Final report of the general clinical results of the British Institute of Radiology fractionation study of 3F/wk versus 5F/wk in radiotherapy of carcinoma of the laryngo-pharynx

The 10 year follow-up of a clinical trial involving the comparison of 3F/wk versus 5F/wk in radiotherapy of squamous cell carcinoma of the larynx and hypopharynx has now been completed. The trial involved an intake of 734 patients between 1966 and 1975. The classification of all patients has been revised to conform with the latest TNM publication. A reduction in total dose was made for 3F/wk compared with 5F/wk. This varied between 13% and 11% in centres treating over 3 weeks and 6 weeks, respectively. No statistically significant differences have been found between the two arms (3F/wk versus 5F/wk) of the trial in any of the main group analyses. A number of sub-group analyses relating to survival, tumour-free and laryngectomy-free rates and to the comparison of acute or late normal-tissue radiation damage have also been performed. No differences have been found that could be considered to be statistically significant in relation to the particular sub-group. Previous interim reports suggested minor differences in sub-group analyses between the 3F/wk and 5F/wk regimes in this trial; these have diminished now that the full follow-up data are available. This trial has provided evidence on which clinicians may base their choice between either a 3F/wk fractionation regime or a conventional 5F/wk treatment protocol in the treatment of carcinoma of the laryngo-pharynx.     

Normal tissue reactions in the British Institute of Radiology Study of 3 fractions per week versus 5 fractions per week in the treatment of carcinoma of the laryngo-pharynx by radiotherapy.

The radiobiological data obtained from a multicentre clinical trial of the British Institute of Radiology, which compared the treatment of carcinoma of the laryngo-pharynx by 3 fractions per week (3F/wk) with 5 fractions per week (5F/wk) radiotherapy, have been studied. The trial involved an intake of 734 patients between 1966 and 1975. The number of fractions, overall treatment time and total doses used by different treatment centres ranges from 9 to 40 fractions, 18 to 70 days and 3880 to 7800 cGy, respectively. An 11-13% reduction in the total radiation dose was applied for treatments with 3F/wk as compared with 5F/wk in centres treating over 6 weeks and 3 weeks, respectively. All patients were followed for 10 years from the start of treatment. Different types of early and late normal-tissue reactions were investigated, ranging from a low percentage incidence of perichondritis to 95% for slight early reactions. Greater than 80% of the late normal-tissue reactions seen were observed within the first year after the start of treatment, and 96% were observed within the first 5 years. There was no statistically significant difference in the normal-tissue event-free rates between the 3F/wk and 5F/wk treatment groups. This finding did not differ when different major treatment centres were studied separately. For a number of end-points, alpha/beta ratios and N- and T-exponents of a modified nominal standard dose (NSD) formula have been calculated.     

MEBO治愈一例泛发性皮肤与皮下组织缺损伴多处筋膜间隙感染

目的:观察湿润烧伤膏(MEBO)治疗广泛性皮肤与皮下组织缺损伴多个筋膜间隙感染的临床疗效,为同类疾病应用MEBO治疗提供临床经验和理论依据.方法:对病变部位进行彻底扩创,采用多部位对口开窗冲洗,将MEBO灌注于病变腔隙内并作对口引流.全身配合抗感染、营养支持等措施治疗.结果:经246天全程使用MEBO治疗,组织缺损部位与坏死的筋膜间隙全部再生愈合.结论:MEBO治疗泛发性组织缺损伴多个筋膜间隙感染疗效可靠.     

Squamous cell carcinoma of the external auditory canal: two cases treated with high dose rate 192Ir remote afterloading system (RALS)

We report two cases of early-stage external auditory canal cancer treated by intracavitary irradiation with a high dose rate (HDR) 192Ir remote afterloading system (RALS) for preoperative treatment. A 6-Fr catheter for the HDR 192Ir remote afterloader, fixed by a plastic earplug, was inserted into the external auditory canal in two cases (case 1, T2N0M0; case 2, T1N0M0). The total intracavitary radiation dosages were 50 Gy (10 Gy/2 Fr/wk for 5 wks) for case 1, and 42 Gy (15 Gy/5 Fr/wk for 3 wks) for case 2. No external irradiation was given in either case. Surgical resection was performed in both cases, three to four weeks after irradiation. Histopathological examination confirmed the post-irradiation changes of necrosis, hyalinosis, and calcification, although vivid cancer cells remained. In preoperative irradiation of external auditory cancer, this method, although limited to treating early-stage cancers, may be a modality of choice for its efficacy and less severe side effects.     

