A Clinician-Free Method Using Top-View Photography for Screening and Monitoring Hallux Valgus

2021 ◽  
Vol 111 (5) ◽  
Author(s):  
Daniel T.P. Fong ◽  
Marabelle Li-wen Heng ◽  
Jing Wen Pan ◽  
Yi Yan Lim ◽  
Pei-Yueng Lee ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Intraclass Correlation ◽  
Self Assessment ◽  
Digital Photograph ◽  
Receiver Operating Characteristic Curves ◽  
Novel Method ◽  
Grade 3 ◽  
Straight Lines ◽  
Top View ◽  
Severe Grade

Background Hallux valgus is a progressive foot deformity that commonly affects middle-aged women. The aim of this study was to develop a novel method using only top-view photographs to assess hallux valgus severity. Methods A top-view digital photograph was taken of each foot of 70 female participants. Two straight lines were drawn along the medial edge of the great toe and forefoot, and the included angle (termed bunion angle) was measured using a free software program. Each foot was also assessed by a clinician using the Manchester scale as no (grade 1), mild (grade 2), moderate (grade 3), or severe (grade 4) deformity. Results The mean bunion angles of the 140 feet were 6.7°, 13.5°, and 16.2° for Manchester grades 1, 2, and 3, respectively (no foot was in grade 4). The reliability was excellent for both intrarater (intraclass correlation coefficient [ICC] = 0.93–0.95) and interrater (ICC = 0.90) assessments. Receiver operating characteristic curves determined the optimal bunion angle cutoff value for screening hallux valgus to be 9°, which gives 89.2% sensitivity and 74.2% specificity. Conclusions The bunion angle is a reliable, clinician-free method that can potentially be integrated into a smartphone app for easy and inexpensive self-assessment of hallux valgus.

scholarly journals Mapping intended spinal site of care from the upright to prone position: an interexaminer reliability study

2014 ◽  
Vol 22 (1) ◽  
Author(s):  
Robert Cooperstein ◽  
Morgan Young
Keyword(s):  
Prone Position ◽  
Mean Squared Error ◽  
Thought Experiment ◽  
Spinous Process ◽  
Intraclass Correlation ◽  
Manual Muscle Testing ◽  
Muscle Testing ◽  
Interexaminer Reliability ◽  
Novel Method ◽  
The Mean

Abstract Background Upright examination procedures like radiology, thermography, manual muscle testing, and spinal motion palpation may lead to spinal interventions with the patient prone. The reliability and accuracy of mapping upright examination findings to the prone position is unknown. This study had 2 primary goals: (1) investigate how erroneous spine-scapular landmark associations may lead to errors in treating and charting spine levels; and (2) study the interexaminer reliability of a novel method for mapping upright spinal sites to the prone position. Methods Experiment 1 was a thought experiment exploring the consequences of depending on the erroneous landmark association of the inferior scapular tip with the T7 spinous process upright and T6 spinous process prone (relatively recent studies suggest these levels are T8 and T9, respectively). This allowed deduction of targeting and charting errors. In experiment 2, 10 examiners (2 experienced, 8 novice) used an index finger to maintain contact with a mid-thoracic spinous process as each of 2 participants slowly moved from the upright to the prone position. Interexaminer reliability was assessed by computing Intraclass Correlation Coefficient, standard error of the mean, root mean squared error, and the absolute value of the mean difference for each examiner from the 10 examiner mean for each of the 2 participants. Results The thought experiment suggesting that using the (inaccurate) scapular tip landmark rule would result in a 3 level targeting and charting error when radiological findings are mapped to the prone position. Physical upright exam procedures like motion palpation would result in a 2 level targeting error for intervention, and a 3 level error for charting. The reliability experiment showed examiners accurately maintained contact with the same thoracic spinous process as the participant went from upright to prone, ICC (2,1) = 0.83. Conclusions As manual therapists, the authors have emphasized how targeting errors may impact upon manual care of the spine. Practitioners in other fields that need to accurately locate spinal levels, such as acupuncture and anesthesiology, would also be expected to draw important conclusions from these findings.

