MANAGEMENT OF ORBITAL RHABDOMYOSARCOMA: ABOUT 2 CASES AND LITERATURE REVIEW

Rhabdomyosarcoma is the most common primary malignancy in children. It constitutes a therapeutic emergency. The ocular region, particularly the orbital soft tissues, is an important anatomic location for RMS, which is the most common primary orbital malignancy of childhood. Radio-chemotherapy with conservative surgery allows a recurrence-free survival of 87% at 5 years. The aim of this study was to improve the understanding of the clinical features by reviewing the literature and analysing the medical records of patients who were diagnosed with orbital Rhabdomyosarcoma in our hospital. We report 2 cases of patients treated for an orbital Rhabdomyosarcoma at the radiotherapy department of the Hassan II University Hospital of FES.

Does the introduction of a formal neutropenic sepsis protocol improve therapeutic radiographer confidence and competence at recognising sepsis within the radiotherapy department?

Aim: The aim of this service review was to review whether implementing a formal training package increased therapeutic radiographer confidence and competence in recognising neutropenic sepsis in radiotherapy patients. In addition, authors also investigated whether the introduction of a weekly National Early Warning Score (NEWS) protocol had been successful in identifying cases of neutropenic sepsis. Material and Methods: Therapeutic radiographer (n = 13) views on the new protocol were collected through an online questionnaire. A review of the clinical observation sheets of patients who received chemo-radiotherapy (n = 49) between 18 April 2019 and 31 October 2019 was undertaken. Information on disease site, NEWS scores, number of patients who had become neutropenic and action taken by therapeutic radiographers was collected. Results: The majority of respondents to the questionnaire found that training benefitted both professionals and patients. Some challenges were highlighted relating to increased workload. For patients receiving regular observations, NEWS scores ranged from 0 to 4. When a patient scored on NEWS, the most common score was 1 across all treatment sites except cervix. Findings: Implementing a neutropenic sepsis protocol appears to be beneficial to therapeutic radiographers as professionals, increasing their confidence in patient assessment and monitoring. Regular observations may help to identify deteriorating patients alongside clinical judgement and symptom reviews.

Clinician's attitude to enteral nutrition with percutaneous endoscopic gastrostomy: a survey in China

Background Percutaneous endoscopic gastrostomy (PEG) is recommended for long-term enteral nutrition. However, long-term nasogastric (NGT) feeding is still commonplace in China. We surveyed Chinese clinicians’ opinions toward PEG feeding in order to identify the potential barriers to acceptancy of PEG feeding. Methods A self-reported questionnaire was developed and distributed to 600 doctors. Five-point Likert scales were used for most responses. Results Of 525 respondents, the mainly nutritional support method was NGT while PEG was less used. Doctors working in the tertiary class A hospitals and radiotherapy department were more likely to choose PEG feeding (p = 0.000). Overall, 241 (46%) participants did not know PEG and 284 (54%) have different understanding degree of PEG. Age (p = 0.002), working life (p = 0.044) and professionalism (p = 0.005) were significantly related to the understanding of PEG. Levels of agreement was high (score of 3.47) for using PEG in patients with prolonged stroke-associated dysphagia. There was high agreement level in the statement that PEG was unnecessary when NGT could sustain the basic needs of patients, though better outcome can be predicted with PEG feeding. The highest scoring factor (score of 3.91) that influenced clinicians’ choice of PEG was resistance from patients and families and the second one was the poor cooperation among departments (score of 3.80). Conclusions Doctors’ insufficient knowledge of PEG feeding, resistance from patients and families, poor cooperation among departments, all these factors leading physicians to prefer more conservative treatment to avoid disputes rather than better ones.

A totally implantable venous access device (TIVAD) abandoned for 5 years is re-accessed normally: A case report and literature review

Regular flushing and locking of totally implantable venous access devices (TIVADs) is recommended to maintain their patency when not in use. In this case report, a 73-year-old male patient received radical resection for rectal carcinoma in January 2010. A TIVAD was implanted in 2014 and a total of 12 rounds of chemotherapy of FOLFIRI was completed in 2015. During the period from 2015 to 2020, the patient never used or conducted the monthly infusion port flushing because of the inconvenience, the COVID-19 pandemic, and so on. On 18th April 2020, the patient was admitted to the radiotherapy department of Yiwu Central Hospital. The nurse evaluated the TIVAD upon admission, finding that the skin around the reservoir was normal without any sign of infection as erythema or induration of the skin overlying the implantable port but there was intraluminal occlusion of the devices. In order to re-access the catheter, discussion of a MDT was performed and several days of unremitting efforts were tried. Gratifyingly, the patient’s port was re-accessed successfully without any adverse reactions. This is a rare infusion port that has not been used and maintained for 5 years. For the port that has not been used and maintained for a long time up to 5 years, the medical staff should not give up easily. During the COVID-19 pandemic, prolonging the flushing interval of TIVADs can be an optimal clinical strategy without negative outcomes.