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Clinical Director, Frank H. Netter M.D. School of Medicine at Quinnipiac University

The most common cause of anorexia is nausea, but occasionally another underlying disease process may be responsible for gastrointestinal signs and should be considered. Some veterinarians will dispense medications for owners to have at home and use on an as-needed basis, for example the ``3-Ms' of maropitant citratee (or metoclopramide), metronidazole, and mirtazapine. Some clinicians, on the other hand, prescribe medications only at the occurrence of clinical signs. In most cases, clinical side effects of chemotherapy are self-limiting or can be managed with owner-administered medications. In some cases, they are life threatening and require hospitalization for more intensive treatment. It may be beneficial to consult a veterinary nutritionist who can formulate a diet specific to the patient. Pain in these patients may be due to the cancer itself, a treatment modality being used. Practitioners have at their disposal comprehensive sources of information on pain management. The linear accelerator is the standard device for administering radiation therapy, and functions by accelerating electrons at relativistic speeds. Goals of Radiation Therapy the goal of definitive or curative radiation therapy is eradication of all viable tumor cells within the patient. Its intent is to cure the patient whenever possible and to prolong survival as long as possible. Most palliative protocols Nutrition the nutritional status of all oncology patients should be routinely assessed beginning at diagnosis and throughout treatment. It is characterized by a distinct set of metabolic changes that are nearly impossible to reverse once they are present, although dietary modifications can slow progression. Diets should be tailored to each individual taking into account their cancer diagnosis, any other disease processes. The most important dietary consideration for canine and feline oncology patients is that the ration is palatable and eaten, otherwise it has no benefit. Providing a complete and balanced diet, whether commercially available or homemade, is imperative. A variety of diets have been used for Pet Radiation Therapy Centers Pet radiology centers are available to veterinarians who wish to refer their oncology patients for radiotherapy. In addition to other resources, the Veterinary Cancer Society provides an online list (vetcancersociety. Preoperative radiation therapy has potential advantages over postoperative radiation. These include treatment of well oxygenated tissue rather than scars, decreased tumor seeding, a smaller treatment volume, and, in some situations, less aggressive surgery. Potential disadvantages include increased wound complications and delayed surgical extirpation. The decision to do so is based on tumor location, surgeon preference, and risk of wound complication. Specifically, canine and feline lymphoma, sarcomas, and carcinomas of the nasal cavity respond favorably to radiation. Canine oral tumors, specifically acanthomatous epulis, squamous cell carcinoma, fibrosarcoma, and melanoma, respond to radiation. Canine soft tissue sarcomas, lymphoma, mast cell tumors, ceruminous gland tumors, thyroid carcinomas, bladder tumors, prostate tumors, perianal adenomas, and apocrine gland anal sac adenocarcinomas also respond to radiation, as does localized lymphoma. Factors affecting acute response to radiation in normal tissue include total dose, overall treatment time (dose intensity), and volume of tissue irradiated. Acute effects in healthy tissue are to be expected and will occur if curative doses are administered, but will resolve with time and supportive care.

In one small study of untreated patients, progression of tumor was observed in all, with almost a doubling of tumor mass after 1 yr, although there were individuals with disseminated disease who experienced prolonged survival (10, 518). Treatment directed against the hepatic metastases is either surgical (selective segmental liver resection, liver transplantation, and ablative therapy) or medical (vascular intervention leading to ischemia of the area occupied by the tumor) (10, 517, 518). Ischemia can be achieved by several techniques directed to the hepatic Downloaded from academic. Because of their slow tumor growth and often incapacitating symptoms related to tumor bulk and hormone production, solitary metastases or multiple lesions confined to one lobe can be surgically resected, aiming either at cure or at removal of at least 90% of tumor burden (516, 517, 519, 520). The location and removal of the primary tumor before hepatic resection also contributed to improved survival (517). The introduction of more specific local ablation techniques, which achieve tumor destruction in situ, has widened