A NEW COMPUTED APPROACH TO OR MANAGEMENT. Tracing Step by Step all the Surgical Path

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Electrode 2 was a mean of 0. These differences between the surgical approaches were proportionally largest in the first basal turn. Electrode distance from the osseous spiral lamina followed a similar pattern Figure 4 B to electrode distance to the central axis of the modiolus in that electrode locations in RWIs were significantly closer to the spiral lamina than the electrodes after a cochleostomy approach. Within the basal turn, electrodes 6 and 8 also demonstrated statistically significant differences between the 2 surgical approaches; in the RWI group they were a mean of 0.

With the exception of the most basal electrode mean difference of 0. The lack of significant findings may be attributed to surgical differences in cochleostomy placement and interindividual variability in bony canal diameter. In this retrospective case-comparison study, RWIs were associated with shorter distances between electrodes and target neural elements in the basal portion of the electrode array. Between the 2 surgical approaches, mean differences were as large as 1.

Ideally, CI relies on the response of surviving spiral ganglion neurons to electric stimulation by the CI. Unfortunately, a substantial fraction of electrical current does not get delivered to the modiolus because of tissue impedance. There is evidence that channel interaction is a limiting factor in CI performance and that reducing channel interactions improves performance scores. Unfortunately, the trade-off with modiolar hugging electrode arrays is an increased probability of inducing intracochlear damage and destroying residual hearing.

Although these electrodes seem to demonstrate preliminary success in acquiring proximal perimodiolar position and lateral wall location, the greater electrode distances come with a compromise of increasing the level of current required for suprathreshold stimulation. The results from this study suggest that Med-El standard electrode arrays nonmodiolar hugging achieve closer proximity to the central axis of the modiolus and the osseous spiral lamina via RWI. Nowadays, intraoperative imaging equipment is commonly equipped with flat-panel detectors ie, Siemens Orbic 3D C-arms, Medtronic O-arms.

These technological advances allow for real-time imaging in the operating room, making it more feasible to monitor electrode array passage at the time of the insertion. A prospective study evaluating the use and advantages of intraoperative FPCT units for CI may be a worthwhile undertaking. There are important limitations to consider regarding this study. Although all of the cochleostomies were placed anterior and inferior to the RW, the study results do not account for millimeter differences in the location of the cochleostomy.

We acknowledge that any variability in positioning relative to the RW could influence final intracochlear electrode position and alter the robustness of the statistical significance found in this study. Metallic artifacts were unavoidable with FPCT scans. We used high-resolution FPCT settings and tailored reconstruction parameters to reduce electrode artifacts. The remaining metallic artifact mainly obscured the lateral bony wall in direct proximity to the electrode and did not interfere with visualization of the bony capsule or the osseous spiral lamina.

We attempted to control for bloom distortion by using digital composite imaging to compare undistorted preoperative CT scans with postoperative FPCT scans Figure 3. Ultimately, our study lacks histologic correlation because our population involves CI users and not cadaveric specimens. Previous studies directly evaluated the results of radiographic imaging multislice CT and FPCT in CI users with temporal bone gross histologic features 26 and histological microgrinding imaging. Nonetheless, the lack of histological confirmation in our study is an important limitation of this study method and should be taken into consideration when interpreting the study findings.

In addition to using preoperative CT scans to control for postimplantation scans, we rotated FPCT secondary reconstructions along the modiolus axis and the basal turn axis to deduce the trajectory of the bony canal. By integrating 3D structures, we were able to reasonably predict the location of the lateral bony wall. Although the basilar membrane and cochlear ducts could not be reliably visualized from the FPCT images with the electrode array present, the osseous spiral lamina was easily visualized on the sagittal oblique axis.

In this study, we observed that differences between electrode distances to the osseous spiral lamina for RWI and cochleostomy approaches were proportionally greater than the electrode distance to the modiolus. There are plausible reasons for this observation. First, the center axis of the modiolus is not necessarily in the center of the sagittal view of the electrode array.

Anatomical studies and histological sections demonstrate interindividual variability in angulation of the modiolus, and this was observed in our study. Electrodes that are located near the floor or the roof of the bony canal will result in shorter distances between the electrode and the orthogonal landmarks. Therefore, surgical differences in cochleostomy placement may confound electrode centroid measurements to the lateral bony wall, osseous spiral lamina, and the central axis of the modiolus. Finally, the 2 modes of measurement operate on different scales and a 0. Ultimately, differences in electrode contact positions between the 2 surgical approaches are greatest in the first third and latter third of the basal turn regardless of which measurement is used electrode centroid to central axis of the modiolus and electrode centroid to osseous spiral lamina.

