doses of radiation C. The treatment of lymphomas with radiation is generally done using relatively low doses in the range of 15 to 36 Gy at standard fractionation, sometimes with doses as low as 4 Gy in 2 fractions F. Sequential chemotherapy carries a high toxicity burden and requires substantial supportive care and the expertise of an experienced multidisciplinary team V. In an individual with advanced or recurrent disease that is felt not to be curative and who is experiencing symptomatic local disease, photon and/or electron techniques are indicated for symptom control 1. Treatment decisions are preceded by workup and staging and planned in conjunction with the appropriate members of the multi-disciplinary team. Page 149 of 258 Initial management requires chemotherapy as the cornerstone of therapy (in a variety of different acceptable regimens), followed by assessment of response leading to an appropriate choice of radiation therapy technique, dose, and use of radioimmunotherapy as clinically indicated. Omitting sites that had no clear involvement in an effort to minimize toxicity ii. Generally encompassable in a single site setup, requiring the use of Complex or 3D techniques, with image guidance iv. Radiation may be considered for an individual with a sub-optimal response to therapy Page 150 of 258 4. Consolidative radiation therapy after initial chemotherapy, to a dose of 36 Gy, to the original extent of disease for the following histologies: a. Long-term outcomes for patients with limited stage follicular lymphoma: involved regional radiotherapy versus involved node radiotherapy. Long-term outcome in localized extranodal mucosa-associated lymphoid tissue lymphomas treated with radiotherapy Cancer. High response rates and lasting remissions after low-dose involved field radiotherapy in indolent lymphomas. Non-malignant disorders for which radiation therapy is medically necessary when criteria are met: A. Choroidal hemangioma (also see separate Guideline, Proton Beam Radiation Therapy) I. Non-malignant disorders for which radiation therapy may be medically necessary when criteria are met (Note that all requests require review by an eviCore radiation oncologist): A. Inflammatory (acute/chronic) disorders not responsive to antibiotics (furuncles, carbuncles, sweat gland abscesses) R. Vernal catarrh For specific details, including criteria needed to meet medical necessity and typical treatment regimen(s), please refer to the comprehensive list in the Key Clinical Points section of this Guideline. Key Clinical Points It was not long after the discovery of xrays in 1895 that radiation was used for therapeutic purposes. Since benign disorders do not always follow a benign course, radiation was employed for many conditions for which there was no suitable therapeutic alternative. Where Page 157 of 258 applicable, comments regarding changed indications are included in the brief discussion that follows of disorders for which radiation may have been used in the past or is presently in use. Acceptance of the appropriateness of using radiation has developed using several means. Historically a trial and error approach prevailed, not different from the empiric use of pharmacological agents and surgical procedures that satisfied logic but lacked validation by now-customary rigor of prospective trials. Current indications may be based on experience-based consensus or on higher-level evidence that has resulted from formal study. Over the past five decades, consensus has been measured by polling practitioners on what is considered the appropriate uses of radiation. Such surveys in the United States, Germany and the United Kingdom supplement peer-reviewed journal publications and chapters in major radiation oncology texts, the latter reporting more evidence-based guidance that is the result of clinical studies. No subsequent modern era radiation oncology review supports the use of ionizing radiation in the treatment of acne. Improved alternative treatments and the risk of radiation-induced cancer render its use obsolete for the treatment of acne. Bulky, fast-growing tumors, especially those causing brainstem compression, most commonly are approached surgically. Factors that influence patient selection include symptoms such as hearing loss, status of hearing in the contralateral ear, age and life expectancy, tumor size and rate of growth, patient preference, comorbidities, and availability of therapeutic options. Adamantinoma (ameloblastoma) these rare, locally aggressive but usually histologically benign tumors are of epithelial origin and are most commonly of jaw or tibial location. The etiology of epithelial tissue in an unusual location is the subject of debate. The 2002 text by Order and Donaldson supplies several references, each with few cases to report, and mainly of mandible or maxillary origin. Amyloidosis There is only an occasional case report of the use of ionizing radiation therapy in the treatment of amyloidosis. Because of the availability of alternative therapy and the typically young age of patients, the use of ionizing radiation is a last resort. Radiation therapy is medically necessary only if accompanied by documentation that its use is considered essential by a multi-disciplinary team. Angiofibroma of nasopharynx (juvenile nasopharyngeal angiofibroma) While optimum management is controversial, there is general agreement that surgery is preferred if considered safe, as in cases when there is no extension into the orbital apex or base of skull. When radiation is used, the radiation dose is lower than in malignant tumors of the same location. Angiomatosis retinae (von Hippel Lindau syndrome) Capillary hemangiomas associated with von Hippel Lindau syndrome may be single or multiple, and can severely affect vision. Ankylosing spondylitis the use of radiation therapy in the treatment of ankylosing spondylitis is of historical interest. Resolution is slow and may take years, during which the risk of hemorrhage is not eliminated. Arthritis (see total lymphoid irradiation for radioimmunosuppression) (see rheumatoid arthritis) (see osteoarthritis) N. Basalioma this synonym for basal cell carcinoma of the skin is sometimes included in lists of "benign" disorders of skin suitable for treatment with radiation therapy. It can be mistaken for other disorders because of the features it shares with psoriasis and eczema. The presentation and behavior ranges from truly benign to aggressive with metastatic potential. Bursitis, synovitis, and tendinitis Randomized studies in 1952, 1970, and 1975 cited in the Order and Donaldson review claimed "no benefit" to the use of radiation therapy for any of these, and the authors of the review recommend against its use. Department of Health, Education, and Welfare survey report of 1977 reporting the results of a survey of American radiation oncologists included these diagnoses as acceptable for treatment, as did the German survey of 2008. There is support in modern era texts, concluding that the use of radiation "may provide an alternative to conventional conservative treatment for patients who are not surgical candidates" (Perez Brady). Typical treatment is with photon beam therapy using, at most, complex treatment planning in five or fewer fractions. For secreting tumors, radiation therapy is limited to those causing symptoms that are not controllable by medical means. The relationship to subsequent malignant lymphoma is unclear, with malignant lymphoma reported in as many as 30% of cases. Synonyms include giant follicular lymph node hyperplasia, follicular lymphoreticuloma, angiomatous lymphoid hamartoma, and giant benign lymphoma. Castration There is evidence that with sufficient dose radiation can effectively and permanently cease gamete production and hormone production in the testes and ovaries. Department of Health, Education, and Welfare survey report of 1977 included castration as an acceptable indication. The availability of drugs which achieve the same result has largely rendered this as obsolete.
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