Comment on ‘Predicting recurrence in axillary node negative breast cancer patients’, by Rosner and Lane

on behalf of the Nottingham Breast Unit     

Prevalence of behaviour disorders in low birthweight infants

OBJECTIVE--To determine the prevalence of behaviour disorders in low birthweight infants. DESIGN--Children of birth weight < or = 2000 g born to mothers resident in Merseyside in 1980-1 assessed using the Rutter parent and teacher behaviour questionnaires and the Conner modification of the Rutter teacher questionnaire. Children attending normal schools were assessed with controls matched for age, sex, and class in school. Children attending special schools were assessed unmatched. SUBJECTS--233 matched case-control pairs attending normal primary schools and 46 unmatched children attending special schools. SETTING--Primary and special schools. MAIN OUTCOME MEASURES--Emotional, conduct, and undifferentiated behaviour disorders and hyperactivity. RESULTS--On the parental questionnaire screen, 36% of the cases and 22% of the controls had a behaviour disorder and on the teacher questionnaire the proportions were 27% and 12% respectively. Hyperactivity was significantly more common among male cases than their controls (21% v 5.0%) but differed little among female cases and controls (9% v 7%). CONCLUSIONS--Improving neonatal survival of low birthweight infants is accompanied by a higher prevalence of behaviour disorders. The long term implications for psychiatric morbidity and other adult disease must be monitored.     

BENIGN GASTROCOLIC FISTULA ASSOCIATED WITH PERITONITIS

SUMMARY Gastrocolic fistula is most often related to malignancy or previous gastric surgery. It is an uncommon complication of benign gastric ulceration in patients who have not had a previous operation. Benign gastrocolic fistula associated with peritonitis is extremely rare — this case is only the fourth ever reported. The patient presented with an acute abdomen, and subsequent investigations demonstrated a gastrocolic fistula of benign aetiology.     

Build-up modification of commercial diodes for entrance dose measurements in 'higher energy' photon beams.

BACKGROUND AND PURPOSE: Several commercially available p-type diodes do not provide sufficient build-up for in-vivo dosimetry in 'higher' energy photon beams, and only limited information could be found in the literature describing the correction factor variation and/or the achievable accuracy for in-vivo dosimetry methods in this energy range. The first aim of this study is to assess and analyze the variation of diode correction factors for entrance dose measurements at higher photon energies. In a second step the total build up thickness of the diode has been modified in order to minimize the correction factor variation. MATERIALS AND METHODS: Diode correction factors accounting for non-reference conditions (field size, source surface distance, tray, wedge, and block) are determined in 18-25 MV photon beams provided by different treatment units for Scanditronix p-type diodes recommended for higher energy photon beams: old type and new type EDP-20, and EDP-30 diodes. Hemispherical build-up caps of different materials (copper, iron, lead) are used to increase the total build-up thickness. Perturbation effects with and without additional build-up caps are assessed for the three diode types. RESULTS: For unmodified diodes field size correction factors (C(FS)) vary between 1.7% and 6%, dependent on diode type and treatment unit. For example, for an old type EDP-20 the C(FS) variation at 18 MV is much higher on a GE linac (5%) as compared to the Philips machine (1.7%). Depending on diode type, this variation can be reduced to 1-2% when adding additional build-up. The variation of source to surface distance correction factors is almost independent of build-up thickness. By adding additional build-up the influence of trays and blocks can be almost eliminated. CONCLUSIONS: The correction factor variation of unmodified diodes reflects the variation of the electron contamination with treatment geometry. A total build-up thickness of 30 mm is found to be the 'best compromise' for the three types of diodes investigated when measuring entrance doses in the energy range between 18 and 25 MV.     

Experimental intrahepatic portacaval anastomosis: use of expandable Gianturco stents

Original Gianturco expandable stents and their modifications were used to create an experimental intrahepatic portacaval anastomosis (EIPCA) in 30 young domestic swine without portal hypertension. The study focused on the design of a suitable stent, the technique of its application, and the evaluation of short-term patency of the EIPCA. A stent with a 2.5-cm-long body and wire skirts on both ends was most suitable for EIPCA creation. Well-positioned stents shunted most of the portal blood in the inferior vena cava circulation and remained patent for 4-6 weeks. Ingrowth of liver parenchyma and abundant proliferation of the intima and connective tissue inside the stent lumen in these rapidly growing animals gradually decreased EIPCA patency, and thrombus formation with diminished blood flow closed them completely.