Despite the aforementioned limitations, this study represents the first effort to use modern imaging techniques to perform a quantitative comparison of electrode distance to bony landmarks between RWI and cochleostomy approaches. This study provides new evidence that RWIs may reduce the distance between electrode contact and the modiolus in the basal turn of the cochlea. Further studies should examine the relationship between electrode distance and preservation of neural structures of the cochlea, as well as the clinical significance of these findings with respect to CI performance.

Various surgical approaches have been used in CI—with the 2 most common techniques being cochleostomy and RWI. In this FPCT study, RWIs were associated with shorter distances between electrodes and target neural elements, particularly in the basal portion of the electrode array. Prospective studies are needed to establish the clinical significance for both surgical insertion approaches.

This study provides imaging-based evidence supporting differences in electrode proximity to neural substrates between the RWI and cochleostomy approaches in CI insertions. Ms Jiam and Dr Limb had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Critical revision of the manuscript for important intellectual content: Conflict of Interest Disclosures: Dr Pearl reports grants from Siemens Corporate Research outside the submitted work. No other disclosures are reported. The 2 corporate funders were not involved in the design and conduct of the study; management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Sagittal and Coronal Oblique Views of the Cochlea. Example of a Digital Composite Image. Accessed January 11, National Institutes of Health; Accessed May 27, Speech perception performance as a function of age at implantation among postlingually deaf adult cochlear implant recipients. PubMed Google Scholar Crossref. Factors affecting open-set word recognition in adults with cochlear implants. Long-term asymmetric hearing affects cochlear implantation outcomes differently in adults with pre- and postlingual hearing loss.

Insertion depth in cochlear implantation and outcome in residual hearing and vestibular function. Impact of electrode insertion depth on intracochlear trauma. Otolaryngol Head Neck Surg. Electrical stimulation of the auditory nerve: Intracochlear placement of cochlear implant electrodes in soft surgery technique [in German].

Round window versus cochleostomy technique in cochlear implantation: Cochlear implantation via the round window membrane minimizes trauma to cochlear structures: Impact of electrode design and surgical approach on scalar location and cochlear implant outcomes. Radiologic results and hearing preservation with a straight narrow electrode via round window vs cochleostomy approach at initial activation. High-resolution secondary reconstructions with the use of flat panel CT in the clinical assessment of patients with cochlear implants. Tissue impedance and current flow in the implanted ear: Ann Otol Rhinol Laryngol Suppl.

Quantitative in vivo measurements of inner ear tissue resistivities. Relationship between electrode-to-modiolus distance and current levels for adults with cochlear implants. Noise susceptibility of cochlear implant users: J Assoc Res Otolaryngol. Simulating the effect of spread of excitation in cochlear implants. Psychophysics of a prototype peri-modiolar cochlear implant electrode array. Effect of peri-modiolar cochlear implant positioning on auditory nerve responses: Scalar localization by cone-beam computed tomography of cochlear implant carriers: Evaluation of a new mid-scala cochlear implant electrode using microcomputed tomography.

The new mid-scala electrode array: Evaluation of the HiFocus electrode array with positioner in human temporal bones. Angiogenesis inhibitors prevent the extensive growth of blood vessels angiogenesis that tumors require to survive. Some, such as bevacizumab , have been approved and are in clinical use.

One of the main problems with anti-angiogenesis drugs is that many factors stimulate blood vessel growth in cells normal or cancerous. Anti-angiogenesis drugs only target one factor, so the other factors continue to stimulate blood vessel growth. Other problems include route of administration , maintenance of stability and activity and targeting at the tumor vasculature. Synthetic lethality arises when a combination of deficiencies in the expression of two or more genes leads to cell death, whereas a deficiency in only one of these genes does not.

The deficiencies can arise through mutations, epigenetic alterations or inhibitors of one or both of the genes. Cancer cells are frequently deficient in a DNA repair gene. This DNA repair defect either may be due to mutation or, often, epigenetic silencing see epigenetic silencing of DNA repair. Non-tumorous cells, with the initial pathway intact, can survive.

There are five different stages of colon cancer, and these five stages all have treatment. Stage 0, is where the patient is required to undergo surgery to remove the polyp American Cancer Society [27]. Stage 1, depending on the location of the cancer in the colon and lymph nodes, the patient undergoes surgery just like Stage 0.