腰椎间盘术后椎间隙感染的诊断和治疗

目的探讨腰椎间盘术后椎间隙感染的诊断和治疗。方法分析腰椎间盘术后腰椎间隙感染23例的临床资料及特点,其中非手术治疗15例,手术治疗8例。结果随访7～36个月,23例均恢复正常生活。结论根据病史、体征及ESR、CRP、MRI检查可早期诊断椎间隙感染。多数患者可经非手术治疗治愈,非术治疗无效、感染扩散、症状严重者,应行病灶清除术。     

创伤性腹膜后血肿的诊断与治疗体会

目的探讨创伤性腹膜后血肿的诊断与治疗方法。方法回顾性分析我院2009年3月～2012年2月收治的60例腹膜后血肿患者临床资料,男性42例,女性18例;年龄11～68岁,平均42岁。穿透性腹部损伤9例,钝性腹部损伤51例。单部位损伤12例,多发伤48例。合并颅脑损伤9例,胸部外伤15例,四肢骨折16例,共损伤腹盆腔脏器125例次。受伤就诊时间为20min～3d,平均2.2h。所有患者行剖腹探查手术45例（打开后腹膜血肿探查19例）,非手术治疗15例。结果本组患者中治愈56例,死亡4例（死亡率6.7%）,死亡原因分别为大血管损伤及严重骨盆骨折致失血性休克。术后并发症包括胃瘘1例,胆瘘2例,十二指肠瘘1例,经充分引流后痊愈。结论 CT检查和剖腹探查是确诊创伤性腹膜后血肿的有效手段,是否打开腹膜后血肿探查依据血肿的动态情况及位置,并结合相关实验室检验结果综合判定。     

Creatine kinase and muscle soreness after repeated isometric exercise

This study examined adaptation to isometric exercise with regard to changes in serum creatine kinase (CK) activity and muscle soreness. Forty-five college-age males were placed into six groups, each performing two bouts of strenuous isometric exercise of the knee extensors. In experiment 1 (N = 27), after performing the first bout of exercise, groups A, B, and C performed the second bout 3, 6, and 9 wk later, respectively. In experiment 2 (N = 18), groups D, E, and F performed the second exercise bout 1, 2, and 3 wk after the first bout, respectively. In experiment 3, group D performed two additional exercise bouts; thus, this group performed a total of four bouts spaced 1 wk apart. Muscle soreness and CK were assessed prior to and 6, 18, and 24 (or 42) h following each exercise. In experiment 1, no significant difference in soreness or serum CK was found between bouts 1 and 2. In experiment 2, a significant decrease in the CK and soreness responses was found on bout 2 compared with bout 1 (P less than 0.05). In experiment 3, serum CK and soreness responses were highest following bout 1 while bouts 2, 3, and 4 were not significantly different from one another. Performance of this isometric exercise results in an adaptation that lasts approximately 3 wk, with the greatest adaptation occurring after one bout.     

模拟飞行缺氧与吸氧对小鼠脏器自由基代谢的影响

目的 观察了两种模拟飞行条件（１５００ｍ轻度低压缺氧和５５００ｍ中度低压吸氧重复暴露下小鼠多脏器自由基代谢变化的特点。方法 昆明种小鼠６０只,随机分为６组（ｎ＝１０）进行缺氧与吸氧实验,实验完毕后,取小鼠尾血做血常规检查。次日,将小鼠断头处死,取脑、心、肺、肝、肾制备匀浆,测定丙二醛（ＭＤＡ）含量和超氧化物歧化酶（ＳＯＤ）活性。结果 １５００ｍ轻度低压缺氧重复暴露８ｗｋ使肺ＭＤＡ含量显著增高,提示     

Iatrogenic pneumocephalus following a cervical epidural steroid injection: A case report

Pneumocephalus is a condition defined by air present in the intracranial space. There are several causes of pneumocephalus, however this is a case of a patient who developed pneumocephalus following a cervical epidural steroid injection. Uniquely, this patient''s chief complaint was sudden onset of syncope, and respiratory arrest following the injection. The diagnosis was made by CT, and conservative treatment was used for resolution of the condition. Patients with pneumocephalus can present with a wide range of neurologic symptoms, and prompt recognition and treatment are key to preventing irreversible neurologic damage.     