scholarly journals Para-Aortic Nodal Radiation in the Definitive Management of Node-Positive Cervical Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Jason C. Sanders ◽  
Donald A. Muller ◽  
Sunil W. Dutta ◽  
Taylor J. Corriher ◽  
Kari L. Ring ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Chi Square ◽  
Node Positive ◽  
Significant Difference ◽  
Grade 3 ◽  
Severe Grade

ObjectivesTo investigate the safety and outcomes of elective para-aortic (PA) nodal irradiation utilizing modern treatment techniques for patients with node positive cervical cancer.MethodsPatients with pelvic lymph node positive cervical cancer who received radiation were included. All patients received radiation therapy (RT) to either a traditional pelvic field or an extended field to electively cover the PA nodes. Factors associated with survival were identified using a Cox proportional hazards model, and toxicities between groups were compared with a chi-square test.Results96 patients were identified with a mean follow up of 40 months. The incidence of acute grade ≥ 2 toxicity was 31% in the elective PA nodal RT group and 15% in the pelvic field group (Chi-square p = 0.067. There was no significant difference in rates of grade ≥ 3 acute or late toxicities between the two groups (p>0.05). The KM estimated 5-year OS was not statistically different for those receiving elective PA nodal irradiation compared to a pelvic only field, 54% vs. 73% respectively (log-rank p = 0.11).ConclusionsElective PA nodal RT can safely be delivered utilizing modern planning techniques without a significant increase in severe (grade ≥ 3) acute or late toxicities, at the cost of a possible small increase in non-severe (grade 2) acute toxicities. In this series there was no survival benefit observed with the receipt of elective PA nodal RT, however, this benefit may have been obscured by the higher risk features of this population. While prospective randomized trials utilizing a risk adapted approach to elective PA nodal coverage are the only way to fully evaluate the benefit of elective PA nodal coverage, these trials are unlikely to be performed and instead we must rely on interpretation of results of risk adapted approaches like those used in ongoing clinical trials and retrospective data.

scholarly journals A Case-control Study of 3D versus 2D Weight Bearing CT Measurements of the M1-M2 Intermetatarsal Angle in Hallux Valgus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0032
Author(s):  
Francois Lintz ◽  
Arne Burssens ◽  
Alesio Bernasconi ◽  
Martin O’Malley ◽  
Rémi Raclot ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Intraclass Correlation ◽  
Intraobserver Reliability ◽  
3D Images ◽  
Intermetatarsal Angle ◽  
Mean Values ◽  
3D Measurements ◽  
2D And 3D ◽  
2D Images

Category: Midfoot/Forefoot Introduction/Purpose: Surgical planning based on angular measurements obtained on conventional radiographs is challenging due to perspective distortion and operator bias. Novel weightbearing CT (WBCT) three-dimensional (3D) measurements using coordinate systems may represent a more reliable and accurate evaluation of this 3D deformity. The objective of this study was to compare the M1-M2 intermetatarsal angle (IMA) obtained manually on WBCT digitally reconstructed 2D radiographs versus a set of coordinates from the full 3D dataset, in patients with hallux valgus (HV) deformity and in healthy controls. We hypothesised that the 3D measurements would be more reliably obtained, demonstrating different values when compared to 2D radiographic measurements. Methods: In this multicenter retrospective comparative study, 83 feet that underwent WBCT of the foot were included (41 HV: mean age 59, 81% female, 42 controls: mean age 52, 80% female). Datasets were analysed by three independent trained foot and ankle surgeons using the same protocol. Coordinates in three planes (x, y, z) of four different landmark points were harvested: center of the heads and midpoint of the proximal metaphysis of the 1st and 2nd metatarsal. The IMA measurements were then performed in reconstructed radiographic images (DRR-IMA). The data collected was then analyzed by a single 4th independent and blinded investigator who calculated the 3D angle (3D-IMA) and its projection on the weightbearing plane (2D-IMA). Intra-observer realiability was assessed by Pearson/Spearman’s correlation. Intermethod correlation was evaluated by intraclass correlation coefficient (ICC). Mean values for measures were comparared by One-way ANOVA. P-values of less than 0.05 were considered significant. Results: Intraobserver reliability was excellent for radiographic DRR-IMA (0.95) and 3D coordinates assessment (0.99). Intermethod correlation between the three different imaging modalities (DDR, 2D and 3D), considering bias and interactions, were respectively 0.71 and 0.51 in control and HV patients. IMA measurements were found to be similar when measured in DRR, 2D and 3D WBCT images, for both controls and HV patients. Mean values and confidence intervals (CI) for controls were 8.8 degrees (CI, 7.9-9.7) in DDR images, 9.8 degrees (CI, 8.7-10.9) in 2D images and 10.6 degrees (CI, 9.5-11.8) in 3D images. When compared to controls, HV patients demonstraded significantly increased IMA (p<0.05): 13.06 degrees (CI, 11.8-14.3) in DDR images, 12.1 degrees (CI, 10.8-13.3) in 2D images and 13.3 degrees (CI, 12.3-14.3) in 3D images. Conclusion: We found that similar values for IMA were measured in 2D reconstructed radiographs, WBCT 3D and 2D projected images. When compared to controls, HV patients were found to have increased IMA in all three different imaging types used (DDR, 2D and 3D). Intermethod correlation was higher for IMA performed in controls. Intraobserver reliability was excellent for both radiographic IMA measurements and WBCT 3D coordinates. Our study is the first study to evaluate measurements of the 3D-IMA in HV and control patients. Further investigations are required before guidelines for its clinical use can be formulated.

