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Lymphangioleiomyomatosis (LAM) is a rare lung disease predominantly affecting women, and it is characterized by the proliferation of smooth muscle cells and cystic lung destruction. LAM diagnosis is challenging due to varied clinical presentations and resemblance to common conditions such as asthma. We present two female cases where LAM was initially misdiagnosed. Case 1 describes a woman treated for asthma-chronic obstruction pulmonary disease overlap syndrome, while also undergoing treatment with vascular endothelial growth factor (VEGF) inhibitor pazopanib for a retroperitoneal leiomyoma, the latter responding well to treatment. Due to progressive dyspnea, pazopanib-induced pneumonitis was suspected. High-resolution computed tomography (HRCT) showed changes compatible with LAM. A revision of biopsies showed that the leiomyoma was in fact a lymphangioleiomyoma, and VEGF-D was increased. Both supported the LAM diagnosis. Treatment with mTORC1 inhibitor sirolimus was initiated. Case 2 describes a woman, who in resemblance with the woman from case 2 was also suspected of asthma and did not respond clinically to treatment. After several years, HRCT was performed and suspicion of LAM was raised. Transbronchial biopsy and later, an increased VEGF-D supported the LAM diagnosis. As in case 1, treatment with sirolimus was initiated. These cases underscore the importance of reevaluating diagnoses when treatments fail to yield expected results. Improved awareness and early detection of LAM can enhance patient outcomes and life quality. Early LAM diagnosis is vital as mTORC1 inhibitors such as sirolimus can prevent further decline in lung function. Notably, the response of case 2 to pazopanib treatment supports suggestions of its potential as a second-line therapy for perivascular epithelioid cell tumors (PEComas), including LAM., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kirkeby, Bendstrup and Rose.)

Purpose: Eating difficulties cause reduced food intake and poor quality of life among adolescents and young adults (AYAs) with cancer. Therefore, next-of-kin eating support is crucial. The purpose of this study was to explore the lived experiences of being close to AYAs with cancer in the context of eating when they are at home between high-emetogenic chemotherapy (HEC) sessions., Method: In-depth interviews were conducted with 12 next-of-kin to AYAs (15-29 years old) with oncological or haematological diseases, treated with HEC. Van Manen's hermeneutic-phenomenological approach guided the design., Results: The essential meaning of the next-of-kin experiences is reflected in the overarching theme "Utilizing meals as an action-opportunity" consisting of two subthemes: 'Being on constant alert' and "Walking a tightrope to maintain usual everyday life.", Conclusions: Findings revealed that utilizing meals as an action-opportunity towards AYAs' food intake involved existential feelings including fear of losing their loved ones. Next-of-kin experienced that providing support through and with food was their only avenue of action. However, this sparked feelings of frustration and powerlessness.

Purpose: The purpose of this study was to provide in-depth understanding of adolescents' and young adults' (AYAs') lived experiences of eating when they are at home between high-emetogenic chemotherapy sessions. Methods: The study was guided by van Manen's hermeneutic-phenomenological methodology. Eligible AYAs were 15-29 years old, diagnosed with either oncological or hematological cancer, treated with high-emetogenic chemotherapy, and Danish speaking. AYAs were recruited from three university hospital departments. Data were collected using semi-structured in-depth interviews. Results: Thirteen AYAs, aged 17-29 years, participated in the interviews via telephone or face-to-face in their homes. The essential meaning of the phenomenon of eating can be characterized by the overarching theme " Struggling to eat to survive " and unfolded through the following three themes: " Cooperating with a deceiving body ", " Capturing moments of eating opportunities ", and " Being loved and cared for at home ". Conclusions: Struggling to eat was essential for survival and a fundamental existential challenge that required reflection and consciousness. AYAs experienced their deceiving bodies as a major concern, which challenged their ability to eat and forced them to develop strategies to capture moments of eating opportunities. AYAs kept hold of doing "something" themselves to maintain the slightest control of their own lives and thereby assist clinical outcomes and cure. However, AYAs had to struggle with food and start viewing food as a friend, not an enemy.