Effects of nandrolone decanoate on VO2max, running economy, and endurance in rats

PURPOSE: The aim of the present study was to determine the effects of treatment with an anabolic androgenic steroid (AAS), nandrolone decanoate, on the submaximal running endurance (SRE), maximum oxygen consumption (VO2max), running economy (VO2submax), and blood oxygen carrying capacity of endurance trained rats. METHODS: Forty male Wistar rats were randomly allocated into two groups: a sedentary group and an exercising group training on treadmill for 8 wk. Half of the trained and half of the sedentary rats received weekly either nandrolone decanoate (10 mg x kg(-1)) or placebo (Pl) for the last 6 wk of experiment. SRE and VO2max tests were performed several times for all four groups (N = 10 each).Red blood cells parameters were measured at the end of the experiment. RESULTS: The trained rats had increased their SRE compared with sedentary rats throughout the experiment. At the end of the trial, the trained rats receiving nandrolone decanoate ran 46% longer than trained rats receiving Pl during the SRE test (P < 0.05). At the end of the experiment, trained rats had greater maximal time to exhaustion and higher VO2max than those of the sedentary rats but there were no differences in VO2max, VO2submax, and red blood cells parameters between the trained rats receiving nandrolone decanoate and those receiving Pl. CONCLUSIONS: Nandrolone decanoate has no effect on the SRE, VO2max and VO2submax of untrained rats. AAS treatment combined with submaximal training enhances SRE more than training alone but exerts no additive effects on VO2max, running economy, and oxygen carrying capacity of blood. The results suggest that this improvement in SRE of trained rats is due to the impact of AAS on other factors involved in exercise adaptation.     

186Re-etidronate in breast cancer patients with metastatic bone pain.

The aim of this study was to evaluate the efficacy of 186Re-1,1-hydroxyethylidene diphosphonate (etidronate) in breast cancer patients with painful bone metastases. METHODS: Thirty patients with advanced breast cancer who had metastatic bone pain were treated with 186Re-etidronate using different dosages in a noncomparative, open-label study. Twenty-four patients were evaluated for efficacy (6 patients had incomplete datasets). Dosages varied from 1295 to 2960 MBq (35 to 80 mCi). Efficacy was evaluated according to the multidimensional pain model using a paper-and-pencil diary. The diary was kept twice daily for 8-10 wk (2 wk before through 6-8 wk after 186Re-etidronate treatment). Response was determined with a strict criteria, in which pain intensity (PI), medication index (MI) and daily activities (DA) were core determinants. Response was defined as: (a) Reduced PI > or = 5% while MI and DA were at least constant; or (b) Reduced PI <25% in combination with improvement of MI or DA > or = 25%, without worsening of either factor. Duration of response should always exceed a minimum of 2 wk. RESULTS: Fifty-eight percent (n = 14) of all patients reported a response. The maximum follow-up period was 8 wk. Duration of response ranged from 2 to 8 wk (mean 4 wk). Patients (14/24) not only experienced considerable pain reduction, but in 12 patients this was also accompanied by noteworthy reduction in MI (> or = 25%). No clear dose-response relationship was found. CONCLUSION: With strict pain assessment criteria, 186Re-etidronate showed a response of 58% in the palliative treatment of metastatic bone pain originating from breast cancer.     

+Gz重复暴露后兔颈椎间盘BMP表达和影像学改变

目的：探讨＋Gz重复暴露对兔颈椎影像学和椎间盘骨形态发生蛋白（BMP）表达的影响。方法：15只兔随机分为对照组、＋G2暴露1d组、2周组、4周组、6周组。每组3只。＋Gz暴露组兔每天连续5次暴露于＋6Gz、持续45s，中间间歇5min。各组动物均于实验前后颈椎侧位拍片作自身对比，实验结束后气栓法处死并取颈椎做BMP免疫组化分析。结果：X线片显示对照组、＋Gz暴露1d组及2周组兔颈椎无明显变化，而＋Gz暴露4周组和6周组兔颈椎均出现显著退行性改变。对照组、＋Gz暴露1d、2周和4周组兔颈椎间盘未见BMP阳性细胞表达，＋Gz暴露6周组兔颈椎间盘的纤维环中可见少量散在分布的BMP阳性表达的软骨细胞。结论：＋6Gz重复暴露4周和6周可引起兔颈椎发生退行性改变和椎间盘BMP的表达。     

Pregnancy testing before high-dose radioiodine treatment: a case report.

