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Feasibility of Upfront Debulking Surgery versus Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery for Advanced Ovarian Cancer

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Journal of Cancer Therapy 2018年第2期9卷 145-155页

作者： Amen Hamdy Zaky Adel Gabr doaa Wadie Maximous ahmed A. S. Salem Amr Farouk Mourad Haisam Atta Marwa Ismail Medical Oncology Department South Egypt Cancer Institute Assiut University Assiut Egypt Surgical Oncology Department South Egypt Cancer Institute Assiut University Assiut Egypt Radiadiagnosis Department South Egypt Cancer Institute Assiut University Assiut Egypt Clinical Oncology Department Faculty of Medicine Assiut University Assiut Egypt

Background: Inappropriately ovarian cancer cannot be detected until an advanced stage. Radical debulking surgery is considered the cornerstone in the management of advanced ovarian cancer pointing to complete tumor resolution. Unless optimal debulking cannot be achieved, these patients gain little benefit from surgery. Neoadjuvant chemotherapy (NACT) has been recommended as a novel therapeutic modality to a diversity of malignant tumors when the disease is not willing to optimal surgical resection at the time of diagnosis or the patient who unfit for aggressive debulking surgery. The purpose of this study is to compare survival in the patient with advanced ovarian cancer (stage III/IV) underwent primary debulking surgery followed by adjuvant chemotherapy (PDS-ACTR) to those who received neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS). Results: Neoadjuvant chemotherapy (NACT-IDS) showed significant complete cytoreduction and decreased in surgical morbidity in comparison to primary debulking surgery (PDS-ACTR). NACT-IDS showed significant improvement in progression-free survival (P-value 0.002) and overall survival (P-value 0.03) in comparison to PDS-ACTR. Response to NACT and residual volume were the two independent prognostic factors for overall survival. Conclusion: NACT-IDS for advanced ovarian cancer (III/IV) resulted in higher frequency of complete resection with no residual tumor, less post-operative surgical morbidity and significant increase progression-free survival and overall survival. Both responses to NACT and residual tumor volume were the two independent prognostic factors for survival in ovarian cancer.

关键词： Advanced Ovarian Cancer Debulking Surgery Neoadjuvant Chemotherapy

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Mental Health Care in Saudi Arabia: Past, Present and Future

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Open Journal of Psychiatry 2014年第2期4卷 113-130页

作者： Harold G. Koenig Faten Al Zaben Mohammad Gamal Sehlo doaa ahmed Khalifa Mahmoud Shaheen Al Ahwal Naseem Akhtar Qureshi Abdulhameed Abdullah Al-Habeeb Duke University Medical Center Durham USA King Abdulaziz University Jeddah KSA Ministry of Health Riyadh KSA

We review the past, present and future state of mental health care in the Kingdom of Saudi Arabia (KSA). The past is reviewed prior to the modern era, discussing early explanations and treatments for mental health illness up through the establishment of the first mental hospital in the 1950s, tracking advances in mental health care over the past 60 years. The present is explored in terms of the current need for mental health care based on the prevalence of mental health problems in KSA. We also discuss the role of the family in caring for the needs of the mentally ill today. Finally, we look forward into the future, discuss the current education system that will produce the next generation of mental health professionals, examine areas of mental health care that need improvement, and provide a research agenda to guide the continued development of the mental health care system in KSA. Our goal is to present a blue print for the development of a state-of-the-art mental health that may serve as a model for other countries in the Middle East, while taking into account the political, cultural and religious factors that are unique to this region of the world.

关键词： Mental Health Care Saudi Arabia Mental Health System Psychiatry Psychiatric Education Middle East Research

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