Radiographic Angles in Hallux Valgus: Differences Between Measurements Made Manually and With a Computerized Program

2006 ◽  
Vol 27 (3) ◽  
pp. 175-180 ◽  
Author(s):  
Carlos Piqué-Vidal ◽  
Ignaci Maled-García ◽  
Juanjo Arabi-Moreno ◽  
Joan Vila
Keyword(s):  
Hallux Valgus ◽  
Measurement Techniques ◽  
Intraclass Correlation ◽  
Intermetatarsal Angle ◽  
Mean Values ◽  
Angle Measurements ◽  
Valgus Angle ◽  
Angular Measurements ◽  
San Rafael ◽  
True Values

Background: The objective of this study was to compare angular measurements in the evaluation of hallux valgus deformities using a goniometer and a computerized program to assess degree of concordance between the two methods and determine the reliability of manual measurements. Methods: Angles measured included the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA), and the proximal phalangeal articular angle (PPAA), also called the hallux valgus interphalangeus angle or interphalangeal angle. Measurements were made on preoperative weightbearing radiographs in 176 patients with symptomatic hallux valgus. Manual measurements were made with a goniometer by an orthopaedic surgeon. An independent experienced technician used digitized images to perform angular measurements with the Autocad® software program (Autodesk Inc., San Rafael, CA). Results: HVA values obtained with the two techniques were similar. However, significantly higher mean values were obtained with the Autocad® for the IMA and PPAA measurements, and higher mean values were obtained for the DMAA measurement with the manual technique. Whereas differences were more or less randomly distributed for the HVA, in the remaining patients, measurements were clearly related to the measurement technique, i.e., for the DMAA, the manual technique had a tendency to show higher values, and for the IMA and PPAA the manual technique showed lower values than the computer. Correlations between both techniques for the different angular measurements were as follows: HVA, −0.179 ( p = 0.018); DMMA, −0.294 ( p >0.001); PPAA, −0.876 ( p >0.001); and IMA, −0.661 ( p >0.001). The intraclass correlation coefficient (ICC) showed that the concordance between manual and Autocad® angular measurements was excellent for the HVA ( ICC = 0.89) and DMAA ( ICC = 0.80) and very poor for the PPAA ( ICC = 0.11) and IMA ( ICC = 0.42). Conclusions: Angular measurements made on weightbearing radiographs with the Autocad® in patients with hallux valgus deformities were more reliable than those made with a goniometer. Although for large angles, such as HVA and DMAA, results obtained with both measurement techniques were similar. Manual measurements, however, may underestimate the true values of the smaller IMA and PPAA angles.

scholarly journals EPID-07. HEMATOLOGICAL ADVERSE EVENTS IN GLIOBLASTOMA PATIENTS TREATED WITH TEMOZOLOMIDE

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi75-vi76
Author(s):  
Catherine Garcia ◽  
Zin Myint ◽  
Rani Jayswal ◽  
Allison Butts ◽  
Heidi Weiss ◽  
...  
Keyword(s):  
Overall Survival ◽  
Adverse Events ◽  
Protective Factor ◽  
Significant Proportion ◽  
Progression Free Survival ◽  
Free Survival ◽  
Significant Difference ◽  
History Of ◽  
Grade 3 ◽  
Severe Grade

