Journal of The American Dietetic Association, 1998
Malnutrition is a common problem in cancer patients and, if untreated, can lead to cancer cachexi... more Malnutrition is a common problem in cancer patients and, if untreated, can lead to cancer cachexia and poor response to therapies. Subjective Global Assessment (SGA) has been shown to be valid and comparable with objective measures such as the Prognostic Nutritional Index (PNI) in general surgery patients. The purpose of this study was to determine the reproducibility of SGA ratings
Objective To determine which hydration (saline, saline + mannitol, or saline + furosemide) is ass... more Objective To determine which hydration (saline, saline + mannitol, or saline + furosemide) is associated with least cisplatin nephrotoxicity. Methods We randomized 49 women who received cisplatin (75 mg/m2 every 3 weeks) into one of the three hydration arms. The 24-h creatinine clearance was measured before and on day 6 after cisplatin infusion. The patients of each arm received 2 l of saline hydration. In the saline + furosemide arm, 40 mg of furosemide was given after hydration. In the saline + mannitol arm, 50 g of mannitol was mixed with the cisplatin. Results For the first cycle of chemotherapy, 15 women were randomized to saline, 17 to saline + furosemide, and 17 to saline + mannitol. For each group, the creatinine clearances before cisplatin infusion were (means±SD, milliliters per minute) 84.5±26.8, 82.5±24.0 and 87.4±25.6, and after cisplatin infusion were 79.1±31.9, 68.7±21.5, and 56.4±22.9, respectively. The decreases in creatinine clearance were similar between the saline group and the saline + furosemide group (P=0.66), but different between the saline + mannitol group and the saline group (P=0.02) or the saline + furosemide group (P=0.02). As each woman received multiple courses of cisplatin, 15 who received saline contributed 41 paired datasets, 17 who received saline + furosemide contributed 49 paired datasets, and 17 who received saline + mannitol contributed 36 paired datasets showed similar patterns. Conclusions Hydration with saline or saline + furosemide appears to be associated with less cisplatin nephrotoxicity than saline + mannitol.
Carcinoma of the vulva is an uncommon gynecologic malignancy primarily affecting postmenopausal w... more Carcinoma of the vulva is an uncommon gynecologic malignancy primarily affecting postmenopausal women. The lesion is most commonly associated with HPV DNA, although, for many, a defined preinvasive to invasive connection is not readily apparent. Most patients experience symptoms of pruritus, irritation, and even pain for weeks or months before the diagnostic biopsy is performed. Patient embarrassment and unfamiliarity and reluctance on the part of the physician to fully evaluate these symptoms add to the delay. Vulvar carcinoma is staged surgically following resection. A concerted effort to conserve as much normal tissue as possible has been the focus of recent investigation. Separate incision resection of the vulvar mass and groin has improved wound healing and quality of life for many patients. The effect these conservative procedures have on long-term survival is currently being evaluated. Increased use of radiation therapy or chemoradiation has allowed organ preservation in many otherwise exenterative cases. In some instances, this neoadjuvant therapy has provided an opportunity to surgically clear otherwise unresectable lesions. Current radiotherapy techniques might also be as effective as groin dissection in certain low-risk patients. Adjuvant radiation and chemoradiation improve local control and reduce groin recurrence risk. In addition, patients with histologically positive groins enjoy longer survival when the pelvis is also treated. Selected use of multimodality therapy will likely extend the lives of women with vulvar cancer.
International Journal of Gynecological Cancer, 2004
Nutritional evaluation of cancer patients may lead to treatment intervention that reduces morbidi... more Nutritional evaluation of cancer patients may lead to treatment intervention that reduces morbidity and mortality. This evaluation can be done subjectively or objectively. We studied the correlation between subjective and objective nutritional assessment in gynecological oncology patients. Sixty-seven consecutive patients admitted to the gynecological oncology service were prospectively evaluated by laboratory criteria using a standardized formula. The prognostic nutritional index (PNI) consists of tests measuring albumin, transferrin, triceps skin fold, and skin sensitivity reaction to common antigens. The patients were also subjectively evaluated using a standardized questionnaire and physical examination, known as the subjective global assessment, by two clinicians who were blinded from the PNI results. Both scores were categorized as normal, mild malnutrition, or severe malnutrition. Reproducibility of the subjective testers and consistency between the subjective and the objective evaluations were assessed with a weighted kappa statistic. Cancer distribution consisted of 39 (58%) cervical, 16 (24%) endometrial, 11 (16%) ovarian, and one (2%) vulvar carcinomas. There was a high level of agreement between the two subjective raters (weighted kappa = 0.797; 95% CI 0.67-0.92). Furthermore, there were no cases in which the ratings differed by two points on the three-point ordered scale of nutritional status. Agreement between the two evaluation methods was only fair to moderate (weighted kappa = 0.435; 95% CI 0.28-0.59). Agreement was exact in 38 of 67 patients (57%). There were eight patients (12%) where the difference in ratings differed by two points on the ordinal scale, all with the subjective scored as normal, but the objective rated as severe malnourishment. In assessing nutritional status of gynecological patients, subjective assessment differs with objective/laboratory measurement.
