Registration accuracy and possible migration of internal fiducial gold marker implanted in prostate and liver treated with real-time tumor-tracking radiation therapy (RTRT).

BACKGROUND AND PURPOSE: We have developed a linear accelerator synchronized with a fluoroscopic real-time tumor-tracking system to reduce errors due to setup and organ motion. In the real-time tumor-tracking radiation therapy (RTRT) system, the accuracy of tumor tracking depends on the registration of the marker's coordinates. The registration accuracy and possible migration of the internal fiducial gold marker implanted into prostate and liver was investigated.MATERIALS AND METHODS: Internal fiducial gold markers were implanted in 14 patients with prostate cancer and four patients with liver tumors. Computed tomography (CT) was carried out as a part of treatment planning in the 18 patients. A total of 72 follow-up CT scans were taken. We calculated the relative relationship between the coordinates of the center of mass (CM) of the organs and those of the marker. The discrepancy in the CM coordinates during a follow-up CT compared to those recorded during the planning CT was used to study possible marker migration.RESULTS: The standard deviation (SD) of interobserver variations in the CM coordinates was within 2.0 and 0.4 mm for the organ and the marker, respectively, in seven observers. Assuming that organs do not shrink, grow, or rotate, the maximum SD of migration error in each direction was estimated to be less than 2.5 and 2.0 mm for liver and prostate, respectively. There was no correlation between the marker position and the time after implantation.CONCLUSION: The degree of possible migration of the internal fiducial marker was within the limits of accuracy of the CT measurement. Most of the marker movement can be attributed to the measurement uncertainty, which also influences registration in actual treatment planning. Thus, even with the gold marker and RTRT system, a planning target volume margin should be used to account for registration uncertainty.     

Adrenal masses: quantification of fat content with double-echo chemical shift in-phase and opposed-phase FLASH MR images for differentiation of adrenal adenomas

PURPOSE: To quantify fat content in adrenal lesions with double-echo chemical shift magnetic resonance (MR) imaging in a phantom study and to differentiate adrenal adenomas from other adrenal masses by assessing fat content in a clinical study. MATERIALS AND METHODS: The study consisted of two parts: a phantom study and a clinical study. To explore the effect of the T1 value on in- and opposed-phase MR images of fat-containing tissues, phantom models with various proportions of fat and gadopentetate dimeglumine concentrations were implemented. Signal intensity (SI) indexes ([SI in-phase - SI opposed-phase]/SI in-phase) were calculated with double-echo fast low-angle shot (FLASH) MR imaging. In the clinical study, 23 patients with 28 adrenal masses (16 adrenal adenomas, nine adrenal metastases, and three pheochromocytomas) underwent double-echo FLASH MR imaging, and SI indexes were calculated. RESULTS: SI index reached a maximum of 0.87 at 53% fat fraction for gadopentetate dimeglumine concentration at 0.5 mmol/L as the simulated T1 of the adrenal mass. The SI indexes of the adrenal adenomas, adrenal metastases, and pheochromocytomas, respectively, were 0.36, -0.15, and -0.07, and estimated fat fraction from the phantom study was 26.5%, 0%, and 0%. All adrenal adenomas contained fat on double-echo FLASH images. There was no overlap in SI index between adenomas and other tumors. CONCLUSION: Preliminary experience indicates that quantitative measurement of the fat fraction of adrenal masses is possible with the double-echo chemical shift FLASH technique and allows for differentiating adrenal adenomas from other adrenal masses.     

Inhibitory Effects of S-Methylcysteine and Cysteine on the Promoting Potential of Sodium Phenobarbital on Rat Liver Carcinogenesis

The effects of S-methylcysteine (SMC) and eysteine on the promotion stages of rodent hepatocar-cinogenesis in a medium-term bioassay previously developed by Ito were examined. Initiation was induced by a single dose of diethylnitrosamine (DEN), followed by dietary administration of the promoter sodium phenobarbital (NaPB) 2 weeks later, for 6 weeks. Partial hepatectomy was conducted on all the animals at week 3. Inhibitory potential was evaluated by analyzing two markers of carcinogenesis, namely numbers of glutathione S-transferase placental form (GST-P)-positive foci, and proliferating cell nuclear antigen (PCNA). In addition, the level of ornithine decarboxylase (ODC), one of the rate-limiting enzymes of polyamine metabolism induced by promoters, was analyzed. SMC and cysteine induced significant reduction in the areas of GST-P-positive foci. A significant reduction in the PCNA index was observed in the entire liver as well as in GST-P-positive areas. SMC also induced down-regulation of the ODC enzyme activity. Thus, SMC and cysteine were found to inhibit the promotion stage of DEN-induced hepatocarcinogenesis. No cocarcinogenic effects were evident on administration of either of these chemicals with NaPB.     

