Evaluation of an iron-filtered epithermal neutron beam for neutron-capture therapy.

An epithermal neutron filter using iron, aluminum, and sulfur was evaluated to determine if the therapeutic performance could be improved with respect to aluminum-sulfur-based filters. An empirically optimized filter was developed that delivered a 93% pure beam of 24-keV epithermal neutrons. It was expected that a thick filter using iron with a density thickness greater than 200 g/cm2 would eliminate the excess gamma contamination found in Al-S filters. This research showed that prompt gamma production from neutron interactions in iron was the dominant dose component. Dosimetric parameters of the beam were determined from the measurement of absorbed dose in air, thermal neutron flux in a head phantom, neutron and gamma spectroscopy, and microdosimetry.     

Stereotaxic treatment of expanding cysts in craniopharyngiomas by endocavitary beta-irradiation (Re-186; Au-198; Y-90)

The authors report the results of 17 intracystic injection of colloidal 186 rhenium, 2 colloidal 198 gold, and 1 colloidal 90 yttrium for endocavitary treatment of 18 cystic craniopharyngiomas (16 pts during a period ranging from January 1975 till July 1982. Follow-up studies ranging from 12 to 72 months (m: 36 m) revealed that all craniopharyngiomas cysts were effectively treated with cessation of fluid formation, progressive shrinkage of the formerly expansive cysts, and finally cyst obliteration in 75% of the cases. No early or late side-effects were observed during the entire observation period. Late reexpansion of one craniopharyngioma cyst, observed at 11 months, was successfully treated by a second injection. Leakage of colloid isotope into the CSF spaces during the "test" or "therapeutic" injections occurred in 18% of the global number of injections, however no clinical complications were observed. On the basis of a clinical dosimetric study a 30 000 rads wall-dose, not exceeding 40 000 rads is actually considered as the safer dose for endocavitary treatment of craniopharyngioma.     

Dynamic CT features of hepatic abscesses

Forty hepatic abscesses were examined with dynamic computed tomography (CT). A "double target sign," consisting of a hypodense central area surrounded by first a hyperdense ring and then a hypodense zone, seems to be highly suggestive of abscess formation. In 12 cases, the hepatic parenchyma surrounding the lesion demonstrated transient hyperdensity after contrast injection, possibly due to localized hepatic venous obstruction secondary to acute hepatic inflammation. This is similar to the appearance of an arterioportal fistula.     

Methodology of "in vivo" anatomical study and stereo-electroencephalographic exploration in brain surgery for epilepsy

Stereotactic implantation of deep SEEG electrodes performed as a prelude to surgery in some patients with drug-resistant focal epilepsy requires previous "in vivo" identification and localization of the cortical and subcortical structures to be explored, visualized "semi-directly" "or directly" by neuroradiological imaging techniques. Stereoscopic stereotactic teleangiography is a safety factor in transcutaneous electrode implantation and biopsies, but it also localizes the cortical sulci in a "semi-direct" manner by identifying vascular segments deeply buried in this sulci, which constitute their lamina vascularis. Although RMI greatly contributes to the study of the pallium, visualizing fragments of sulci and gyri does not necessarily mean that these structures can be identified with certainty, notably on the convexity of the brain. To solve this problem, RMI sections are enlarged by a photographic process, then combined with the images obtained from neuroradiological stereotaxis by means of anatomical landmarks that are common to both types of documents, using the bicommissural reference systems, bicallosal l/nl or vascular segments. This enables the angiographic laminae vascularis, which define the sulci in a "semi-direct" manner, to be used a kind of "Ariadne's clew" to identify cortical structures on RMI sections. In percutaneous stereotactic electrode implantation, the choice of the trajectories results from a compromise between the need to reach the desired anatomical structures, identified and localized within the stereotactic space, and the necessity to avoid the blood vessels displayed by stereoangiography. In some cases, the accuracy of anatomical definition can be verified during the SEEG study and/or by the evoked potential technique. Once the electrodes have been removed, their traces can be identified in a control RMI examination which constitutes a further verification.     

