Treatment of localized prostate cancer using a combination of high dose rate Iridium‐192 brachytherapy and external beam irradiation: Initial Australian experience

Combination high dose rate brachytherapy (HDRB) and external beam radiation therapy is technically and clinically feasible as definitive treatment for localized prostate cancer. We report the first large Australian experience using this technique of radiation dose escalation in 82 patients with intermediate‐ and high‐risk disease. With a median follow up of 3 years (156 weeks), complications were low and overall prostate‐specific antigen progression‐free survival was 91% using the American Society for Therapeutic Radiology and Oncology consensus definition. The delivery of hypofractionated radiation through the HDRB component shortens overall treatment time and is both biologically and logistically advantageous. As a radiation boost strategy, HDRB is easy to learn and could be introduced into most facilities with brachytherapy capability.     

Comparing sulindac with indomethacin for closure of ductus arteriosus in preterm infants

Objectives: A prospective study comparing the efficiacy and side-effects of oral sulindac with intravenous indomethacin in clinically stable preterm infants (<1750 g) requiring non-invasive closure of haemodynamically significant patent ductus arteriosus.
Methodology: As maturity and birthweight are the two major determinants of ductal closure, infants were matched as closely as possible for these parameters. An eligible patient was first assigned to the sulindac group and a subsequent patient with similar gestational age (± 1 week) and birthweight (±100 g) to the previously recruited infant would automatically receive indomethacin. A total of eight infants were enrolled in each group.
Results: The ductus arteriosus was successfully closed in all eight infants receiving indomethacin, and in seven of eight infants receiving sulindac. No significant differences were found with regards to the ductal size between the two groups at diagnosis or on each of the consecutive days of treatment ( P >0.25). More renal adverse effects were encountered in the indomethacin group. Significant differences in changes from baseline value for urine output, plasma sodium, urea and creatinine concentrations were noted at 24, 48 and 72 h after commencement of treatment between the two groups ( P <0.05). All the parameters returned to normal or pre-treatment levels 48 h after stopping therapy. Unexpectedly, severe gastrointestinal complications were encountered in the sulindac group.
Conclusions: Sulindac is capable of promoting ductal constriction in clinically stable preterm infants without compromising the renal function. The spectrum of gastrointestinal complications observed in sulindac treated infants were similar to those described for indomethacin. The use of sulindac for ductal closure in the preterm infant should remain experimental.     

Erythromycin treatment for gastrointestinal dysmotility in preterm infants

To report our clinical experience on the use of oral erythromycin for the treatment of severe gastrointestinal dysmotility in preterm infants.

Methodology:

A case series study of seven preterm infants (six were very low birthweight) with severe intestinal dysmotility in a tertiary neonatal centre.

Results:

All responded favourably without adverse effects and tolerated full enteral feeding within 1–2 weeks of the commencement of the drug.

Conclusions:

As prolonged total parenteral nutrition carries significant risk of complications, this therapy could be considered in selected preterm infants who fail to establish enteral feeding after an extended period, and in whom an anatomically obstructive lesion of the gastrointestinal tract has been excluded. Meanwhile, we would caution against the widespread implementation of this therapeutic approach until formal evaluation by randomized controlled trials have established the exact role of erythromycin, or its analogues, in the treatment of intestinal dysmotility in preterm infants.     

A follow-up study of infants ≤ 2000 g birthweight treated in central Queensland

This follow-up study was undertaken in an effort to ascertain the morbidity in the survivors of infants ≤2000 g birthweight cared for in the two Rockhampton intensive care nurseries.

Methodology:

The records of all infants ≤2000 g delivered in or transferred to Rockhampton during the 11 year period 1979 through 1989 inclusive were extracted. Efforts were made to contact and examine all of these children. Those found to be disabled were assessed as being mildly, moderately or severely affected.

Results:

Of the 482 infants of birthweight ≤2000 g treated in the period under review, 393 survived to be discharged from hospital. Eight were known to have died subsequently. Of the remaining 385 children, 288 (74.8%) were able to be contacted and their health status determined. A total of 36 infants were found to have significant disabilities. Twenty-four were mildly affected, five moderately and seven severely affected. Severe disability in infants of ≤1000 g was 16% (3/19).

Conclusions:

The incidence of disability was established in 74.8% of the surviving population, It was not dissimilar to the incidence of disability in similar birthweight groups in some Australian tertiary centres for the years under study. It is emphasized that the follow-up was incomplete and recognized that the survival rates and incidence of disability in survivors has improved in tertiary centres since the time frame of this study.     