Introduction: Total body irradiation (TBI) is an important treatment modality that is used in combination with chemotherapy in many stem cell transplantation protocols. Therefore, the quality of the irradiation is important. Two techniques for planning and delivering TBI are presented and compared., Methods and Materials: The technique named ExIMRT is a combination of manually shaped conventional fields from an extended SSD and isocentric IMRT fields. The technique named ExVMAT is a combination of conventional and IMRT fields from an extended SSD and isocentric VMAT fields. Dosimetric data from 32 patients who were planned and treated according to one of the two techniques were compared., Results: When comparing the two techniques, it is determined that the ExVMAT technique is able to significantly reduce the mean total volume overdosed by 120% from 408 to 12 cm 3 . The dose covering 98% of the total lung volume is significantly increased by this technique from a mean of 9.7 Gy to 10.3 Gy. Additionally, the dose covering 2% of the total kidney volume is significantly decreased from a mean of 12.8 to 12.5 Gy. Furthermore, the population-based variance of the median dose to the total lung volume, the heart and the volume of the body prescribed to 12.5 Gy is significantly reduced. The results are obtained without compromising overall treatment quality as treatment time or dose rate to the lungs., Conclusion: Using the ExVMAT technique, a superior dose distribution can be delivered both from a patient and a population perspective compared to the ExIMRT technique., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Purpose: This study explored how the phenomenon of meals appeared in the interrelationship between adolescents and young adults (AYAs) receiving high-emetogenic chemotherapy, their next of kin and health professionals in the clinical setting., Method: Data were collected by 140 h of participant observation conducted to gain insights into the nature of how meals appeared in the interrelationship between 12 AYAs (age 15-29 years), their next-of-kin and health professionals. The AYAs were patients with oncological and haematological diseases recruited from three university hospital departments. Data analysis was guided by van Manen's hermeneutic-phenomenological approach., Results: The essential meaning of the phenomenon may be characterized by the overarching theme; 'Seeking the joy of meals in the shadow of treatment' and the following three themes: 'Meals as a necessary evil' (AYAs); 'Meals as a matter of love' (next-of-kin); and 'Meals in the shadow of medical treatment' (health professionals)., Conclusions: Meals is a multi-facetted and complex phenomenon that has different meanings to AYAs, next-of-kin and health professionals. To the AYAs, meals emerged as a necessary evil in connection with which urges to eat occurred as glimpses of desire. Prominent feelings of powerlessness and food as love were highlighted by the next-of-kin, whereas food and meals appeared secondary to treatment for health professionals, reflecting the traditional biomedical paradigm. The findings revealed that adopting a holistic approach to AYAs concerning meals can have the potential to increase their food intake., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Aims: About a half of all cancer patients receive radiotherapy as part of their oncological treatment. Because of the carcinogenic effect of ionising radiation, there is a rare, but definite, risk of developing secondary malignancies, including sarcomas. The aim of this retrospective study was to describe the prevalence, patient and tumour characteristics, as well as prognosis and outcome, of patients with radiation-induced sarcomas (RIS) in a cohort of patients treated in the Sarcoma Centre at Aarhus University Hospital over a period of 34 years., Materials and Methods: All patients who fulfilled the criteria for RIS and were treated for RIS in the period 1979-2013 were included. Patient data were retrieved from the Aarhus Sarcoma Registry and the National Danish Sarcoma Database, crosschecked with the National Register of Pathology and validated using the patients' medical records. The primary end point was the effect of surgery and treatment intent on overall survival. Overall survival is reported using the Kaplan-Meier estimates and compared using the Log-rank test. Descriptive statistics are presented for patients, tumours and treatment characteristics., Results: Of 2845 patients diagnosed with sarcoma between 1979 and 2013, 64 (2%) were diagnosed with RIS. The median interval from the original malignancy was 11 years. The most common histological type was undifferentiated pleomorphic sarcoma (33%). Curative treatment was intended for 45 patients. Fifty patients underwent surgery, of whom 80% had microscopically radical resection (R0). The 5-year overall survival for the whole cohort was 32%. Patients who underwent surgery had a significantly better overall survival compared with patients who were not treated with surgery. In the univariate Cox proportional hazard analyses, no metastases at diagnosis, surgery and R0 resection were favourable prognostics factors of survival., Conclusion: This study showed that RIS patients are unique in their epidemiology and tumour characteristics. They have a poor prognosis and need special research investigating new intensive treatment strategies to improve the outcome., (Copyright © 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Background and Purpose: This study presents Danish consensus guidelines for delineation of the heart and cardiac substructures across relevant Danish Multidisciplinary Cancer Groups., Material and Methods: Consensus guidelines for the heart and cardiac substructures were reached among 15 observers representing the radiotherapy (RT) committees of four Danish Multidisciplinary Cancer Groups. The guidelines were validated on CT scans of 12 patients, each with five independent contour sets. The Sørensen-Dice similarity coefficient (DSC), the distance between the centers of the arteries and the mean surface distance were used to evaluate the inter-observer variation., Results: National guidelines for contouring the heart and cardiac substructures were achieved. The median DSC was 0.78-0.96 for the heart and the four cardiac chambers. For the four substructures of the left ventricle, the median DSC was 0.35-0.57. The coronary arteries were contoured in ten segments, with the best agreement for the left anterior descending coronary artery segments, with a median distance between the arteries ranging from 2.4-4.4 mm. The median variation was 3.7-12.8 mm for the right coronary artery segments and 3.7-6.2 mm for the left circumflex coronary artery segments, with the most pronounced inter-observer variation in the distal segment for all three coronary arteries., Conclusion: National guidelines for contouring the heart and cardiac substructures were developed across relevant Danish Multidisciplinary Cancer Groups, where RT dose to the heart is of concern. The inter-observer contour overlap was best for the heart and chambers and decreased for smaller structures., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Doege-Potter syndrome is a rare paraneoplastic syndrome, in which a solitary fibrotic tumour secretes insulin-like growth factor II leading to hypoglycaemia. In this case report, a 70-year-old woman known with a big intra-abdominal tumour was admitted to hospital, unconscious with a blood sugar of 1.8 mmol/l. She was treated with intravenous glucose until surgery, which cured her temporarily. After four months she had relapse and no effect of chemotherapy. Surgery is the only curative treatment for Doege-Potter syndrome, which is important to remember, if a patient has unexplained hypoglycaemia and a tumour.