The efficacy of the ketogenic diet-1998: a prospective evaluation of intervention in 150 children

OBJECTIVE: The ketogenic diet is a high-fat, low-protein, low-carbohydrate diet developed in the 1920s for the treatment of children with difficult to control seizures. Despite advances in both the pharmacotherapy and the surgery of epilepsy, many children continue to have difficult-to-control seizures. This prospective study sought to determine the ketogenic diet's effectiveness and tolerability in children refractory to today's medications. METHODS: One hundred fifty consecutive children, ages 1 to 16 years, virtually all of whom continued to have more than two seizures per week despite adequate therapy with at least two anticonvulsant medications, were prospectively enrolled in this study, treated with the ketogenic diet, and followed for a minimum of 1 year. Seizure frequency was tabulated from patients' daily seizure calendars and seizure reduction calculated as percentage of baseline frequency. Adverse events and reasons for diet discontinuation were recorded. RESULTS: The children (mean age, 5.3 years), averaged 410 seizures per month before the diet, despite an exposure to a mean of 6.2 antiepileptic medications. Three months after diet initiation, 83% of those starting remained on the diet and 34% had >90% decrease in seizures. At 6 months, 71% still remained on the diet and 32% had a >90% decrease in seizures. At 1 year, 55% remained on the diet and 27% had a >90% decrease in seizure frequency. Most of those discontinuing the diet did so because it was either insufficiently effective or too restrictive. Seven percent stopped because of intercurrent illness. CONCLUSIONS: The ketogenic diet should be considered as alternative therapy for children with difficult-to-control seizures. It is more effective than many of the new anticonvulsant medications and is well tolerated by children and families when it is effective.     

Incidental heterotopic pregnancy demonstrated on magnetic resonance imaging

We report a case of an assisted pregnancy in an asymptomatic woman who was found to have an extrauterine mass on ultrasound and MRI. This complex mass had equivocal imaging features and was found to be a ruptured ovarian ectopic pregnancy at surgery. This case illustrates that vigilance is required regarding the possibility of coexisting ectopic and intrauterine pregnancy following assisted conception, even in entirely asymptomatic cases.     

Marrow transplantation with or without donor buffy coat cells for 65 transfused aplastic anemia patients

Sixty-five multiply transfused patients with severe aplastic anemia were given cyclophosphamide followed by grafts anemia were given cyclophosphamide followed by grafts from HLA-identical siblings. The effect of the administration of viable donor buffy coat cells following the marrow inoculum was evaluated with regard to graft rejection and survival. Results in 43 patients so treated are presented along with those in 22 concurrent patients given marrow alone. Most patients given buffy coat had positive in vitro tests of sensitization indicating a high risk for graft rejection, while all but one of the patients given marrow alone had negative tests. Thirty of the 43 (70%) patients given marrow and buffy coat are alive between 10 and 61 mo (median 36) after grafting; 4 died after graft rejection and 6 with acute or chronic graft-versus-host disease (GVHD). Eleven of the 22 (50%) patients given marrow alone are alive between 29 and 65 mo (median 52); 7 died after graft rejection and 3 with GVHD. The addition of buffy coat cell infusions to the marrow inoculum reduced the risk of rejection and increased survival in the currently reported transfused patients when compared to patients grafted before 1976. However, there was an increased risk of chronic GVHD. Recipients of marrow from female donors survived slightly better (73%) than recipients of male marrow (58%).     

Exploring the utility of whole‐exome sequencing as a diagnostic tool in a child with atypical episodic muscle weakness

The advent of whole‐exome next‐generation sequencing (WES) has been pivotal for the molecular characterization of Mendelian disease; however, the clinical applicability of WES has remained relatively unexplored. We describe our exploration of WES as a diagnostic tool in a 3½‐year old female patient with a 2‐year history of episodic muscle weakness and paroxysmal dystonia who presented following a previous extensive but unrevealing diagnostic work‐up. WES was performed on the proband and her two parents. Parental exome data was used to filter potential de novo genomic events in the proband and suspected variants were confirmed using di‐deoxy sequencing. WES revealed a de novo non‐synonymous mutation in exon 21 of the calcium channel gene CACNA1S that has been previously reported in a single patient as a rare cause of atypical hypokalemic periodic paralysis. This was unexpected, as the proband's original differential diagnosis had included hypokalemic periodic paralysis, but clinical and laboratory features were equivocal, and standard clinical molecular testing for hypokalemic periodic paralysis and related disorders was negative. This report highlights the potential diagnostic utility of WES in clinical practice, with implications for the approach to similar diagnostic dilemmas in the future.     

A Brazilian multicentre study evaluating pregnancies induced by cabergoline in patients harboring prolactinomas

Pituitary - To evaluate the maternal–fetal outcomes of CAB-induced pregnancies in patients with prolactinoma in a large cohort. The prevalence of tumor growth, miscarriage, preterm, low birth...