This case emphasizes that negative urine pregnancy testing and a written declaration of the patient are not sufficient to safely exclude an early pregnancy. Serum pregnancy testing inherently has a diagnostic gap of about 1 wk following conception. We recommend sufficient contraception at least 1 mo before radioiodine treatment in women of childbearing age.     

Optic neuropathy following an altitude exposure

This case report describes a 20-yr-old man who presented with retro-orbital pain and blurred vision in his left eye 3 wk after an altitude exposure in a hypobaric chamber. He was found to have significant deficits in color vision and visual fields consistent with an optic neuropathy in his left eye. The patient was diagnosed with decompression sickness and treated with hyperbaric oxygen with a U.S. Navy Treatment Table VI. All signs and symptoms resolved with a single hyperbaric oxygen treatment but recurred. A head MRI revealed a left frontoethmoid sinus opacity. A concomitant sinusitis was diagnosed. The patient had full resolution of symptoms after a total of four hyperbaric oxygen treatments and antibiotic therapy at 6-wk follow-up. Although a para-infectious etiology for this patient's optic neuropathy cannot be excluded, his history of altitude exposure and significant, rapid response to hyperbaric oxygen treatment strongly implies decompression sickness in this case.     

Arthroscopic stabilisation of an acute acromioclavicular dislocation grade III in a patient with ectopic insertion of the pectoralis minor: technical considerations

The different approaches used in arthroscopic stabilisation of the acromioclavicular joint are well known. However, and despite a great incidence of ectopic pectoralis minor insertion, an alternative choice for the use of arthroscopic portal has not being sufficiently described. Here, we describe a case of acute acromioclavicular dislocation grade III. The arthroscopic stabilisation was achieved using the TightRope (Arthrex, Naples, USA) implant. Through this technique, the approach to the articular portion of the coracoid process can be made intra-articularly or from the subacromial space. We accessed intra-articularly, by opening the rotator interval to reach the coracoid process from the joint cavity. After opening the rotator interval, an ectopic insertion of the pectoralis minor was observed. The choice of approach of the coracoid process from the subacromial space would have complicated the intervention, making it necessary to sever the ectopic tendon to complete the technique, lengthening the surgical time and increasing the chance of complications. For this reason, the use of a standard posterior portal providing intra-articular arthroscopic access through the rotator interval is recommended since the aforementioned anatomical variation is not infrequent. Level of evidence Therapeutic studies—investigating the results of treatment, Level V.     

Comparative 18F-FDG PET of experimental Staphylococcus aureus osteomyelitis and normal bone healing.

PET using (18)F-FDG is a promising imaging modality for bone infections, based on intensive consumption of glucose by mononuclear cells and granulocytes. The method may have limitations in distinguishing uncomplicated bone healing from osteomyelitis. Bone healing involves an inflammatory phase that represents a highly activated state of cell metabolism and glucose consumption, mimicking infection on PET images. This laboratory study of a standardized model was designed to compare the (18)F-FDG PET characteristics of normal bone healing with those of local osteomyelitis. METHODS: A localized osteomyelitis model of the rabbit tibia was created by modifying a previously reported canine model. In the osteomyelitic group (n = 8), a standardized metaphyseal defect of the proximal right tibia was surgically created and filled with a block of orthopedic bone cement, followed by injection of a predetermined amount (0.1 mL) of Staphylococcus aureus (strain 52/52A/80, 1 x 10(5)/mL) into the space around the cement. The control group of animals with normal bone healing (n = 8) underwent the same procedure, but the bacterial injection was replaced by a sterile saline injection. The bone cement was surgically removed during debridement at 2 wk. Osteomyelitis was confirmed with positive bacterial cultures during the debridement and 6 wk later at the time of sacrifice. (18)F-FDG PET and peripheral quantitative CT were performed 3 and 6 wk after the debridement. The presence of osteomyelitic bone changes on plain radiographs was classified according to a previously published system. RESULTS: Before surgery, the standardized uptake values of (18)F-FDG did not differ markedly between the right and left tibias. In the control animals, uncomplicated bone healing was associated with a temporary increase in (18)F-FDG uptake at 3 wk (P = 0.007), but it returned almost to normal by 6 wk. In the experimental animals, localized osteomyelitis resulted in an intense continuous uptake of (18)F-FDG, which was higher than that of healing and intact bones at 3 wk (P = 0.014 and P < 0.001, respectively) and at 6 wk (P < 0.001). CONCLUSION: (18)F-FDG PET seems to be an efficient tool in the differentiation of uneventful bone healing from bone healing complicated by localized osteomyelitis.     