树突状细胞与卵巢癌细胞的融合及体外抗肿瘤作用的研究

目的 :比较脐血及以卵巢癌患者外周血来源的树突状细胞 (DC)的特点 ,研究DC 卵巢癌融合瘤苗的体外免疫应答效果。方法 :从脐血及卵巢癌患者外周血中诱导扩增DC ,从数量、形态、细胞表面标志及刺激增殖活性方面进行比较。体外培养卵巢癌患者癌细胞 ,将其与脐血DC在聚乙二醇 (PEG)介导下融合 ,活化自体T细胞 ,MTT法检测杀伤效果。结果 :体外诱导卵巢癌患者外周血DC ,每 2 0ml血能够获得 (0 .6～ 1.6 )× 10 6 个细胞 ;体外诱导脐血DC ,每 2 0ml血能够获得 (1.8～ 3.5 )× 10 6 个细胞 ,二者有明显差异 (P<0 .0 5 )。卵巢癌患者外周血DC在混和淋巴细胞反应 (mixedlymphocytereaction ,MLR)中显示了更为显著的刺激增殖活性。两者表达高水平的MHCII类分子和共刺激分子。经脐血DC 自体卵巢癌融合细胞活化的T细胞 ,对卵巢癌细胞株细胞的杀伤没有增加 ,而增强了对自体卵巢癌细胞的杀伤力。结论 :由脐血诱导可以获得更多数量的DC。脐血DC与自体卵巢癌细胞融合 ,能使肿瘤相关抗原有效提呈 ,激活T细胞 ,使它成为抗原特异性CTL ,有效杀伤自体癌细胞     

小儿伸直型肱骨髁上骨折的治疗方法分析

目的：探讨伸直位石膏固定治疗伸直型肱骨髁上骨折的方法及并发症的预防。方法：用闭合复位方法治疗52例（1-12岁）伸直型肱骨髁上骨折；介绍伸直位石膏固定的复位固定方法及并发症的预防。结果：本组获2年以上的随访，且无缺血性肌挛缩、肘内翻和关节僵硬等并发症。结论：伸直型肱骨髁上骨折伸直位石膏固定经济方便。并发症少。效果良好。值得推广。     

妇科恶性肿瘤患者的生存期预测

目的建立一个预测临终期妇科肿瘤患者生存时间的评分办法。方法回顾性分析不再适于接受任何抗肿瘤治疗,并于院内死亡的91例临终期妇科恶性肿瘤患者的临床资料。91例患者年龄中位数56岁(13~83岁),从入院起生存中位数27d(1~240d)。分析19项临床和生化指标与生存时间的关系。对单因素分析方法显示的9项显著影响生存时间的指标进行多元逻辑回归分析,以逐步后退方法建立一个包括5项指标的回归模型。将各项指标的回归系数转换为简单分数,相加后得到每一例患者的预后评分。依据本评分方法将患者分为两组,A组≤9·5分,B组≥10分。结果单因素分析显示,对生存时间有显著影响的9项指标为:呼吸困难、Karnofsky功能指数(KPS)、年龄、发热、肿瘤发展速度、有无并发症、血尿素氮、肌酐、血小板。多元逻辑回归结果建立了包括呼吸困难、KPS、年龄、发热和血尿素氮5项指标在内的回归方程。方程的正确分辨能力83·5%。A组37例,平均生存时间为(65±7)d。B组54例,平均生存时间为(19±2)d。A组存活≥30d者占83·8%(31/37)、B组存活≤29d者占85·2%(46/54)。两组生存曲线的差异有统计学意义(P<0·001)。结论依据本组资料建立的评分办法简单实用,是预测临终患者生存时间的有效方法。     

Pattern of ocular injuries in stone pelters in Kashmir valley

PurposeTo describe the pattern and types of ocular injuries in stone pelters in Kashmir valley during recent turmoil.DesignCross sectional study.MethodsSixty patients with different types of eye injuries were assessed between June–September 2010 and initial visual acuity was recorded. The injuries were classified according to Systems for Classifying Ocular Injuries (OTCS) and Ocular Trauma Score (OTS) was calculated in order to estimate the probability of follow-up visual acuity range.ResultsMost of the victims (75%) were young boys between 16–26 years with a mean age of 20.95, 95% of cases were males. The main cause of injury was stones (48.3%) and pellets (30%) besides rubber bullets, sling shots and tear gas shells.Most of the open-globe injuries due to stones were of Type B and A, Grade E, Zone II and III with Afferent Pupillary Defect (APD) in 30% of the cases. Closed-globe injuries were mostly of Type A, Grade C and D and Zone II and III.Most of the open-globe injuries due to pellets were of Type D, Grade D, Zone II and APD in 33.3%. Pellets Intra Ocular Foreign Body (IOFB) was in 41.6%. Most of the closed-globe injuries were of Type A, Grade D and E and of Zone III.Overall OTS of 1 was calculated in 16.6% and 3 in 53.3% of the cases.ConclusionIn stone pelting demonstrations eye injuries can result in visually significant trauma. Injuries due to pellets are mostly perforating and pellet IOFB, and both tend to have a very poor prognosis. OTS can be used to estimate visual prognosis.