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Scalp Cooling to Prevent Chemotherapy-Induced Alopecia

Chemotherapy-induced alopecia (CIA) causes psychosocial stress and changes in self-esteem. Some patients will even refuse treatment because of fear of hair loss. CIA is usually reversible and regrowth can be observed within 3–6 months after chemotherapy cessation. 

Alopecia depends on the specific agent, the dose and duration of therapy, the route by which it is administered and the response of the individual. Certain classes of chemotherapy agents are known to cause alopecia more readily. The typical agents include alkylating agents, anthracyclines, antibiotics, antimetabolites, vinca alkaloids and taxanes.

Scalp cooling: Scalp cooling was introduced in the 1970's 1. It is a relatively easy way to prevent hair loss caused by certain chemotherapy drugs. The latter targets rapidly dividing cells indiscriminately thus killing tumour cells but also attacking hair follicles, resulting in alopecia (hair loss) in around 2 weeks (1-4 weeks) after the beginning of the chemotherapy.  
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Sarin’s classification of gastric varices

Gastric varices are called GOVs (Gastro Oesophageal Varices) if they happen to be present in continuity with esophageal varices.
They are called IGVs (Isolated  Gastric Varices) if found in isolated clusters in the stomach.

Sarin's classification is the most commonly used one:
- GOV1: esophageal varices that extend along the lesser curvature of stomach.
- GOV2: esophageal varices that extend along the greater curvature into the fundus of the stomach.
- IGV1: isolated gastric varices in the fundus of stomach.
- IGV2: isolated gastric varices in the other parts of the stomach.

Below is a diagram reminding us the anatomical terms in the above classification.

The following diagram illustrates the Sarin's classification:

GOV1 are most common type of gastric varices and are often seen together with large esophageal varices. They occur when there are anastomoses between the left gastric vein and the deep submucosal veins in the gastric zone.

GOV2 are the most common source of gastric…