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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.  

A "cooling cap" is worn and the temperature is decreased to around 22°C and maintained immediately before, during and after the administration of the chemotherapeutic agents. This causes vasoconstriction and decreases the blood flow (20-40% less) to the hair follicles thus decreasing the concentration of the drugs delivered there. The lower temperature also slows down the metabolism of the cells in that region and eventually both of these factors are responsible for a lower cytotoxicity.

The 2 FDA approved devices are:

The Paxman system consists of a refrigeration unit that circulates fluid with a temperature of  -5°C through a light weight silicone cap while in the Dignicap system the coolant is circulated at a temperature between 3 and 8°C.

A recent randomized clinical trial, the SCALP trial 2, concluded that women who underwent scalp cooling were significantly more likely to have less than 50% hair loss after chemotherapy compared to those who did not receive scalp cooling. 

1) Dean, J.C., Salmon, S.E., et al., 1979. Prevention of doxorubicin-induced hair loss
with scalp hypothermia. N. Engl. J. Med. 301 (26), 1427–1429. DOI: 10.1056/NEJM197912273012605
2) Nangia J, Wang T, Osborne C, et al. Effect of a scalp cooling device on alopecia in women undergoing chemotherapy for breast cancer: the SCALP randomized clinical trial. JAMA. doi:10.1001/jama.2016.20939


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Sarin’s classification of gastric varices

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- 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:

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