Perfusion lung scan in patients operated for transposition of the great arteries

Fifty perfusion lung scans were performed with Tc-99m albumin microspheres in 42 patients, 15 days to 12 years after corrective surgery for transposition of the great arteries. The scan was entirely normal in nine of 42 patients. Absence of left lung perfusion was observed in three patients and hypoperfusion of the left lung in 19 patients. Segmentary zones of hypoperfusion was visualized in 13 patients either in the right or left lung. A moderate right to left shunt was observed in eight cases. The absence or decrease in left lung perfusion was due to pulmonary vein occlusion in four patients, left pulmonary artery stenosis in two patients, and preferential right blood flow in one patient. Right to left shunt was due to dehiscence of the atrial patch in four patients.     

SEM-EDX study of prepared human dentine surfaces exposed to gingival retraction fluids

OBJECTIVES: To evaluate the effects of gingival retraction fluids (GRF) on prepared dentine surfaces, and to test the null-hypothesis that prior exposure of dentine surfaces for prolonged period to any of the fluids evaluated does not influence acid-etching of the exposed surfaces. METHODS: The investigation was carried out using SEM and energy-dispersive X-ray analysis (EDX). The GRF studied were Hemodent (HMDT), Astringedent (AST) and Ultradent buffered 25% Aluminium Chloride (ULTB). Longitudinal sections of 220-grit ground dentine surfaces were exposed to GRF for 0.5-, 1-, 2- and 5-min (n=4 each). Another group of samples was produced by 20s application of 35% phosphoric acid (PA) on GRF-pretreated dentine. Control samples were not exposed to GRF. Differences in etching effect-a function of the Ca-contents detected by EDX, were analysed using Friedman's and Wilcoxon's rank test (P<0.05). RESULTS: The SEM demonstrated the presence of a relatively non-porous amorphous dentine matrix, but many of the dentine tubule orifices remained occluded. Granular precipitates, which remained even after acid-etching, were noted on surfaces exposed to Hemodent for 5 min. Characteristic crystal growth was observed on surfaces exposed to Astringedent for 1- or 2-min prior to acid-etching. The EDX data demonstrated that there were differences in resulting Ca-content; ULTB >AST>HMDT>ULTB+PA>HMDT+PA>AST+PA>PA, but AST and HMDT were not significantly different. CONCLUSIONS: The exposure of dentine prepared surfaces to these three GRF altered its morphology and reduced the dentine's susceptibility to acid-etching, thus the null-hypothesis is rejected.     

Evidence-based review of three-dimensional conformal radiotherapy for localized prostate cancer: an ASTRO outcomes initiative

PURPOSE: To perform a systematic review of the evidence to determine the efficacy and effectiveness of three-dimensional conformal radiotherapy (3D-CRT) for localized prostate cancer; provide a clear presentation of the key clinical outcome questions related to the use of 3D-CRT in the treatment of localized prostate cancer that may be answered by a formal literature review; and provide concise information on whether 3D-CRT improves the clinical outcomes in the treatment of localized prostate cancer compared with conventional RT. METHODS AND MATERIALS: We performed a systematic review of the literature through a structured process developed by the American Society for Therapeutic Radiology and Oncology's Outcomes Committee that involved the creation of a multidisciplinary task force, development of clinical outcome questions, a formal literature review and data abstraction, data review, and outside peer review. RESULTS: Seven key clinical questions were identified. The results and task force conclusions of the literature review for each question are reported. CONCLUSION: The technological goals of reducing morbidity with 3D-CRT have been achieved. Randomized trials and follow-up of completed trials remain necessary to address these clinical outcomes specifically with regard to patient subsets and the use of hormonal therapy.     

Selective mediastinal node irradiation based on FDG-PET scan data in patients with non-small-cell lung cancer: a prospective clinical study

PURPOSE: To evaluate the patterns of recurrence when selective mediastinal node irradiation based on FDG-PET scan data is used in patients with non-small-cell lung cancer (NSCLC). METHODS AND MATERIALS: A prospective Phase I/II study was undertaken on 44 patients with NSCLC without detectable distant metastases on CT and FDG-PET scan, delivering either 61.2 Gy in 34 fractions over 23 days or 64.8 Gy in 36 fractions over 24 days (1.8 Gy b.i.d. with 8-h interval). Only the primary tumor and the positive mediastinal areas on the pretreatment FDG-PET scan were irradiated. Isolated nodal failure was defined as recurrence in the regional nodes outside of the clinical target volume, in the absence of in-field failure. RESULTS: The CT and FDG-PET stage distribution was as follows: Stage I: 8 patients (18%) and 13 patients (29%); Stage II: 6 patients (14%) and 10 patients (23%); Stage IIIA: 15 patients (34%) and 7 patients (16%); Stage IIIB: 15 patients (34%) and 14 patients (32%), respectively. After a median follow-up time of 16 months (95% confidence interval [CI], 11-21 months) postradiotherapy, 11 patients (25%) developed a local recurrence. Only 1 patient (crude rate, 2.3%; upper bound of 95% CI, 10.3%), with a Stage II tumor on both CT and PET, developed an isolated nodal failure. The median actuarial overall survival was 21 months (95% CI, 14-28 months), and the median actuarial progression-free survival was 18 months (95% CI, 12-24 months). CONCLUSIONS: Selective mediastinal node irradiation based on FDG-PET scan data in patients with NSCLC results in low isolated nodal failure rates. In the Phase I component of this trial, radiation dose escalation up to 64.8 Gy in 36 fractions over 24 days is feasible.