martedì, ottobre 30

Tortine di mele e cannella: il buon giorno si vede dal mattino [#2]!

Non molto tempo fa abbiamo aperto un capitolo sulla prima colazione che vale la pena di proseguire, stamane, riagganciandoci pure a quanto detto sabato a proposito di ritmi lenti e buoni propositi per pensare noi stessi attraverso la gastronomia e la buona tavola. Cominciamo di primo mattino: una buona tazza di latte fresco, caffè delle migliori miscele e queste squisite tortine che potremo comodamente preparare per tempo nel week end, godendone per buona parte della settimana. Una preparazione semplice e genuina che può aiutarci a cominciare bene la giornata. Il Maiale sa che molti hanno ritmi serrati e proprio non riescono a uscire dal canonico cappuccino + cornetto al bar, preso di fretta e furia prima di affrontare una giornata di lavoro. Ma, avete fatto caso a quanto dura il senso di pienezza che questo tipo di colazione regala? Io si.. e intorno alle dieci, più o meno, ogni volta ho nuovamente fame. Il consiglio è, per quanto possibile, di guadagnare un pò di tempo in più nel primo mattino, appena svegli. Di dedicare un attimo in più ad una buona colazione per vedersi sorridenti ed appagati nel resto della giornata. Del resto è un consiglio quasi banale; leggiucchiando qui e lì tra le varie riviste sempre si incappa in argomenti del genere. Ma non è mai superfluo dire che piccoli gesti come questo vanno a costruire un universo di buone abitudini che col tempo lasciano scoprire una quotidianità migliore. Pensare a pensarsi. Amare i piccoli gesti. Magari non tutti i giorni se proprio non ci riuscite, ma anche solo nel week end. Ciò che importa per noi, adesso, è ritrovare pienezza di spirito partendo dalle piccole cose. Buona giornata!

Ingredienti

250 g di mele (Golden o Stark)
1 cucchiaino di succo di limone
200 g di farina bianca
175 g di zucchero
1 cucchiaino di lievito in polvere
1/2 cucchiaino di bicarbonato
2 cucchiaini di cannella in polvere
1 pizzico di sale
2 uova
150 g di burro morbido
7 cucchiai di latte
1 cucchiaino di zucchero a velo

Lavare e sbucciare le mele, tagliarle a dadini e irrorarle con il succo di limone. Mescolare la farina setacciata, lo zucchero, il lievito, il bicarbonato, la cannella e il sale. A battere battere le uova e incorporarvi il burro e il latte. Aggiungere un pò alla volta la miscela di farina, poi le mele e amalgamare bene l'impasto. Distribuirlo negli stampini precedentemente imburrati e infarinati, riempiendoli per 3/4. Cuocere in forno a 180° per circa mezz'ora (verificare sempre la cottura con un bastoncino di legno). Una volta raffreddati disporli su di un piatto di portata e spolverizzare con lo zucchero a velo.

Stefano Tripodi & Daniela Caselli

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13 Comments:

Blogger Jelly said...

La colazione è forse il "momento mangereccio" che preferisco.
Ed è per questo che preferisco alzarmi un po' prima del necessario, per avere il tempo di farla come si deve. E queste tortine sarebbero un buon modo di iniziare la giornata...

30/10/07 2:40 PM  
Anonymous Anonimo said...

buona, davvero ottima ricetta!

31/10/07 12:35 PM  
Anonymous Anonimo said...

sandra
cari amici, parole le sante!!! :-)
io se posso produco nel week end e consumo in settimana, cercando il più possibile di ritardare l'ora della colazione, altrimenti anche con le mie tortine alle 11 ho già una bella voragine nel pancino!!! :o)
Per esempio un paio di qs me le mangerei anche ora che son quasi le 13!!
buona festa per domani!
;-**

31/10/07 12:49 PM  
Blogger il maiale ubriaco said...

festa...certo, festeggiate pure! io purtroppo lavoro qui oltre manica!

Re

31/10/07 2:25 PM  
Anonymous sicula said...

Ragazzi mi deliziate. Che bel blog che è il vostro. Davvero complimnti.

31/10/07 3:09 PM  
Blogger k said...