Abstract BACKGROUND Temozolomide (TMZ) is the cornerstone for glioblastoma (GBM) treatment. A significant proportion of patients develops hematologic toxicities with limited investigations on outcomes and risk factors for their development. METHODS Our study combines data from the two largest group trials, RTOG 0525 and RTOG 0825, to analyze serious hematologic adverse events (HAE) associated with TMZ therapy for GBM. We analyzed frequency and outcomes of HAE during chemoradiation. RESULTS 1154 patients were evaluated with a median age of 57 years. Over 79% of patients developed HAE during the entire course of GBM treatment. During chemoradiation the most common HAE during chemoradiation was lymphopenia (41.5%), followed by thrombocytopenia (39.0%), and anemia (35.3%). Of these, 34.1% were severe (Grade 3 or 4) and 65.9% were mild (grade 1 or 2). During maintenance the most common HAE was leukopenia (50.7%), followed by neutropenia (50.4%), and lymphopenia (45.3%). MGMT methylation was not associated with HAEs. A history of HAEs during chemoradiation was a protective factor for developing HAEs during maintenance. MGMT methylated and age younger than 50 were protective factors for mortality. Patients that presented HAEs anytime during treatment had a longer overall survival and progression free survival. There was no significant difference in survival between mild or severe HAEs. CONCLUSION HAE are common during chemoradiation with TMZ for GBM, but are more commonly grade 1 or 2 per CTCAE. HAE during GBM treatment is associated with decreased progression free survival and overall survival.

Impact of Cyclosporine a (CsA) Concentration on the Incidence of Severe Acute Graft-Versus-Host Disease (GVHD) after Allogeneic Stem Cell Transplantation (allo-SCT).

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1150-1150
Author(s):  
Florent Mallard ◽  
Eolia Brissot ◽  
Patrice Chevallier ◽  
Thierry Guillaume ◽  
Jacques Delaunay ◽  
...  
Keyword(s):  
Stem Cell ◽  
Blood Concentration ◽  
Acute Gvhd ◽  
Conditioning Regimen ◽  
Solid Organ ◽  
Stem Cell Source ◽  
Cell Source ◽  
Trough Blood ◽  
Grade 3 ◽  
Severe Grade

Abstract CsA is widely used as the backbone immunosuppressive agent for GVHD prevention after allo-SCT. Previous studies have demonstrated that the immunosuppressive effects of CsA (eg. inhibition of calcineurine in lymphocytes) may be correlated with CsA blood concentration, especially in the context of solid organ transplantation. This report aimed to investigate the impact of CsA concentrations in the early post allo- SCT period, on the incidence of severe acute GVHD, in 85 consecutive patients treated in a single centre between Jan. 2006 and Jan. 2008, and for whom CsA concentrations in the blood were monitored weekly after the start of infusion. 85 patients (45 males) received CsA (usually at 3 mg/Kg/d, 2 or 3 days prior to graft infusion) as a 24-h continuous infusion until hematopoietic recovery and switch to oral formulation. Dose modifications of CsA were performed to maintain adequate trough blood levels and to prevent nephrotoxicity. Patients’ and donors characteristics were as follow: median age: 51 (range, 18–67), 46 (54%) female donors, 33 (39%) myeloid malignancies, 49 (58%) lymphoid malignancies, and 3 cases of SAA. The stem cell source was PBSC in 66 (78%) patients, while bone marrow was used in 19 (22%) patients. 37 (43.5%) were transplanted from a matched related donor, and 48 (56.5%) from a matched unrelated donor. A myeloablative conditioning regimen was used in 24 (28%) patients, and 61 (72%) received a reduced intensity regimen. The median concentrations of CsA in the blood at 1, 2, 3 and 4 weeks after allo-SCT were 348 (range, 172–733), 284 (range, 137–535), 274 (range, 107–649), and 247 (37–695) ng/mL respectively. All patients engrafted at a median of 17 (range, 0–42) days after allo-SCT. With a median follow-up of 16 (range, 5–29) months, grade 2–4 acute GVHD occurred in 36 patients (42%) at a median of 29 (range, 6–100) days after allo-SCT. The incidence of severe grade 3–4 acute GVHD was 23% (95%CI, 14–32%). In this cohort, all acute GVHD risk factors (age, donor-recipient gender, CMV serostatus, ABO compatibility, diagnosis, disease status, stem cell source, donor type, conditioning regimen type, GVHD prophylaxis regimen, CsA concentrations) were assessed. In multivariate analysis, we found that higher whole-blood CsA concentration in the first week following graft infusion, and before onset of acute GVHD was the strongest parameter significantly associated with a reduced the risk of severe grade 3–4 acute GVHD (P=0.01; RR=0.24; 95%CI, 0.08–0.73). Despite its retrospective nature, these data strongly indicate a close relationship between CsA trough blood concentration during the early post allo-SCT period and the severity of acute GVHD. Inadequate or insufficient early exposures of CsA can be a serious risk for developing severe acute GVHD. Therefore, precise monitoring of CsA concentrations and achievement of a high CsA target concentration may be an effective tool to prevent the onset of severe acute GVHD.