the possibilities for treating liver metastases and has potentially extended the indications for surgery. Several ablative techniques are currently used, including ethanol injections (520); cryosurgery, where tumor cells are killed after injection of liquid nitrogen (196 C) (522); or radiofrequency ablation, a slow wave diathermy technique that destroys tumor cells by protein coagulation caused by heat (520). Hepatic radioembolization has also been tried, although in a limited number of patients (523). All of these techniques, while promising, still need to be tested prospectively in a large group of patients. Currently, only a small number of retrospective reviews provide some indirect evidence suggesting that surgical resection of hepatic metastases may prolong survival in selected cases, although this is rarely curative (406, 516, 517). Invasive medical therapy of hepatic metastases (hepatic artery embolization-chemoembolization). Selective embolization of the hepatic arteries causes a temporary but complete ischemia (10, 524), with objective symptomatic and hormonal responses of 65 and 81%, respectively (525). Chemoembolization is embolization combined with liver-targeted intraarterial administration of chemotherapy; initially, small particles of iodized oil containing a chemotherapeutic agent are injected and, to obliterate peripheral arterial branches, are followed by sponge particles to embolize larger proximal feeding tumor arteries (10, 515). Contraindications include complete portal vein obstruction and hepatic insufficiency (515, 526). Chemoembolization is more efficient if the bulk of tumor mass, and particularly the primary tumor, has been resected (532). The side effects of the procedure are usually mild and transient and mainly constitute the postembolization syndrome (nausea, vomiting, abdominal pain, fever up to 37. However, when they do occur they can be life threatening, and we would advise that the procedure is only carried out in major centers with the relevant experience and expertise (534). External radiotherapy has occasionally been attempted for locally unresectable carcinoid and pancreatic islet cell carcinomas. Although a few cases showing substantial tumor regression have been described (464, 535), there is no evidence of the effect of such therapy, which is mainly used for palliation of metastatic disease. The use of this therapy can be considered either early in an adjuvant setting, after surgery to eradicate occult disease, or later for treatment of disseminated disease (538). Most of the patients treated so far had no other therapeutic options or were refractory to conventional treatment strategies, with only a few prospective trials incorporating treatment-naive patients. Since then, the results of treatment in another 30 patients were reported demonstrating a 60% symptomatic response, but a hormonal response of only 12. Severe myelosuppression is mainly seen in patients with widespread bone metastases and diffuse bone marrow involvement, and in patients heavily pretreated with chemotherapy (347, 546). Transient hepatic failure, presumably secondary to widespread hepatic lesion necrosis, has also been described (79, 547). Of these 21 patients, six showed an antiproliferative effect demonstrated as shrinkage of the tumor, whereas in another eight patients there was stabilization of disease; there was a tendency toward better results in patients with high tumor uptake (83). In 27 additional patients treated with two doses of 111In pentetreotide, an objective partial response occurred in two (8%), whereas significant tumor necrosis occurred in seven (27%) patients without any major side effect; the median survival was 18 months, compared with 6 months expected (550). However, in recent studies it was shown that the response may not be sustained in time, probably due to the preferential survival of resistant clones (551, 552), and that its efficacy in large tumors and end-stage patients is limited (551, 552). Therefore, it was suggested that 111Inpentetreotide should be given either in combination with -emitters or to eradicate micrometastases (553). Radionuclides emitting -radiation have greater therapeutic potential because the particles they emit have sufficient energy to cause cell damage, and they deliver higher radiation doses in a larger part of the tumor without penetrating very far into surrounding tissue (54, 83, 554). Concomitant iv administration of amino acids reduces renal radioactivity uptake without altering tumor uptake (73, 554, 555). Thirty-nine patients with a variety of tumors received OctreoTher in an escalating dosage with minor toxicity, whereas the objective response rate (complete Kaltsas et al. The top panel shows uptake in the mediastinum and left shoulder; the middle and lower panels show metastases in the pelvis, femur, spine, and ribs.

