SummaryOver the last 40 years, great progress has been made in treating childhood and adult cancers. However, this progress has come at an unforeseen cost, in the form of emerging long-term effects of anthracycline treatment. A major complication of anthracycline therapy is its adverse cardiovascular effects. If these cardiac complications could be reduced or prevented, higher doses of anthracyclines could potentially be used, thereby further increasing cancer cure rates. Moreover, as the incidence of cardiac toxicity resulting in congestive heart failure or even heart transplantation dropped, the quality and extent of life for cancer survivors would improve. We review the proposed mechanisms of action of anthracyclines and the consequences associated with anthracycline treatment in children and adults. We summarise the most promising current strategies to limit or prevent anthracycline-induced cardiotoxicity, as well as possible strategies to prevent existing cardiomyopathy from worsening.
The incidence of multiple pregnancy has increased significantly in recent years as a result of assisted reproductive therapy. The most important complication of these pregnancies remains preterm delivery. We report an extraordinary case of delayed delivery after late abortion of the first twin. Tocolysis successfully prolonged the pregnancy for more than three months, and combined with antibiotics and corticosteroids resulted in a term delivery of a second healthy sibling. A total of 37 reports that describe 145 cases of intentional delayed delivery are available. Delay of delivery may offer significant improvement in survival and outcome for the remaining fetus. Delay of delivery beyond 37 weeks is uncommon with only eight reports. A protocol for the procedure of delayed delivery of the second twin is suggested.
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