Preventive approach of allergic reaction to oxaliplatin

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 13574-13574
Author(s):  
M. Suenaga ◽  
N. Mizunuma ◽  
T. Watanabe ◽  
K. Hatake ◽  
T. Muto
Keyword(s):  
Adverse Events ◽  
Allergic Reaction ◽  
Type I ◽  
Allergic Reactions ◽  
Platinum Compound ◽  
Rapid Infusion ◽  
Preventive Approach ◽  
Grade 3 ◽  
Antihistaminic Drugs ◽  
Severe Grade

13574 Background: Oxaliplatin is a well-known platinum compound as a key agent of FOLFOX regimen, the world standard chemotherapy in colorectal cancer. Allergic reaction due to oxaliplatin is a chronic adverse event regarded as almost type I allergy. In our institute, we have also experienced allergic reaction including severe cases and started to apply practical preventive approach to the patients treated with FOLFOX regimens. Methods: Preventive approach was as follows: 40mg of famotidine and 8mg of dexamethasone before oxaliplatin infusion were given to all patients from the initial cycle and 50mg of diphenhydramine after cycle 4. Further intensive anti-allergic procedure was performed for the patients who showed any allergic reactions against initial preventive approach. Increased dose of dexamethasone to 20mg and diphenhydramine were administered before oxaliplatin infusion and oxaliplatin was prolonged from 2 up to 4 hours for patients with grade 1, 2 allergic reactions (CTCAE v3.0). Treatment was discontinued in patients with severe grade 3 adverse events. Results: 139 patients received FOLFOX regimens during 6 months. 15 patients (10.8%) presented with allergic reaction, 11 (73.3%) of those were grade 1, 2 and the other 4 (26.7%) were grade 3. Immediate discontinuation of oxaliplatin infusion and administration of antihistaminic drugs, steroid or rapid infusion were routine proceeding, and almost of the patients entirely recovered within 2 hours. 9 patients were re-exposed to oxaliplatin using the preventive approach and grade1 reaction appeared in 3 patients (33.3%) again. Conclusions: Our initial preventive approach was effective to reduce the incidence of allergy, severe adverse events. And further intensive anti-allergic procedure contributed to re-expose to oxaliplatin. No significant financial relationships to disclose.

Cetuximab use without chronic antihistamine premedication

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 13521-13521 ◽  
Author(s):  
J. Timoney ◽  
K. Y. Chung ◽  
V. Park ◽  
R. Trocola ◽  
C. Peake ◽  
...  
Keyword(s):  
Side Effects ◽  
Cancer Center ◽  
First Year ◽  
Institutional Practice ◽  
Chemotherapy Administration ◽  
Time Period ◽  
Life Threatening ◽  
Anaphylactoid Reactions ◽  
Grade 3 ◽  
Severe Grade

