Preoperative treatment planning with intraoperative optimization can achieve consistent high-quality implants in prostate brachytherapy

Advances in brachytherapy treatment planning systems have allowed the opportunity for brachytherapy to be planned intraoperatively as well as preoperatively. The relative advantages and disadvantages of each approach have been the subject of extensive debate, and some contend that the intraoperative approach is vital to the delivery of optimal therapy. The purpose of this study was to determine whether high-quality permanent prostate implants can be achieved consistently using a preoperative planning approach that allows for, but does not necessitate, intraoperative optimization. To achieve this purpose, we reviewed the records of 100 men with intermediate-risk prostate cancer who had been prospectively treated with brachytherapy monotherapy between 2006 and 2009 at our institution. All patients were treated with iodine-125 stranded seeds; the planned target dose was 145 Gy. Only 8 patients required adjustments to the plan on the basis of intraoperative findings. Consistency and quality were assessed by calculating the correlation coefficient between the planned and implanted amounts of radioactivity and by examining the mean values of the dosimetric parameters obtained on preoperative and 30 days postoperative treatment planning. The amount of radioactivity implanted was essentially identical to that planned (mean planned radioactivity, 41.27 U vs. mean delivered radioactivity, 41.36 U; R² = 0.99). The mean planned and day 30 prostate V100 values were 99.9% and 98.6%, respectively. The mean planned and day 30 prostate D90 values were 186.3 and 185.1 Gy, respectively. Consistent, high-quality prostate brachytherapy treatment plans can be achieved using a preoperative planning approach, mostly without the need for intraoperative optimization. Good quality assurance measures during simulation, treatment planning, implantation, and postimplant evaluation are paramount for achieving a high level of quality and consistency.     

Effect of wheat grass therapy on transfusion requirement in β-thalassemia major

Objective  To assess the efficacy of wheat grass juice on transfusion requirement in patients with beta thalassemia major. Methods  Fifty-three patients of thalassemia major with a median age of 16 years were given wheat grass juice tablets. Results  The Mean pre and post wheat grass therapy, the pack cell requirement was 288.06 ± 53.25 gm/Kg/year and 301.25 ± 54.86 gm/Kg/year (p =0.054) respectively. No adverse effects were noted. Conclusion  We conclude that wheat grass therapy for one year is not effective in reducing the transfusion requirement in transfusion dependent thalassemia.     

Microneurovascular reimplantation in a case of total penile amputation

Amputation of the penis is a rare condition reported from various parts of the world as isolated cases or small series of patients; the common aetiology is self-mutilating sharp amputation or an avulsion or crush injury in an industrial accident. A complete reconstruction of all penile structures should be attempted in one stage which provides the best chance for full rehabilitation of the patient. We report here a single case of total amputation of the penis, which was successfully reattached by using a microsurgical technique. After surgery, near-normal appearance and function including a good urine flow and absence of urethral stricture, capabilities of erection and near normal sensitivity were observed.     

Epstein‐Barr virus associated post‐transplant lymphoproliferative disorder mimicking acute graft versus host disease

We present a case series of 3 patients to highlight the fact that PTLD post‐transplant can mimic GVHD, and should be part of the differential diagnosis for diarrhea post allo‐HCT. Awareness of this presentation has important therapeutic implications, as increased immune suppression for the management of GVHD, can worsen clinical features of PTLD. Diagnostic imaging and tissue biopsies should be undertaken early in post‐transplant patients presenting with diarrhea or hepatic abnormalities, especially with atypical presentations like fever, and EBV PCR monitoring can expedite clinical decision‐making in such complicated scenarios while awaiting results of gut biopsies.     

Borrelial Lymphocytoma Cutis: A Diagnostic Dilemma

Lymphocytoma cutis (LC) is one of the most common types of cutaneous B cell pseudolymphoma. Borrelial LC occurs most commonly in areas endemic for Ixodes ricinus tick in Europe, and it is rare in North America. The disease is rarely seen in India and may cause diagnostic difficulties for dermatologist residing in parts of the world that are not endemic for Lyme disease. The diagnosis is critical as LC may present as the only early manifestation of Lyme disease. Herein, we have presented a case of borrelial LC in an 11-year-old boy of German descent, residing in India.