Ecco, mi fate venire in mente che stasera abbiamo fatto fuori l'ultima fetta di cake morbidoso per la colazione... uff! Troppo tardi per mettermi a cucinare ora, ma domani queste tortine le provo.
buona serata e buon ponte a chi lo fa!
katia

31/10/07 11:21 PM  
Blogger Cipolla said...

Adoro la colazione con una fetta di torta appena sfornata! Purtroppo tutti giorni non è possibile, ma almeno nel week-end...

1/11/07 1:03 PM  
Anonymous Fede - Fiordimela said...

W mele e cannella abbinamento divino... Come nello STRUDEL!

8/11/07 7:14 PM  
Anonymous Anonimo said...

How many times a day do
you see a credit card logo on a cash register?
Why do they still call them cash registers when they really want you
to charge anyway? How much is spent in advertising to get you to spend
what you don't have just because you have room left on your credit
card? Maybe you thought that sale was just too good to pass up. Maybe
you thought that you could handle the payments and maybe you could
until...late fees, over-the-limit fees, the increase of your interest
rate, you got sick for a week or maybe there was even a real
emergency.



Getting into debt is easy, just buy a few things that you can't afford
to pay cash for and don't think about how many payments you're going
to have to make before it's paid off completely. Getting into debt is
fun; just go out to dinner and a show or away for a few days to make
yourself feel better about the fact that you don't have the money to
go out to dinner and a show or to get away for a few days. Getting
into to debt can impress people. Don't drive around in something that
you can afford to pay for, figure out how much you can squeeze out of
your monthly budget, and if you don't have a budget even better just
guess, then tell a car salesperson that you'd like to make 48 payments
and see what you'll be driving around town in. The best part is you'll
guarantee you'll be driving it to work for the next 1,460 days just to
make the payments. Now that's impressive!

Take the "How Did I get Into Debt Quiz". Pull out one of your credit
cards and determine how much you owe on it. Now, quickly, what did you
buy for all that money? I'll bet you don't know because you bought
stuff. Stuff you may not even have anymore let alone still use or be
able to identify. Now ask why do you use it at all? Be honest. How
does "I want stuff I can't afford to pay cash for" sound? The
Unexpected Event
Many people get into debt because of unexpected events, events beyond
their control. The most common of these are medical bills and job
loss. And the most common causes are lack of affordable medical
insurance and globalization. Not only are these problems beyond your
control they also appear to be beyond the control of our political
system so don't expect the problems to be fixed any time soon.

Globalization, the process of businesses taking their money to far off
countries to earn better returns, is not new. In the 1790s Benjamin
Franklin Backe published a newspaper called the Aurora. In it he wrote
that he believed that the merchants of the day were "men who know no
country but that where they can make money," who "carry their capitals
ships and our sailors to the country which will encourage them."

The sad part, debt-wise, of having an unexpected event is that even
though you didn't cause the problem it is up to you to fix it. So
whether you're in debt because of an event or the "easy monthly
payments" trap relax because I've got some good news. Getting out of
debt is going to be even more fun than getting into debt was. I done
both and becoming debt-free feels great. So if you're ready let's get
started...but first let's discuss, Good Debt/Bad Debt and business
debt. Good Debt/Bad Debt
Much like cholesterol, where there is good and bad cholesterol, debt
comes in two versions. It can be okay to take on debt in a reasoned
way for a good purpose. In fact many people become wealthy by
borrowing money to invest in business opportunities. They call it
using other peoples' money. But my focus here is on how individuals
spend their money on themselves. It's how you spend your money.


There can be some very good reasons to take on debt. Financing
education, for example, can be an admirable thing. If you go to school
to increase your income potential, taking out a student loan would be
a good thing. If you take out a $2,000 loan and you learn a skill that
let's you earn an extra $5,000 a year, you'd be crazy not to take the
loan. If you take out a student loan because you don't know what you
want to do with your life and you don't want to get a job, well,
that's not a good idea.

For most people taking out a mortgage is the only way they'll be able
to purchase a home. This could be considered good debt. Because of the
way mortgage payments are structured with the first few years being
heavily weighted towards paying interest and mere pittance going
towards principle, it's a good idea to pay off even this good debt as
soon as possible. Many wise financial minds teach that before
investing in something that will give you thirty years of monthly
payments it's better to invest in income producing assets first,
something like rental property.