Stage 2 patients undergoes removing nearby lymph nodes, but depending on what the doctor says, the patent might have to undergo chemotherapy after surgery if the cancer is at higher risk of coming back. Stage 3, is where the cancer has spread all throughout the lymph nodes but not yet to other organs or body parts. The last a patient can get is Stage 4.

Stage 4 patients only undergo surgery if it is for the prevention of the cancer, along with pain relief. If the pain continues with these two options, the doctor might recommended radiation therapy. The main treatment strategy is Chemotherapy due to how aggressive the cancer becomes in this stage not only to the colon but to the lymph nodes. Although the control of the symptoms of cancer is not typically thought of as a treatment directed at the cancer, it is an important determinant of the quality of life of cancer patients, and plays an important role in the decision whether the patient is able to undergo other treatments.

Although doctors generally have the therapeutic skills to reduce pain, Chemotherapy-induced nausea and vomiting , diarrhea, hemorrhage and other common problems in cancer patients, the multidisciplinary specialty of palliative care has arisen specifically in response to the symptom control needs of this group of patients. Pain medication , such as morphine and oxycodone , and antiemetics , drugs to suppress nausea and vomiting, are very commonly used in patients with cancer-related symptoms.

Improved antiemetics such as ondansetron and analogues, as well as aprepitant have made aggressive treatments much more feasible in cancer patients. Cancer pain can be associated with continuing tissue damage due to the disease process or the treatment i. Although there is always a role for environmental factors and affective disturbances in the genesis of pain behaviors, these are not usually the predominant etiologic factors in patients with cancer pain. Some patients with severe pain associated with cancer are nearing the end of their lives, but in all cases palliative therapies should be used to control the pain.

Issues such as social stigma of using opioids , work and functional status, and health care consumption can be concerns and may need to be addressed in order for the person to feel comfortable taking the medications required to control his or her symptoms. The typical strategy for cancer pain management is to get the patient as comfortable as possible using the least amount of medications possible but opioids, surgery, and physical measures are often required.

Historically, doctors were reluctant to prescribe narcotics to terminal cancer patients due to addiction and respiratory function suppression. The palliative care movement, a more recent offshoot of the hospice movement, has engendered more widespread support for preemptive pain treatment for cancer patients. The World Health Organization also noted uncontrolled cancer pain as a worldwide problem and established a "ladder" as a guideline for how practitioners should treat pain in patients who have cancer [28].

Cancer-related fatigue is a very common problem for cancer patients, and has only recently become important enough for oncologists to suggest treatment, even though it plays a significant role in many patients' quality of life. Hospice is a group that provides care at the home of a person that has an advanced illness with a likely prognosis of less than 6 months.

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As most treatments for cancer involve significant unpleasant side effects, a patient with little realistic hope of a cure or prolonged life may choose to seek comfort care only, forgoing more radical therapies in exchange for a prolonged period of normal living. This is an especially important aspect of care for those patients whose disease is not a good candidate for other forms of treatment. In these patients, the risks related to the chemotherapy may actually be higher than the chance of responding to the treatment, making further attempts to cure the disease impossible.

Of note, patients on hospice can sometimes still get treatments such as radiation therapy if it is being used to treat symptoms, not as an attempt to cure the cancer. Clinical trials , also called research studies, test new treatments in people with cancer. The goal of this research is to find better ways to treat cancer and help cancer patients.

Treatment of cancer - Wikipedia

Clinical trials test many types of treatment such as new drugs, new approaches to surgery or radiation therapy, new combinations of treatments, or new methods such as gene therapy. A clinical trial is one of the final stages of a long and careful cancer research process. The search for new treatments begins in the laboratory, where scientists first develop and test new ideas.

If an approach seems promising, the next step may be testing a treatment in animals to see how it affects cancer in a living being and whether it has harmful effects. Of course, treatments that work well in the lab or in animals do not always work well in people. Studies are done with cancer patients to find out whether promising treatments are safe and effective.

Patients who take part may be helped personally by the treatment they receive.

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They get up-to-date care from cancer experts, and they receive either a new treatment being tested or the best available standard treatment for their cancer. At the same time, new treatments also may have unknown risks, but if a new treatment proves effective or more effective than standard treatment, study patients who receive it may be among the first to benefit. There is no guarantee that a new treatment being tested or a standard treatment will produce good results.

Treatment of cancer

In children with cancer, a survey of trials found that those enrolled in trials were on average not more likely to do better or worse than those on standard treatment; this confirms that success or failure of an experimental treatment cannot be predicted. Exosomes are lipid-covered microvesicles shed by solid tumors into bodily fluids, such as blood and urine. Current research is being done attempting to use exosomes as a detection and monitoring method for a variety of cancers. The same process can also be used to more accurately monitor a patient's treatment progress. Enzyme linked lectin specific assay or ELLSA has been proven to directly detect melanoma derived exosomes from fluid samples.