Enthalpy (H) Enthalpy (H): A measure of the potential energy of a system found in intermolecular attractions and chemical bonds. Pressure, density, temp, volume, enthalpy, internal energy, Gibbs free energy, and entropy. Fusion: Solid liquid Freezing: Liquid solid Vaporization: Liquid gas Sublimation: Solid gas Deposition: Gas solid Triple Point: Point in phase diagram where all 3 phases exist. Supercritical Fluid: Density of gas = density of liquid, no distinction between those two phases. Entropy (S) Entropy (S): A measure of the degree to which energy has been spread throughout a system or between a system and its surroundings. General Chemistry 8: the Gas Phase Ideal Gases Ideal Gas: Theoretical gas whose molecules occupy negligible space and whose collisions are perfectly elastic. Includes H2, N2, O2, F2, Cl2, Br2, and I2 Mnemonic: "Have No Fear Of Ice Cold Beer" the 7 Diatomic Gases 8 General Chemistry 9: Solutions Terminology Solution: Homogenous mixture. Most Dissolution: dissolutions are endothermic, although dissolution of gas into liquid is exothermic. Solubility: Maximum amount of solute that can be dissolved in a solvent at a given temp. Solubility in Water: Polar molecules (with +/- charge) are attracted to water molecules and are hydrophilic. Colligative Properties: Physical properties of solutions that depend on the concentration of dissolved particles but not on their chemical identity. Solutions Equilibria Saturated solutions are in equilibrium at that particular temperature. Boiling Point Elevation: I = I = ionizationfactor I = boilingpointdepressionconstant - = molalconcentration Freezing Point Depression: The presence of that ion shifts the dissolution reaction to the left, decreasing its dissociation. Titrations Half-Equivalence Point: the midpoint of the buffering region, in which half the (midpoint) titrant has been protonated or deprotonated. Equivalence Point: the point at which equivalent amounts of acid and base have reacted. Titrations: p) = -log) p, = -log(,) Titration Setup Burette p) + p, = p" = 14 Conjugate Acid/Base Pairs: Strong acids & bases / weak conjugate Weak acids & bases / weak conjugate Neutralization Reactions: Form salts and (sometimes) H2O Analyte / Titrand (weak base in this example) Titrant (strong acid in this example) Conical flask Buffers Buffer: Weak acid + conjugate salt Weak base + conjugate salt Buffering Capacity: the ability of a buffer to resist changes in pH. No indicator is used, and the equivalence point is determined by a sharp change in voltage 11 General Chemistry 12: Electrochemistry Galvanic Cell Electrolytic Cell Electrochemical Cells Anode: Always the site of oxidation. It is the concentration gradient between the two solutions that causes mvmt of charge. Rechargeable Can experience charging (electrolytic) and discharging Batteries: (galvanic) states. Lead-Acid: Discharging: Pb anode, PbO2 cathode in a concentrated sulfuric acid solution. Standard Electromotive Force: the difference in standard reduction potential between the two half-cells. Step 2: Number the chain in such a way that the highest-priority functional group receives the lowest possible number. Step 4: Assign a number to each substituent depending on the carbon to which it is bonded. Step 5: Alphabetize substituents and separate numbers from each other by commas and from words by hyphens.

If many factors influence your chance of having a disease, it is called a multifactorial disease. When two different sets of data change together, there may be a link, which is called a correlation. For example, mortality data from a disease such as atherosclerosis may change in a similar pattern to a lifestyle factor such as smoking or lack of exercise. They could both be caused by something else which would explain why they change in the same way. In most areas of the world, the risk of dying from heart disease is about three times greater for smokers than for non-smokers. Explain why this does not mean that an individual person who smokes will die from heart disease. The risks of developing diabetes and heart disease linked to obesity are well known. Suggest any other information you might need to make accurate comparisons between the causes of disease in the two countries. Everywhere you look, on television, in newspapers and on the internet, there are reports of factors which affect your health. There are many ways in which you can evaluate the design of studies to decide if the data are meaningful. That means that it is properly designed to answer the question or questions being asked. It is also important to know who carried out the research, who funded it and where it was published. Then to decide whether or not any of these factors might have affected or biased the study. You need to evaluate the data and conclusions from the study in the light of all these factors. The ideal is to investigate one factor or variable, keeping all other variables the same (controlled). However, controlling variables is almost impossible when you are working with human beings. The way people live is complex and varies a lot, so it is hard to detect how any one factor affects people. When a larger number of people are studied, it is more likely that patterns may emerge, even with all the other differences between the people involved. Evidence based on large amounts of data is more likely to be statistically significant than evidence based on small studies. These longitudinal studies are very valuable because they follow the same group of individuals over many years (see fig A). This means the impact of their known lifestyle on their health can be tracked over time. The results from this study are still seen as important because so many people were involved over a long period of time. One major objective of the study is to examine how environmental inputs and genetic factors interact to affect the health and development of children. Sometimes, scientists look at all the available studies in a subject area and analyse the available data in a massive literature study. Valid: answers the question the scientists are asking Precise: measurements with little difference between them Reliable: the investigation is repeatable by other scientists who get similar results They are important in evaluating all practical work and research. In each case, you need to look carefully at the type of evidence that is presented and think about what else you need to know to make firm conclusions.