Well, what about if there's an emergency? Maybe the plumbing broke, or
you have a medical emergency. Well let's not be stupid about this, if
its real emergency and the only way to pay for it is by taking on
debt, then take it on. If you break your leg it's a good idea to take
on the debt of a doctor's bill rather then waiting until you have the
money to get the bone set. Personal vs. Business Debt
There can be some big differences between personal and business debt.
But it mostly depends upon how the business structure is setup. If the
business is setup as a sole-proprietorship then there really is no
difference between the business owner and the business, it is all
considered one entity.

If on the other hand the business is set up as a corporation then
there is a vast difference between the business and the business
owner, in this case the share-holders. This is true even if only one
person owns all the shares. Legally the corporation is considered a
separate entity and if the business has debt problems it doesn't
translate to shareholder debt problems. That's why entrepreneurs like
having their businesses in a separate legal entity.

It's also why if you are considering going into business as a way to
make more money to get out of debt it's a good idea to have the proper
business structure. Is There Another Way?
Even with good debt you want to think twice before taking it on.
Taking a student loan to improve your employment situation is a great
idea, good debt. But wait, before you take on debt ask "Is there a
better way?" There are many sources of grants, and yes a grant is
money that you don't have to pay back. So before you take the easy way
and "Just sign here," do some checking to make sure there's not a
better way. You need to be fully informed as to the terms and
conditions of any loan before you take it. You should always shop
around to see if there is a better deal, better terms or a way to
avoid taking the loan out at all.


One way to avoid having to take on even good debt is to plan in
advance and save money on a regular basis. If you've been driving for
a while you have probably had a flat tire. Because everyone gets a
flat tire once in a while it couldn't really be considered an
unexpected expense. Do you have money set aside for your next flat
tire? Well, you should. If fact you should have money set aside that
would cover a variety of "unexpected" expenses. If you do you can deal
with life's little surprises without upsetting your monthly budget.
You will have to pay yourself back but you won't be charging yourself
interest or calling yourself at dinner demanding payment.

So, yes, there is good debt under certain conditions, just be sure
that you've investigated other ways of taking care of it before you
sign your way into debt. And if you do take it on don't allow yourself
to feel burdened by it. You did what you had to and you'll pay it off

http://debt1consolidation.com

15/11/07 2:38 AM  
Anonymous Anonimo said...


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WHAT WE NEED FROM YOU

We will need to document your income and expenses for the last two years. Documentation will include pay stubbs, tax returns, bank statements and property tax bills, and all of the paperwork associated with your mortgage. We will need copies of your bills to document your financial situation and the factors that led to your falling behind. Please provide any other letters or notices that demonstrate that you faced a reduction in your income or higher than expected expenses.

TELLING YOUR STORY

We will ask you to prepare a draft letter that explains in your own words what factors have led to your need for a modification from the lender. It is important that you author this letter, and that it is not generic. Please include the details that bring to life the financial difficulties that you have faced. If you feel that you were not properly and fully informed regarding the terms of your loan, please describe the process by which you came to sign the loan papers and what your understanding of the terms of your loan was at that time.
CaliforniaLoanRate.com..

23/12/08 4:29 AM  
Anonymous Anonimo said...


Mesothelioma
• Mesothelioma Causes
• Mesothelioma Symptoms
• Mesothelioma Latency Period
• Mesothelioma Prognosis
• Mesothelioma Survivors
• Pleural Mesothelioma
• Peritoneal Mesothelioma
• Pericardial Mesothelioma
• Malignant Mesothelioma
• Mesothelioma Diagnosis
• Epithelial Mesothelioma
• Sarcomatoid Mesothelioma
• Mesothelioma Staging Systems

Treatment Options
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• Mesothelioma Chemotherapy
• Mesothelioma Doctors
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• Mesothelioma Clinical Trials
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• Mesothelioma Support
Asbestos Cancer
• Cancer Facts
• Asbestos Cancer
• Lung Cancer
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Asbestos Info
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• Asbestos Types
• Asbestosis
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Exposure Areas
• Shipyards
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• Occupations
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• State Index
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Navy Veterans
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Legal Options
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27/2/09 4:03 PM  
Anonymous Anonimo said...