13521 Background: Cetuximab is a human-murine chimeric monoclonal antibody against EGFR with approximately a 3% reported incidence of severe (≥ grade 3) anaphylactoid reactions. The overwhelming majority of such reactions have been reported with the initial dose of cetuximab. Diphenhydramine (Benedryl)or a related antihistamine is often given as a premedication for cetuximab, however this may cause fatigue or other side effects. Most early clinical trials of cetuximab permitted investigator discretion in use of premedication beyond the initial cetuximab dose. Methods: We obtained an IRB waiver of authorization to review the records of patients treated with cetuximab at Memorial Sloan Kettering Cancer Center for the first year of commercial availability of cetuximb (Feb, 2004 through Feb, 2005). Computerized pharmacy records were reviewed to identify all patients who were treated with cetuximab (outside of a clinical trial) and use of premedication was then evaluated. Records of institutional adverse event reports regarding chemotherapy administration were reviewed, and, any moderate or severe/life-threatening reactions were evaluated for presence or absence of concurrent premedication. Results: As per our institutional guidelines, all patients received 50 mg of diphenhydramine prior to the initial loading dose of cetuximab, and 25 mg of diphenhydramine prior to the second dose. While there was inconsistency in terms of cessation of diphenhydramine, overall a total of 115 patients received one or more doses of cetuximab without premedication. A total of 746 doses of cetuxmab without diphenhydramine premedication were given over this time period. No severe/life-threatening reactions to cetuximab occurred during these doses given without premedication. Conclusions: Omission of diphenhydramine premedication after the initial two doses of cetuximab is our current institutional practice, and appears not to alter the safety profile of cetuximab. Considering the side effects of diphenhydramine, routine long tern use of antihistamine premedication with cetuximab administration does not appear to be warranted. [Table: see text]

Celiac disease and chemotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19561-19561
Author(s):  
S. I. Robinson ◽  
J. Murray ◽  
R. R. McWilliams
Keyword(s):  
Celiac Disease ◽  
Retrospective Chart Review ◽  
Uterine Sarcoma ◽  
Gluten Free Diet ◽  
Common Side Effect ◽  
Gluten Free ◽  
Severe Diarrhea ◽  
High Incidence ◽  
Grade 3 ◽  
Severe Grade

19561 Background: Diarrhea is a common side effect of chemotherapy (CT). At times, often unpredictably, patients develop profound diarrhea during CT. Though the clinical diagnosis of celiac disease (CD) is relatively rare, (1/ 2000), the serologic prevalence is much higher (1/ 133), suggesting a large number of undiagnosed cases. Latent CD may be unmasked by stressors, such as CT. We hypothesized that undiagnosed CD may account for some cases of severe diarrhea from CT. Methods: We performed a retrospective chart review at the Mayo Clinic (1980–2006) for patients with diagnoses of cancer and CD that received CT at our center. CD cases were confirmed by biopsy (n= 25) or serologic studies. Data analyzed included severe (grade ≥ 3,) diarrhea while on CT, site of primary cancer, diagnosis of CD prior to or after CT, and specific CT agents received. Results: We identified 27 patients with CD and cancer (12 lymphoma, 6 gastrointestinal, 2 leukemia, 2 breast, 1 brain, bladder, lung, uterine, sarcoma) who received CT at our center. Fifteen were diagnosed with CD prior to receiving CT and 12 after, with the former group presumably on a gluten-free diet. One patient was excluded for lack of clinical data. Five of remaining 14 patients (35%) managed for their CD prior to CT had diarrhea, though 4 of these 5 had only mild diarrhea (gr. 1). One patient suffered gr. 3 diarrhea, though was reported to be poorly compliant with his diet. Three patients received treatment with 5- fluorouracil (5FU), and 2 had gr. 1 diarrhea. Five of the 12 patients (42%) with celiac disease undiagnosed prior to CT were reported to have diarrhea during treatment (3 gr. 4; 2 gr. 1). Of those receiving 5FU, 3 out of 4 had severe (gr. 4) diarrhea. The small numbers of patients precluded meaningful statistical analysis. Conclusion: Patients with known CD compliant with a gluten-free diet tolerated CT well. However, in a subset of undiagnosed patients, severe diarrhea developed during CT, most notably with 5FU-based regimens. We propose that when patients have diarrhea disproportionate to other effects, CD should be considered. Also, in malignancies with a high incidence of CD such as lymphoma and small bowel cancer, underlying CD should be considered before CT is given. No significant financial relationships to disclose.

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