ELLSA directly measures exosome particles in complex solutions, and has already been found capable of detecting exosomes from other sources, including ovarian cancer and tuberculosis-infected macrophages. Exosomes, secreted by tumors, are also believed to be responsible for triggering programmed cell death apoptosis of immune cells; interrupting T-cell signaling required to mount an immune response; inhibiting the production of anti-cancer cytokines, and has implications in the spread of metastasis and allowing for angiogenesis.

It is believed that decreasing the tumor-secreted exosomes in a patient's bloodstream will slow down progression of the cancer while at the same time increasing the patients own immune response. Complementary and alternative medicine CAM treatments are the diverse group of medical and health care systems, practices, and products that are not part of conventional medicine and have not been shown to be effective.

Some alternative treatments which have been investigated and shown to be ineffective continue to be marketed and promoted. Mindfulness -based interventions appear to facilitate physical and emotional adjustment to life with cancer through symptom reduction, positive psychological growth, and by bringing about favourable changes in biological outcomes.

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The incidence of concurrent cancer during pregnancy has risen due to the increasing age of pregnant mothers [39] and due to the incidental discovery of maternal tumors during prenatal ultrasound examinations. In some cases a therapeutic abortion may be recommended. Radiation therapy is out of the question, and chemotherapy always poses the risk of miscarriage and congenital malformations.

Even if a drug has been tested as not crossing the placenta to reach the child, some cancer forms can harm the placenta and make the drug pass over it anyway. Diagnosis is also made more difficult, since computed tomography is infeasible because of its high radiation dose. Still, magnetic resonance imaging works normally. As a consequence of the difficulties to properly diagnose and treat cancer during pregnancy, the alternative methods are either to perform a Cesarean section when the child is viable in order to begin a more aggressive cancer treatment, or, if the cancer is malignant enough that the mother is unlikely to be able to wait that long, to perform an abortion in order to treat the cancer.

Fetal tumors are sometimes diagnosed while still in utero. Teratoma is the most common type of fetal tumor, and usually is benign. In some cases these are surgically treated while the fetus is still in the uterus. Cancer is a significant issue that is affecting the world. Specifically in the U. S, it is expected for there to be 1,, new cases of cancer, and , deaths by the end of Adequate treatment can prevent many cancer deaths but there are racial and social disparities in treatments which has a significant factor in high death rates.

Minorities are more likely to suffer from inadequate treatment while white patients are more likely to receive efficient treatments in a timely manner. It has been shown that chances of survival are significantly greater for white patients than for African American patients. The annual average mortality of patients with colorectal cancer between and was 27 and In a journal that analyzed multiple studies testing racial disparities when treating colorectal cancer found contradicting findings.

The Veterans administration and an adjuvant trial found that there were no evidence to support racial differences in treating colorectal cancer. However, two studies suggested that African American patients received less satisfactory and poor quality treatment compared to white patients. Furthermore, black patients were more likely to be diagnosed with oncologic sequelae, which is a severity of the illness in result of poorly treated cancer.

Lastly, for every 1, patients in the hospital, there were In a breast cancer journal article analyzed the disparities of breast cancer treatments in the Appalachian Mountains. African American women were found to be 3 times more likely to die compared to Asians and two times more likely to die compared to white women.

Furthermore, The National Cancer Institute panel, identified breast cancer treatments, given to black women, as inappropriate and not adequate compared to the treatment given to white women. From these studies, researchers have noted that there are definite disparities in the treatment of cancer, specifically who have access to the best treatment and can receive it in a timely manner. This eventually leads to disparities between who is dying from cancer and who is more likely to survive.

It is important to recognize these disparities because it violates the fourth and fourteenth amendments of the Constitution, which supports that everyone is entitled to equal rights and protection under the law. The cause of these disparities is generally that African Americans have less medical care coverage, insurance and access cancer centers than other races. From Wikipedia, the free encyclopedia. This article has multiple issues. Please help improve it or discuss these issues on the talk page.

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Retrieved 23 November The British Journal of Surgery. A Multidisciplinary Approach 11 ed. Journal of Controlled Release. Similarities, Differences, and Implications of Their Inhibition". American Journal of Clinical Oncology. Journal of the National Cancer Institute. Journal of Clinical Oncology. First LDT companion diagnostic test also approved to identify appropriate patients".

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