mesothelioma Mesotheliomais a form of cancer that is almost always caused by exposure to Asbestos In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart the pericardium (a sac that surrounds the heart or tunica vaginalis.
Most people who develop
mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. Washing the clothes of a family member who worked with asbestos can also put a person at risk for developing Mesothelioma Unlike lung cancer, there is no association between mesothelioma and smoking but smoking greatly increases risk of other asbestos induced cancer.Compensation via
Asbestos funds or lawsuits is an important issue in
mesothelioma The symptoms of
mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis, which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural
mesotheliomaSymptoms of peritoneal
mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal
mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:
chest wall pain
pleural effusion, or fluid surrounding the lung
shortness of breath
fatigue or anemia
wheezing, hoarseness, or cough
blood in the sputum (fluid) coughed up hemoptysis
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung The disease may metastasize, or spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:
abdominal pain
ascites, or an abnormal buildup of fluid in the abdomen
a mass in the abdomen
problems with bowel function
weight loss
In severe cases of the disease, the following signs and symptoms may be present:
blood clots in the veins, which may cause thrombophlebitis
disseminated intravascular coagulation a disorder causing severe bleeding in many body organs
jaundice, or yellowing of the eyes and skin
low blood sugar level
pleural effusion
pulmonary emboli, or blood clots in the arteries of the lungs
severe ascites
A
mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs
Diagnosing
mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for
mesothelioma A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of
mesothelioma A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude
mesothelioma it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure
If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of
mesothelioma A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
There is no universally agreed protocol for screening people who have been exposed to
asbestosScreening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for
mesotheliomaThe level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening. Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells
Incidence
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year. For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades. It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[ Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.
asbestos
is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven.
asbestos
has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
The combination of smoking and
asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer bronchial carcinoma). The Kent brand of cigarettes used
mesothelioma in its filters for the first few years of production in the 1950s and some cases of
mesothelioma have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.
Some studies suggest that simian virus 40 may act as a cofactor in the development of mesothelioma.
Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with
asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of
asbestos exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for
mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with
asbestos wear personal protective equipment to lower their risk of exposure. Recent findings have shown that a mineral called erionite has been known to cause genetically pre-dispositioned individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned genetically. A study in Cappadocia, Turkey has shown that 3 villiages in Turkey have death rates of 51% attributed to erionite related
mesotheliomaExposure to
asbestos fibres has been recognised as an occupational health hazard since the early 1900s. Several epidemiological studies have associated exposure to asbestos with the development of lesions such as asbestos bodies in the sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the pleura and peritoneum.
The documented presence of
asbestos fibres in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibres. Although many authorities consider brief or transient exposure to
asbestos fibres as inconsequential and an unlikely risk factor, some epidemiologists claim that there is no risk threshold. Cases of mesothelioma have been found in people whose only exposure was breathing the air through ventilation systems. Other cases had very minimal (3 months or less) direct exposure.
Commercial
asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.
Family members and others living with
asbestos workers have an increased risk of developing
mesothelioma and possibly other asbestos related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to asbestosMany building materials used in both public and domestic premises prior to the banning of
asbestos may contain
asbestos Those performing renovation works or activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue
asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to
mesothelioma radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although
mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel.
Radiation Therapy when given alone with curative intent has never been shown to improve survival from
mesothelioma The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
Chemotherapy is the only treatment for
mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy) in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery. This trial was the first to report a survival advantage from chemotherapy in malignant pleural
mesothelioma showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.
Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.
In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer.
mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

What is the mesothelium?
The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs to glide easily against adjacent structures.
The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The
mesothelioma tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.
What is mesothelioma?
mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs.
cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.
How common is mesothelioma?
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.
What are the risk factors for mesothelioma?
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to
Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.
Who is at increased risk for developing mesothelioma?
asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.
The risk o f asbestosrelated disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.
There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to
asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
What are the symptoms of mesothelioma?
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to
asbestos Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis
How is
mesotheliomadiagnosed?
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the
cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the
cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
How is
mesotheliomatreated?
Treatment for mesothelioma depends on the location of the
cancerthe stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
Surgery is a common treatment for
mesotheliomaThe doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural
mesotheliomaa lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Stereo Tactic Radiation Therapy also called radiotherapy, involves the use of high-energy rays to kill
cancercells and shrink tumors Radiation therapy affects the
cancercells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the
cancercells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat
mesotheliomaare given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation Therapy and surgery may also be helpful in relieving symptoms.

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