In this case report a 73-year-old male with liver-metastatic colon cancer was admitted to hospital due to severe abdominal pain merely four days after receiving chemotherapy including epidermal growth factor receptor inhibitors. An acute computed tomography revealed gas-filled liver metastases with two possible diagnoses of either a rapid tumour response resulting in tumour necrosis or severe bacterial infection involving liver metastases. Moreover, the patient had an anaerobic infection with Clostridium septicum, and despite relevant treatment he died within 12 hours after admission.

The conventional "round" during which the individual patient is seen by the physician and his assistants, has been replaced in many psychiatric hospitals by the so-called "group round". This is the result of the efforts made by therapists to reduce the distance and "gradients" between therapists and the patients they have to look after. In this respect, therefore, the "group round" is based on the principle of collective therapy, i.e. of the therapeutic community. The present article discusses the attitude and ideology forming part of the traditional round in hospitals. The form and organisation of the "group round" as practiced for the last decade in a sociopsychiatrically oriented University hospital are described. The article goes into details of the therapeutic value and advantages of this institutionalized interaction with the patient, basing on the author's experience, while pointing out the limitations of this method and the risks involved whenever it is employed without previous consideration of its aims and possibilities.

Certain institutional and organizational prerequisites are fundamental in present-day translation into reality of essential concepts of psychiatric therapy and rehabilitation. These include, for example, the basic structure of therapeutic co-operation and the form of such co-operation as practices by a multiprofessional team. The creation and shaping of facilities based on the principle of mutual therapeutic co-operation and joint working of team members engaged in therapy, are innovations and are representative of a development by which a specific style in psychiatry gradually takes shape and by which it becomes adequately conscious of its social tasks. As with all innovatory developments there is an inherent danger that individual elements of such innovations assume of life of their own and undergo mystification. The concept "team" in psychiatry form of co-operation can solve many more problems than it can cope with. Hence it is definitely useful to investigate critically into the structure of teamwork in psychiatry, into its possibilities and prerequisites and into the extent to which teams are superior to conventional forms of organization in meeting the specific demands made by treating the mentally diseased. It becomes evident that among the basic conditions of teamwork are significant attitudes to therapy and that the therapeutic approaches derived therefrom can be successful only on teamwork basis. At the same time, however, limitations become apparent beyond which teamwork - now no longer understood as a problem-related principle of co-operation, but as an ideology - threatens to become dysfunctional and anti-therapeutic, creating compulsions which are diametrically opposed to the very essence of therapy and also to the needs of the therapist group.

Together with a general assessment of gerontopsychiatric care in the Federal Republic of Germany, the paper presents a model in hospitalised gerontopsychiatric treatment that has been tested at Hanover College of Medical Studies (Medizinische Hochschule Hanover). Results presented cover a wide range of divergent disorders, and appear to justify the employment of the model elsewhere.

In recent years, depot neuroleptics have gained in importance in the outpatient treatment of chronic schizophrenics. These neuroleptics make drug therapy safer than before, thus improving the prerequisites for socio-therapeutic and rehabilitative measures. The present study analyses the ranking and value of this kind of treatment in the management of outpatients. A random sample of 80 schizophrenics treated as outpatients, by a psychiatric university clinic working on a sectorial basis was examined for the purpose of this study. Treatment results, problems of indication, limitations of therapeutic possibilities using depot neuroleptics, as well as constellative conditions under which therapy was discontinued, are discussed.