Breast and ovarian cancer account for over 30% of malignant pleural effusions (MPEs). Treatment of the metastatic disease requires control of the MPE. Even though primarily symptomatic, the treatment of the MPE can potentially affect the oncological course of the disease. The aim of this review is to analyze the effectiveness of intrathoracic chemotherapy in the treatment of MPE caused by breast and ovarian cancer. Methods: A systematic literature research was conducted up until May 2021. Studies published in English on patients undergoing either surgical or interventional intrapleural chemotherapy were included. Results: Thirteen studies with a total of 497 patients were included. Analysis was performed on 169 patients with MPE due to breast cancer and eight patients with MPE secondary to ovarian cancer. The pooled success rates of intrathoracic chemotherapy for controlling the MPE were 59.1% and 87.5%, respectively. A survival analysis was not possible with the available data. The overall toxicity of the treatment was low. Conclusions: Intrathoracic chemotherapy achieves symptomatic control of the MPE in 59.1% of patients with metastatic breast cancer and 87.5% of patients with metastatic ovarian cancer. This is inferior to other forms of surgical pleurodesis. Data from small case series and studies on intraperitoneal chemotherapy show promising results. However, formal oncological studies on the use of intrathoracic chemotherapy for metastatic breast or ovarian cancer are lacking. Further prospective pilot studies are needed to assess the therapeutic oncological effects of this treatment.
Background
A thorough knowledge of sonography is essential in clinical practice. Therefore, sonography training is increasingly incorporated into the medical school curriculum, entailing different course models. The question arises which model is most effective to convey sustained sonographic skills.
Methods
Two different peer-assisted learning (PAL) sonography course models were developed as part of a clinical prospective study. The course content was based on the national resident curriculum of the German Society for Ultrasound in Medicine (DEGUM). Model A consists of a 10-week course and model B of a two-day compact course. Each model entailed 20 teaching units (TU). A script was used to prepare for each unit. Two modified OSCE exams of the ultrasound skills (max = 50 points per exam) were performed during the last teaching unit to assess the competence level. For subjective self-assessment and model evaluation, a questionnaire with a 7-point Likert scale was employed.
Results
A total of 888 students of the 3rd year participated as part of a voluntary elective in the study (744 in model A and 144 in model B). In the exams, participants in model A (median 43 points) scored significantly higher than those in model B (median 39; p < 0.01). Participants in model A (mean 1.71 points) obtained significantly higher mean competency gain scores in subject knowledge than model B (mean 1.43 points; p < 0.01) participants. All participants were satisfied with the course concept (A: mean 1.68 vs. B: mean 1.78 points; p = 0.05), the teaching materials (A: mean 1.81 vs. B: mean 1.69 points; p = 0.52), and the tutor’s didactic skills (A: mean 1.24 vs. B: mean 1.15 points; p < 0.05).
Conclusion
These results suggest that sonography-specific competency may be obtained through different course models, with a model stretching over several weeks leading to a higher competence level. Further research should assess the long-term retention of the skills obtained in different models.
ZusammenfassungInnerhalb von 4 Jahren (2014–2017) haben wir 2 Neugeborene mit der
genetisch gesicherten Diagnose eines Kagami-Ogata-Syndroms (OMIM #608149)
betreut. Pränatal fielen bei beiden Föten ein Polyhydramnion und
in einem Fall eine Hepatomegalie auf. Beide Patienten litten postnatal unter
einer respiratorischen Insuffizienz und wiesen mit einer Muskelhypotonie, einem
vorspringenden Philtrum, vollen Wangen sowie einer breiten Nasenwurzel die
typischen phänotypischen Merkmale dieses Imprinting-Defekts auf.
Wegweisend für die Diagnosestellung waren die
kleiderbügelförmigen Rippen („coat-hanger ribs“)
und der glockenförmige Thorax (bell-shaped thorax) im
Röntgenbild. Das Kagami-Ogata-Syndrom ist auf eine Veränderung
der Genexpression auf dem Chromosom 14 zurückzuführen und wurde
erstmals im Jahr 1991 beschrieben. Als Ursachen werden eine paternale
uniparentale Disomie des Chromosoms 14 von Epimutationen sowie Mikrodeletionen
unterschieden. Bisher sind in der Literatur rund 70 Fälle beschrieben
worden. 34 Betroffene zählen zu der Kohorte der namensgebenden Forscher
M. Kagami und T. Ogata. Die Inzidenz der Erkrankung ist bis heute unbekannt. Die
Patienten zeigen oft eine verzögerte Entwicklung mit einer mentalen
Retardierung, wobei mittlerweile in der Literatur auch Kasuistiken mit milderen
Verläufen zu finden sind. 3 Kinder der Kohorte entwickelten im Verlauf
ein Hepatoblastom, sodass Schnittstellen zu anderen Imprintingdefekten wie dem
Beckwith-Wiedemann-Syndrom nach dem heutigen Stand der Wissenschaft nicht
ausgeschlossen und bei den Nachuntersuchungen berücksichtigt werden
müssen.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.