Comparison of dynamic and step-and-shoot intensity-modulated radiation therapy planning and delivery.

Intensity-modulated radiation therapy (IMRT) is commonly delivered using the dynamic or segmental mode of multileaf collimators (DMLC or SMLC). Both methods are designed to deliver intensity-modulated beams as determined by inverse planning software. In this study, we have used the Helios IMRT planning system to generate ideal treatment plans for 10 cases of 2 common treatment sites (prostate and head and neck) and have investigated the actual treatment fluence distributions generated for each of the MLC leaf motion choices. The 2 dose delivery techniques were dosimetrically compared to each other and to the treatment plans. For each technique, point doses were measured in a water phantom using ionization chambers. Also for each technique, 2-dimensional dose distributions at a selected depth in a plastic phantom were obtained, using extended range film. The total delivery time and the number of monitor units (MU) delivered by each method were also compared. Our results indicate that the 2 delivery methods produce comparable results dosimetrically. For the cases reviewed, the delivery time was an average of 15% longer for SMLC deliveries, while the number of MUs (beam-on time) required by SMLC was an average of 15% fewer, than that for the DMLC. In the interest of simplicity, lower beam-on time, and potentially fewer mechanically-related problems, we think that the SMLC delivery technique may be the better choice when Helios is used for planning and Varian linear accelerators are used for delivery.     

SUICIDE ATTEMPT DUE TO METOCLOPRAMIDE-INDUCED AKATHISIA

Akathisia as a side-effect of metoclopramide has received increasing attention in consultation-liaison psychiatry in recent years. A case of metoclopramide-induced akathisia resulting in a suicide attempt is reported in order to highlight the suffering of such patients and the factors that lead to misdiagnosis.     

Alternatives in the surgical management of in situ breast cancer. A meta-analysis of outcome

The surgical management of lobular carcinoma in situ (LCIS) and ductal carcinoma in situ (DCIS) remains controversial. For in situ breast cancer local excision (LE), local excision and radiation therapy (LERT) and mastectomy (MAST) have all been advocated. A search of the English literature found 13 reports concerning the surgical management of LCIS and 12 reports concerning the management of DCIS. The data were combined in a meta-analysis of outcome. As expected, recurrence rates following LE with both LCIS 8.4%) and DCIS (17%) are high. However,the overall mortality following mastectomy for recurrence, LCIS (2.8%) and DCIS (2.3%) does not differ statistically from those treated initially with mastectomy for LCIS (0.9%) and DCIS (1.7%). We conclude from these data that local recurrence after breast conserving procedures for in situ breast cancer does not carry an ominous prognosis. This knowledge should aid in planning individual therapy.     

The ocular changes of incontinentia pigmenti achromians (hypomelanosis of Ito)

Incontinentia pigmenti achromians is a multisystem hereditary disorder characterized specifically by a whorled or streaked cutaneous hypopigmentation and frequently characterized by numerous neurologic, musculoskeletal, and ocular abnormalities. We present a patient with incontinentia pigmenti achromians in whom the ocular abnormalities included the commonly reported exotropia, myopia, small optic nerve, and hypopigmentation of the fundus, as well as rarely reported corneal asymmetry, pannus, and atropic irides with irregular pupillary margins. The patient also had a cataract in the right eye and a retinal detachment in the left eye.     

Growth hormone resistance in uremia

Growth retardation is a major complication in children with uremia. Protein restriction, calorie deficit, metabolic acidosis, renal osteodystrophy, and endocrinologic disturbances contribute to the growth failure. The effect of these factors on growth retardation can be attenuated in part by therapy with vitamin D metabolites, adequate nutrition, alkalization, and dialysis. Linear growth in children with uremia is markedly retarded despite normal or increased levels of circulating serum growth hormone. An increased growth hormone level in children with uremia is due to normal growth hormone secretion from the pituitary gland and impaired growth hormone clearance in the kidney. However, the elevated growth hormone level does not lead to a commensurate rise in serum insulin-like growth factor I (IGF-I); the serum IGF-I level is decreased or normal in relation to the degree of renal failure. This discrepancy suggests growth hormone resistance in the liver in uremia. Recent molecular techniques open a new era in studying the gene expression for growth hormone or IGF-I. There is no doubt today that growth hormone treatment has the beneficial effect of growth promotion in children with uremia, which also suggests endogenous growth hormone resistance in target organs or target cells in uremia.     

Sticking coefficients of adsorbing proteins.

The protein sticking coefficient, phi, the fraction of collisions that result in adsorption, is a function of the molecular interactions between the protein and the surface. A random walk and diffusion-to-capture model was used to describe the kinetics of protein adsorption. The assumption of a constant sticking coefficient leads to a first-order model of the kinetics. A solution of the problem of adsorption from a semi-infinite medium with first-order kinetics at the boundary was obtained by numerical simulation on the computer. The results of the computer simulations match the time dependence observed experimentally. A correlation was developed to estimate phi from experimental data. phi has been found to be in the range 10(-5)-10(-8) for several protein adsorption kinetic studies reported in the literature.