Correlating the degree of needle trauma during prostate brachytherapy and the development of acute urinary toxicity

PURPOSE: To determine if there is an association between the degree of prostate trauma during prostate brachytherapy and development of acute urinary toxicity. METHODS AND MATERIALS: In a consecutive prospective cohort of permanent (125)I prostate brachytherapy patients, the number of times each needle was repositioned was tracked, and the dosimetry plans were used to determine the number of times needles within 1 cm of the urethra were manipulated. Additionally, prostate volume, total number of needles, number of needles/prostate volume, and the number of periurethral needle manipulations/prostate volume were determined. The need for catheterization beyond 24 hours and the Radiation Therapy Oncology Group (RTOG) urinary toxicity score at 4 weeks were recorded. The independent samples t test was used to search for a correlation between these parameters and the recorded toxicity scores. RESULTS: Twenty-eight consecutive implant patients were evaluated in the study. Median (range) values were as follows: prostate volume 35 cc ( range, 15-51 cc), number of needles per patient 32 (range, 21-41), number of needle manipulations per patient 94.5 ( range, 55-147), and number of periurethral needle manipulations 42 (range, 17-65). The only significant association between urinary toxicity and these variables was for the number of periurethral needle manipulations (p = 0.025). CONCLUSIONS: These data provide evidence that needle prostate trauma during brachytherapy contributes to acute urinary toxicity.     

Delayed apoptotic cell clearance and lupus-like autoimmunity in mice lacking the c-mer membrane tyrosine kinase

Mice lacking the membrane tyrosine kinase c-mer have been shown to have altered macro-phage cytokine production and defective phagocytosis of apoptotic cells despite normal phagocytosis of other particles. We show here that c-mer-deficient mice have impaired clearance of infused apoptotic cells and that they develop progressive lupus-like autoimmunity, with antibodies to chromatin, DNA, and IgG. The autoimmunity appears to be driven by endogenous antigens, with little polyclonal B cell activation. These mice should be an excellent model for studying the role of apoptotic debris as an immunogenic stimulus for systemic autoimmunity.     

Metastatic choriocarcinoma in a middle-aged man presenting as a right thigh mass with venous thrombosis: a case report

Choriocarcinoma is a highly aggressive beta-subunit of human chorionic gonadotropin (betaHCG)-producing germ cell tumor. In men, it is a rare neoplasm and can arise in the testes or in various extragonadal locations such as the retroperitoneum, mediastinum, and pineal body. We present a highly unusual case of a middle-aged man with primary metastatic betaHCG-producing choriocarcinoma of the right thigh along with right lower-extremity venous thrombosis. We comment on prognostic variables as well as discuss several theories to account for the unusual location of his choriocarcinoma.     

Treatment planning aids in prostate cancer: friend or foe?

BACKGROUND: Rectal barium is commonly used as a treatment planning aid for prostate cancer to delineate the anterior rectal wall. Previous research at the Ottawa Regional Cancer Centre demonstrated that retrograde urethrography results in a systematic shift of the prostate. We postulated that rectal barium could also cause prostate motion. PURPOSE: The study was designed to evaluate the effects of rectal barium on prostate position. METHODS AND MATERIALS: Thirty patients with cT1-T3 prostate cancer were evaluated. Three fiducial markers were placed in the prostate. During simulation, baseline posterior-anterior and lateral films were taken. Repeat films were taken after rectal barium opacification. The prostate position (identified by the fiducials) relative to bony landmarks was compared before and after rectal barium. Films were analyzed using PIPsPro software. RESULTS: The rectal barium procedure resulted in a significant displacement of the prostate in the anterior and superior direction. The mean displacement of the prostate measured on the lateral films was 3.8 mm (SD: 4.4 mm) in the superior direction and 3.0 mm (SD: 3.1) in the anterior direction. CONCLUSIONS: Rectal barium opacification results in a systematic shift of the prostate. This error could result in a geographic miss of the target; therefore, alternate methods of normal tissue definition should be used.     

The pancreas and tuberculosis: a diagnostic challenge.

Pancreatic tuberculosis is often mistaken for malignancy and can pose a diagnostic challenge. A high degree of suspicion is necessary to diagnose this condition which responds well to anti-tuberculosis treatment (ATT). Fine-needle aspiration cytology helps to differentiate malignancy from treatable conditions like tuberculosis. Records of four patients treated for pancreatic tuberculosis between 1997 and 2006 were studied. All patients had a pancreatic mass which was suspected to be malignant at imaging. The diagnosis of tuberculosis was established by FNAC in one case and after laparotomy in one; two had tuberculosis of other systems. All showed good response to ATT which included resolution of the pancreatic mass over mean follow up of 2 years. We suggest that all inoperable masses of the pancreas should be subjected to FNAC to rule out treatable conditions like pancreatic tuberculosis.     

Echocardiographic characteristics of perimembranous ventricular septal defects associated with aortic regurgitation.

Development of aortic regurgitation (AR) can complicate an isolated perimembranous ventricular septal defect (VSD). The objective of this study was to identify echocardiographic features of perimembranous VSDs associated with AR. Echocardiograms were evaluated for the presence of aortic cusp override, aortic cusp movement abnormality, and presence of color flow mapping across the ventricular septum in a standard, parasternal long-axis view. Echocardiograms of 26 patients with isolated VSDs were included in the study, 13 had AR and 13 had no evidence of AR. Aortic cusp override in the apical 5-chamber and subcostal coronal views were correlated with the presence of AR, with high sensitivity and low specificity. Flow across the septum in the parasternal long-axis view was associated with AR, with moderate sensitivity and specificity. Aortic cusp movement abnormalities had high sensitivity and low specificity. Our data indicate that these findings may identify patients with perimembranous VSD susceptible to AR.