Quadrilateral space syndrome: a rare cause of shoulder pain

The authors report a case of quadrilateral space syndrome in a baseball pitcher. The diagnosis was made by means of subclavian arteriography performed with the arm in abduction and external rotation. This entity is a rare cause of shoulder pain caused by occlusion of the posterior humeral circumflex artery in the quadrilateral space.     

CT定位经皮肺穿刺活检术对周围型肺占位病变诊断的临床应用

目的 探讨CT定位经皮肺穿刺活检术用于肺周围型占位病变诊断的意义。方法 采用美国Cook公司的PREMED716、18、19、20G软组织活检针或不带针芯的细针，长度分别为8、10、12、16cm，外径分别为0．7、0．8、0．9mm，多数选用0．8mm，在PICKER IQXTRACT机导向下穿刺65例肺周围型占位病变。结果 65例经皮肺穿刺活检，经病理检查证实62例，其中原发性恶性肿瘤56例，结核3例，炎性假瘤2例，转移性癌1例，3例未能得到明确诊断，组织学诊断率为95．4％，术后4例并发少量气胸，2例出现血丝痰，均未作特殊处理。结论 CT定位经皮肺穿刺活检是比较安全、准确率很高的诊断手段，且在经济上也是可行的技术，可在有条件的单位广泛应用。     

The effects of moderate exercise training on immune response

The relationship between moderate exercise training (ET) (five 45-min sessions per week, brisk walking at 60 heart rate reserve for 15 wk) and changes in immune system variables and function was investigated in a group of 36 sedentary, mildly obese women. The study was conducted using a two (exercise (EX) and nonexercise (NEX) groups) by three (baseline, 6 wk, and 15 wk testing sessions) factorial design, with data analyzed using repeated measures ANOVA. The pattern of change over time between groups for number of peripheral blood lymphocytes (total), T cells (CD5), B cells (CD20), and serum IgG, IgA, and IgM levels was significantly different. This was not the case for spontaneous blastogenesis or number of T helper/inducer cells (CD4) or T cytotoxic/suppressor cells (CD8). Within-EX-group changes were characterized by significant decreases in percentage and number of total lymphocytes, and in T cell number after 6 wk, and significant increases in each of the serum immunoglobulins after both 6 and 15 wk of training. B cell number increased significantly in NEX subjects relative to baseline values at both 6 and 15 wk, with no significant changes experienced in EX subjects. In summary, these data suggest that moderate ET is not associated with an improvement in lymphocyte function but is associated with a 20% increase in serum immunoglobulins and several small changes in circulating numbers of immune system variables, highlighted by significant decreases in circulating numbers of lymphocytes, particularly the T cell subpopulation. These changes were especially apparent after 6 wk of training, with some attenuation by 15 wk.     

Deep vein thrombosis following calf strain: a case study

Deep vein thrombosis (DVT) has been the subject of considerable media attention after a number of deaths and scares in apparently low risk individuals following long haul flights. While many contributory factors have been put forward for the development of DVT, few cases have been reported following muscle strain. The recent publicity surrounding the calf strain sustained by Steve Waugh, the Australian cricket captain, during the Ashes series was initially unremarkable. The case was however, subsequently complicated by the development of DVT following his return (long haul) flight to Australia. Latest reports indicate that following anticoagulant treatment he has made a full recovery and returned to playing. This case could easily be dismissed as a ‘one off’ or an unusual set of circumstances. The following case report illustrates that DVT following calf strain is by no means unique. The ramifications of these cases may have serious implications for Physicians and manual therapists working in sports medicine.