Journal of The American Dietetic Association, 1998
Malnutrition is a common problem in cancer patients and, if untreated, can lead to cancer cachexi... more Malnutrition is a common problem in cancer patients and, if untreated, can lead to cancer cachexia and poor response to therapies. Subjective Global Assessment (SGA) has been shown to be valid and comparable with objective measures such as the Prognostic Nutritional Index (PNI) in general surgery patients. The purpose of this study was to determine the reproducibility of SGA ratings
Objective To determine which hydration (saline, saline + mannitol, or saline + furosemide) is ass... more Objective To determine which hydration (saline, saline + mannitol, or saline + furosemide) is associated with least cisplatin nephrotoxicity. Methods We randomized 49 women who received cisplatin (75 mg/m2 every 3 weeks) into one of the three hydration arms. The 24-h creatinine clearance was measured before and on day 6 after cisplatin infusion. The patients of each arm received 2 l of saline hydration. In the saline + furosemide arm, 40 mg of furosemide was given after hydration. In the saline + mannitol arm, 50 g of mannitol was mixed with the cisplatin. Results For the first cycle of chemotherapy, 15 women were randomized to saline, 17 to saline + furosemide, and 17 to saline + mannitol. For each group, the creatinine clearances before cisplatin infusion were (means±SD, milliliters per minute) 84.5±26.8, 82.5±24.0 and 87.4±25.6, and after cisplatin infusion were 79.1±31.9, 68.7±21.5, and 56.4±22.9, respectively. The decreases in creatinine clearance were similar between the saline group and the saline + furosemide group (P=0.66), but different between the saline + mannitol group and the saline group (P=0.02) or the saline + furosemide group (P=0.02). As each woman received multiple courses of cisplatin, 15 who received saline contributed 41 paired datasets, 17 who received saline + furosemide contributed 49 paired datasets, and 17 who received saline + mannitol contributed 36 paired datasets showed similar patterns. Conclusions Hydration with saline or saline + furosemide appears to be associated with less cisplatin nephrotoxicity than saline + mannitol.
Carcinoma of the vulva is an uncommon gynecologic malignancy primarily affecting postmenopausal w... more Carcinoma of the vulva is an uncommon gynecologic malignancy primarily affecting postmenopausal women. The lesion is most commonly associated with HPV DNA, although, for many, a defined preinvasive to invasive connection is not readily apparent. Most patients experience symptoms of pruritus, irritation, and even pain for weeks or months before the diagnostic biopsy is performed. Patient embarrassment and unfamiliarity and reluctance on the part of the physician to fully evaluate these symptoms add to the delay. Vulvar carcinoma is staged surgically following resection. A concerted effort to conserve as much normal tissue as possible has been the focus of recent investigation. Separate incision resection of the vulvar mass and groin has improved wound healing and quality of life for many patients. The effect these conservative procedures have on long-term survival is currently being evaluated. Increased use of radiation therapy or chemoradiation has allowed organ preservation in many otherwise exenterative cases. In some instances, this neoadjuvant therapy has provided an opportunity to surgically clear otherwise unresectable lesions. Current radiotherapy techniques might also be as effective as groin dissection in certain low-risk patients. Adjuvant radiation and chemoradiation improve local control and reduce groin recurrence risk. In addition, patients with histologically positive groins enjoy longer survival when the pelvis is also treated. Selected use of multimodality therapy will likely extend the lives of women with vulvar cancer.
International Journal of Gynecological Cancer, 2004
Nutritional evaluation of cancer patients may lead to treatment intervention that reduces morbidi... more Nutritional evaluation of cancer patients may lead to treatment intervention that reduces morbidity and mortality. This evaluation can be done subjectively or objectively. We studied the correlation between subjective and objective nutritional assessment in gynecological oncology patients. Sixty-seven consecutive patients admitted to the gynecological oncology service were prospectively evaluated by laboratory criteria using a standardized formula. The prognostic nutritional index (PNI) consists of tests measuring albumin, transferrin, triceps skin fold, and skin sensitivity reaction to common antigens. The patients were also subjectively evaluated using a standardized questionnaire and physical examination, known as the subjective global assessment, by two clinicians who were blinded from the PNI results. Both scores were categorized as normal, mild malnutrition, or severe malnutrition. Reproducibility of the subjective testers and consistency between the subjective and the objective evaluations were assessed with a weighted kappa statistic. Cancer distribution consisted of 39 (58%) cervical, 16 (24%) endometrial, 11 (16%) ovarian, and one (2%) vulvar carcinomas. There was a high level of agreement between the two subjective raters (weighted kappa = 0.797; 95% CI 0.67-0.92). Furthermore, there were no cases in which the ratings differed by two points on the three-point ordered scale of nutritional status. Agreement between the two evaluation methods was only fair to moderate (weighted kappa = 0.435; 95% CI 0.28-0.59). Agreement was exact in 38 of 67 patients (57%). There were eight patients (12%) where the difference in ratings differed by two points on the ordinal scale, all with the subjective scored as normal, but the objective rated as severe malnourishment. In assessing nutritional status of gynecological patients, subjective assessment differs with objective/laboratory measurement.
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