Parkersburg, WV, United States
Parkersburg, WV, United States

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Nguyen N.P.,Howard University | Kratz S.,University of Arizona | Chi A.,West Virginia University | Vock J.,Lindenhofspital | And 13 more authors.
Cancer Investigation | Year: 2015

A retrospective review of 32 patients with stage III nonsmall cell lung cancer who underwent chemoradiation with image-guided radiotherapy (IGRT) was recorded. Acute grade 3-4 hematologic and esophageal toxicities developed in 6 and 13 patients respectively. At a median follow-up of 14.5months, only one patient developed grade 3 pneumonitis. Themedian survival was estimated to be 17 months. Five patients (15%) developed loco-regional recurrences, and 17 patients (53%) distantmetastases. Grade 3-4 toxicities remained significant during chemoradiation with IGRT. However, the reduced rate of severe pneumonitis despite a high tumor dose is encouraging and needs to be investigated in future prospective studies. Copyright © 2015 Informa Healthcare USA, Inc.


Nguyen N.P.,University of Arizona | Shen W.,University of Arizona | Kratz S.,University of Arizona | Vock J.,Lindenhofspital | And 10 more authors.
Frontiers in Oncology | Year: 2013

Background: To assess the tolerance of patients with small cell lung cancer undergoing chemoradiation with tomotherapy-based image-guided radiotherapy (IGRT). Materials and Methods: A retrospective review of the toxicity profile for nine patients with small cell lung cancer of the limited stage who underwent chemoradiation delivered with helical tomotherapy (HT) has been conducted. Results: Acute grade 3-4 hematologic and esophagitis toxicities developed in two and three patients respectively. One patient developed a pulmonary embolism during radiotherapy. Seven patients had weight loss ranging from 0 to 30 pounds (median: 4 pounds). Three patients had treatment breaks ranging from 2 to 12 days. At a median follow-up of 11 months (range: 2-24 months), no patients developed any radiation related toxicities such as grade 3-4 pneumonitis or other long-term complications. The median survival was estimated to be 15 months. There were two local recurrences, three mediastinal recurrences, and six distant metastases. Conclusion: Grade 3-4 toxicities remained significant during chemoradiation when radiation was delivered with tomotherapy-based IGRT. However, the absence of grade 3-4 pneumonitis is promising and the use of HT needs to be investigated in future prospective studies. © 2013 Nguyen, Shen, Kratz, Vock, Vos, Vincent, Altdorfer, Ewell, Jang, Karlsson, Godinez, Mills, Sroka, Dutta, Chi and The International Geriatric Radiotherapy Group.


Bindlish S.,Heritage University | Bindlish S.,Camden Clark Medical Center | Presswala L.S.,St John Medical Center | Schwartz F.,Camden Clark Memorial Hospital
Postgraduate Medicine | Year: 2015

Context: Lipodystrophy (LD) is a relatively rare complex collection of diseases that can be congenital or acquired. It is commonly missed in the clinical setting. Thus, the spectrum of disease presentation mandates clinician expertise in the pathophysiology and management of all forms of LD, obesity, and insulin resistance. Methods and materials: An extensive literature search of clinical trials, systematic reviews, and narrative reviews was completed in PubMed for the years 1970 to 2013. The search terms were lipodystrophy, congenital LD, acquired LD, HIV-associated LD, severe insulin resistance, adiposity, obesity, and dyslipidemia. Evidence synthesis: Lipodystrophies are a heterogeneous group of disorders with abnormal adipose tissue distribution, utilization, and metabolism. Adipose tissue can undergo significant changes in composition (hypertrophy and atrophy) in response to a nutritional state. Paradoxically, both excess and deficient adipose tissue is associated with insulin resistance and the metabolic syndrome. Bone density scan (DEXA) for body fat composition analysis or magnetic resonance imaging are optimal modalities for the assessment of abnormal adipose tissue distribution. Ongoing clinical studies suggest thiazolidinediones, insulin like growth factor-1, leptin, and growth hormone–releasing hormone as possible treatment for LPD; however, none of them is approved to reverse fat loss or treat severe insulin resistance due to LPD. Conclusion: The underlying mechanisms for LPD causing insulin resistance may be lipotoxicity and derangements in adipose tissue-derived proteins (adipocytokines). However, the lack of evidence to support this model means that clinicians are on their own as they navigate through the phenotypic presentation of lipodystrophies, obesity, insulin resistance, and the metabolic syndrome. © 2015 Informa UK Ltd.


Khan R.,Camden Clark Medical Center
The West Virginia medical journal | Year: 2013

Methemoglobin is formed upon iron oxidation of the heme molecule from ferrous (Fe2+) to its ferric (Fe3+) state. Normal methemoglobin levels in the body vary between 1-2% of the total hemoglobin. Cause of methemoglobinemia can be inherited or acquired. Inherited causes include an enzymatic deficiency in the enzyme cytochrome b5 reductase where as acquired causes are most commonly from routinely used medications. Herein, we present to you a case of methemoglobinemia after Cetacaine (a benzocaine based topical anesthetic) utilization during a transesophageal echocardiography. Some of the other common potential inciting agents are also discussed here along with an overview of treatment strategies.

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