Primary Ewing's sarcoma family tumors of the lung a case report and review of the literature

Ewing's sarcoma family tumors (ESFT) have been reported to originatein a variety of sites, most commonly in the extremities. Weherein report a case of a primary ESFT of the lung presentingin an 8-year-old boy. A histological examination of hematoxylin–eosinstained sections showed a homogeneous population of closelypacked small neoplastic cells. The tumor cells were stronglypositive for CD99/MIC2 and negative for the leukocyte commonantigen, myoglobin, desmin, epithelial membrane antigen, AE1/AE3and synaptophysin. The patient was treated with neoadjuvantchemotherapy and surgery. Nine months later, he is in good conditionand chest CT scans have revealed no evidence of either localrecurrence or distant metastasis. Cases of ESFT of the lunghave been reported in recent years but there are still few reportsof primary ESFT of the lung. To date, only eight cases of ESFTof the lung have been reported in the literature. This is thefirst report of an ESFT of the lung occurring in a patient under10 years of age. The clinical course and therapeutic managementof ESFT are also discussed.     

Burkitt lymphoma of the uterus in a human T lymphotropic virus type-1 carrier

A 71-year-old Japanese woman who was seropositive for T-lymphotropic virus type-1 (HTLV-1) developed primary Burkitt lymphoma of the uterus. CT showed marked enlargement of the uterine body. Chromosomal abnormalities were detected in biopsied cells, and most showed the t (8; 14) (q24; q32) translocation. Fluorescence in situ hybridization (FISH) with a dual-color stain for IgH/C-MYC fusion showed 99% positively. Biopsies from abdominal operation were diagnosed as Burkitt lymphoma. Treatment was started with intensive chemotherapy according to a protocol for Burkitt lymphoma and mature-B cell leukemia. Two regimens were done with four courses with rituximab. Treatment response was fast, with a documented and lasting first complete remission on CT and laboratory markers after the 4 cycle treatment.     

Effects of home massage rehabilitation therapy for the bed-ridden elderly: a pilot trial with a three-month follow-up

OBJECTIVES: To assess the effects of home massage rehabilitation therapy on the bed-ridden elderly. DESIGN: Alternatively allocated trial. SETTING: Subjects' homes, three home nursing stations, 13 visit care stations and one day service centre in Aichi prefecture, Japan. SUBJECTS: Bed-ridden patients who were 65 years and above, no dementia, stable general condition, and receiving no rehabilitation therapy. INTERVENTION: Thirty-minute sessions of home massage rehabilitation therapy by a massage practitioner 2 or 3 days a week for three consecutive months or usual care. MAIN MEASUREMENTS: Barthel Index (BI), Subjective Satisfaction and Refreshment Scale, Apathy Scale and Self-rating Depression Score. RESULTS: Fifty-three subjects were recruited, 26 in the home massage rehabilitation group (HMG) and 27 in the routine care group without massage (RCG). The protocol was completed for 40 subjects, 22 in the HMG and 18 in the RCG. There were no significant differences between the baseline characteristics of both groups; age, presence of spouse, diseases associated with disabilities and use of day care rehabilitation (p = 0.76, 0.36, 0.94 and 0.71, respectively). The total BI score of the HMG (15.27+/-4.51) at baseline was nonsignificantly lower (p= 0.03) than those of the RCG (11.44+/-5.90). Subjective Satisfaction and Refreshment Scale, Apathy Scale and Self-rating Depression Score of both groups at baseline were matched (p = 0.12, 0.32 and 0.89, respectively). There were no statistical differences between the intergroup changes over time in BI, Subjective Satisfaction and Refreshment Scale, Apathy Scale and Self-rating Depression Score (p = 0.35, 0.08, 0.70 and 0.55, respectively). CONCLUSION: Home massage rehabilitation therapy did not show a positive effect on the bed-ridden elderly, either mentally or physically. We would require large-size trials to determine whether it is effective.     

Synergistic effect of fosfomycin and fluoroquinolones against Pseudomonas aeruginosa growing in a biofilm

Ulifloxacin is the active form of the prodrug prulifloxacin and shows a highly potent antipseudomonal activity. In this study, we examined the combined effect of fosfomycin and ulifloxacin against Pseudomonas aeruginosa (P. aeruginosa) growing in a biofilm using a modified Robbins device with artificial urine, and compared it to that of the combination of fosfomycin and ciprofloxacin or levofloxacin. An ATP bioluminescence assay was used to evaluate the antibacterial activity of the agents against sessile cells in a mature biofilm developed on a silicon disk. The total bioactivity of P. aeruginosa growing in a biofilm that had not been fully eradicated by fosfomycin or any of the fluoroquinolones alone at 10 times the MIC decreased after combination treatment with fosfomycin and fluoroquinolones. Morphological changes occurred in a time-dependent fashion; namely, swollen and/or rounding cells emerged within a couple of hours after combination treatment, marking the initial stage in the process leading to the destruction of the biofilms. We could not find any difference among the 3 fluoroquinolones with regard to their synergistic effects when administered with fosfomycin. The combination treatment of fosfomycin and fluoroquinolones with highly potent antipseudomonal activities was effective in eradicating sessile cells of P. aeruginosa in the biofilm and promises to be beneficial against biofilm-associated infectious diseases.     

Castleman's disease arising from the accessory spleen: ultrasonography, computed tomography, and magnetic resonance imaging findings

Castleman's disease is a rare lymphoproliferative disorder of unknown etiology. To our knowledge, Castleman's disease arising from the accessory spleen has not been reported in the literature. We report the case of localized Castleman's disease arising from the accessory spleen in a 34-year-old woman and discuss the characteristic findings of ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging.