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An unusual solution to a not unusual problem
CORRESPONDENCE
aware of it in patients with or without a history of malignancy, including lung cancer, and should be considered in the differential diagnosis. N. Y. K. H. K.
HARAGUCHI YAMAMOTO SASAKI SATOH SEKIZAWA
Divisions of Respiratory Medicine and Plastic Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
References 1 Turken O, Etiz D, Orhan B, et al. Muscle metastases as initial manifestation of epidermoid carcinoma of the lung. Clin Oncol 2002;14: 129–131. 2 Baser S, Fisekci FE, Bir F, Karabulut N. Rhomboideus major metastasis as an initial clinical manifestation of pulmonary adenocarcinoma. Thorax 2004;59:728.
doi:10.1016/j.clon.2004.09.007
An Unusual Solution to a Not Unusual Problem Sir d We report a case of a child treated for acute lymphocytic leukaemia, who received total-body irradiation and cyclophosphamide before an unrelated cord blood transplant. The 7-year-old girl was initially diagnosed and treated in Romania for her disease but, on moving to England, required further treatment. This was a particular problem in view of the fact that the family spoke limited English and the child spoke no English at all. The initial consultations and
587
planning process were done with a translator present, but subsequent visits were without a translator. After an uneventful planning process, she was seen by a play specialist who helped her prepare for the radiotherapy treatment, and who attended with the patient on all radiotherapy visits. Despite all these preparations, the first treatment session was very difficult, with the patient very frightened and distressed while in the room alone. She was reassured by the radiographers on duty, but unfortunately, because of previous experiences, she remained inconsolable. Although told repeatedly (via her parents) that the procedure would not be painful, she remained convinced it would be. She was compliant and not distressed when her parents were with her, but not when they left the room to begin the radiotherapy. The initial treatment was finally carried out with difficulty, and with her mother talking via the intercom at all times. After these initial problems, a solution was sought to help reassure the patient and enable the radiotherapy to be carried out more efficiently. A red ribbon was used, and one end given to the patient. The ribbon was then unrolled around the room and maze, and the other end given to her father. The ribbon was fed under the door so as not to interfere with the door interlocks, and the radiotherapy treatment begun. Whenever the patient was anxious or needed reassurance, she pulled on the ribbon and her father pulled back. The girl was then reassured her family were nearby and she was compliant. Although this was a simple and cheap solution to the problem, it was very effective and, by the end of her treatments, the girl emerged smiling each day! We thought this was a technique that many had not thought of and that should be shared in case it was helpful to others in the future. S. J. CLENTON K. S. DUNN
Department of Radiotherapy, Weston Park Hospital, Sheffield, UK
Book Review doi:10.1016/j.clon.2004.09.001
Interventional radiology in cancer. Medical radiology: diagnostic imaging. Edited by A Adam, RF Dondevinger and PR Mueller. Springer, Berlin, 2004. Hard cover, 279 pages, Price: £107.50. ISBN 3 540 41873 3 This slim and well-produced volume in the series ‘‘Medical Radiology: Diagnostic Imaging’’ seeks to highlight the important role of interventional radiology in cancer. There is a scarcity of books on this topic and the series editors are to be congratulated on filling this particular hole in the market. The layout of each chapter follows the general pattern of the previous volumes in the Medical Radiology series and this does tend to suggest a bland uniformity about the content. However, this feeling is soon dispelled by the differing styles of the authors, drawn from the interventional radiology community on both sides of the Atlantic. The majority of the 12 chapters are an easy read, are very informative and include 162 figures (444 images) of good quality. The most important techniques used by interventional radiologists as a means of management of the commonest malignancies are covered. The evidence for each technique, where it exists, is given in the copious lists of references.
The longest chapter, 46 pages, gives an excellent review of embolisation and chemo-embolisation procedures with much useful information and pearls of wisdom for young and old interventionists alike! There are also very helpful sections on venous access, percutaneous cementoplasty, venous stents, oesophageal stents and tracheobronchial stents. The overall impact of the book was only slightly reduced by relatively disappointing chapters on biliary intervention and radiofrequency ablation. Those who feel that the future of interventional radiology is limited because of the potential loss of some aspects of vascular work should explore the ground outlined in this book. There are clearly very many aspects of intervention for cancer that require a high degree of technical expertise, both inside and outside of blood vessels. This text also indicates the high degree of clinical awareness required to apply the technique most appropriate for the individual patient. This is a good little bench book for the interventional suite and for the aspiring interventionist with a reasonable price tag. It will provide a basic understanding of the latest procedures for the noninterventionist and genuinely fulfils the editors’ ambitions. J. ROSE
aware of it in patients with or without a history of malignancy, including lung cancer, and should be considered in the differential diagnosis. N. Y. K. H. K.
HARAGUCHI YAMAMOTO SASAKI SATOH SEKIZAWA
Divisions of Respiratory Medicine and Plastic Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
References 1 Turken O, Etiz D, Orhan B, et al. Muscle metastases as initial manifestation of epidermoid carcinoma of the lung. Clin Oncol 2002;14: 129–131. 2 Baser S, Fisekci FE, Bir F, Karabulut N. Rhomboideus major metastasis as an initial clinical manifestation of pulmonary adenocarcinoma. Thorax 2004;59:728.
doi:10.1016/j.clon.2004.09.007
An Unusual Solution to a Not Unusual Problem Sir d We report a case of a child treated for acute lymphocytic leukaemia, who received total-body irradiation and cyclophosphamide before an unrelated cord blood transplant. The 7-year-old girl was initially diagnosed and treated in Romania for her disease but, on moving to England, required further treatment. This was a particular problem in view of the fact that the family spoke limited English and the child spoke no English at all. The initial consultations and
587
planning process were done with a translator present, but subsequent visits were without a translator. After an uneventful planning process, she was seen by a play specialist who helped her prepare for the radiotherapy treatment, and who attended with the patient on all radiotherapy visits. Despite all these preparations, the first treatment session was very difficult, with the patient very frightened and distressed while in the room alone. She was reassured by the radiographers on duty, but unfortunately, because of previous experiences, she remained inconsolable. Although told repeatedly (via her parents) that the procedure would not be painful, she remained convinced it would be. She was compliant and not distressed when her parents were with her, but not when they left the room to begin the radiotherapy. The initial treatment was finally carried out with difficulty, and with her mother talking via the intercom at all times. After these initial problems, a solution was sought to help reassure the patient and enable the radiotherapy to be carried out more efficiently. A red ribbon was used, and one end given to the patient. The ribbon was then unrolled around the room and maze, and the other end given to her father. The ribbon was fed under the door so as not to interfere with the door interlocks, and the radiotherapy treatment begun. Whenever the patient was anxious or needed reassurance, she pulled on the ribbon and her father pulled back. The girl was then reassured her family were nearby and she was compliant. Although this was a simple and cheap solution to the problem, it was very effective and, by the end of her treatments, the girl emerged smiling each day! We thought this was a technique that many had not thought of and that should be shared in case it was helpful to others in the future. S. J. CLENTON K. S. DUNN
Department of Radiotherapy, Weston Park Hospital, Sheffield, UK
Book Review doi:10.1016/j.clon.2004.09.001
Interventional radiology in cancer. Medical radiology: diagnostic imaging. Edited by A Adam, RF Dondevinger and PR Mueller. Springer, Berlin, 2004. Hard cover, 279 pages, Price: £107.50. ISBN 3 540 41873 3 This slim and well-produced volume in the series ‘‘Medical Radiology: Diagnostic Imaging’’ seeks to highlight the important role of interventional radiology in cancer. There is a scarcity of books on this topic and the series editors are to be congratulated on filling this particular hole in the market. The layout of each chapter follows the general pattern of the previous volumes in the Medical Radiology series and this does tend to suggest a bland uniformity about the content. However, this feeling is soon dispelled by the differing styles of the authors, drawn from the interventional radiology community on both sides of the Atlantic. The majority of the 12 chapters are an easy read, are very informative and include 162 figures (444 images) of good quality. The most important techniques used by interventional radiologists as a means of management of the commonest malignancies are covered. The evidence for each technique, where it exists, is given in the copious lists of references.
The longest chapter, 46 pages, gives an excellent review of embolisation and chemo-embolisation procedures with much useful information and pearls of wisdom for young and old interventionists alike! There are also very helpful sections on venous access, percutaneous cementoplasty, venous stents, oesophageal stents and tracheobronchial stents. The overall impact of the book was only slightly reduced by relatively disappointing chapters on biliary intervention and radiofrequency ablation. Those who feel that the future of interventional radiology is limited because of the potential loss of some aspects of vascular work should explore the ground outlined in this book. There are clearly very many aspects of intervention for cancer that require a high degree of technical expertise, both inside and outside of blood vessels. This text also indicates the high degree of clinical awareness required to apply the technique most appropriate for the individual patient. This is a good little bench book for the interventional suite and for the aspiring interventionist with a reasonable price tag. It will provide a basic understanding of the latest procedures for the noninterventionist and genuinely fulfils the editors’ ambitions. J. ROSE