Patient exposure and associated radiation risks from fluoroscopically guided vertebroplasty or kyphoplasty

PURPOSE: To derive normalized data for the estimation of effective, gonadal, and peak skin doses to patients undergoing vertebroplasty or kyphoplasty and to investigate the potential for cancer induction, genetic effects, and radiation-induced skin injury after such procedures. MATERIALS AND METHODS: Dose values normalized over dose-area product were determined for all radiosensitive organs and tissues by using a humanoid phantom and thermoluminescence dosimetry separately for anteroposterior and lateral projections. Measurements were obtained for treatments of the fifth, eighth, and 11th thoracic vertebrae and the first, third, and fifth lumbar vertebrae. Total fluoroscopy time and resultant dose-area product from each fluoroscopic exposure were monitored in 11 consecutive patients (seven women and four men) undergoing kyphoplasty. The age range of these patients was 41-78 years, and the mean age was 58 years. RESULTS: Mean total fluoroscopy time for kyphoplasty was 10.1 minutes +/- 2.2 (standard deviation). Mean effective dose to patients from kyphoplasty was 8.5-12.7 mSv, and mean gonadal dose was 0.04-16.4 mGy, depending on the level of the treated vertebra. Skin injuries after kyphoplasty are improbable if source-to-skin distance is 35 cm or more; however, such injuries may occur if the total fluoroscopy time per projection is extended and/or the source-to-skin distance is less than 35 cm during the procedure. CONCLUSION: Patient radiation exposure and associated risks from vertebroplasty or kyphoplasty may be considerable. Data obtained in the current study may be used to establish patient effective dose, gonadal dose, and entrance skin exposure, as well as associated risks, from these fluoroscopically guided surgical treatments of spinal disorders.     

Mediterranean countries impact on the implementation of Council Directive 91/414/EEC

For the implementation of the Framework Council Directive 91/414/EEC, participation of all member states (MS) is required. In the first round of the review program of plant protection products, Mediterranean countries have successfully performed their proportional work share for the central registration of the active substances and the national registration of the respective plant protection products. However, some issues of risk assessment, related to appropriate estimation of exposure, still require further refinement and adaptation to the Mediterranean conditions. Issues related to the estimation of agricultural worker exposure to plant protection products due to different agronomic practices and conditions, identified shortcomings in the consumer risk assessment related to different habits of the Mediterranean population and different needs of Mediterranean agriculture will be discussed. Finally, the possible effects of the Directive 91/414/EEC upon the plant protection of Mediterranean countries, due to the withdrawal from the market of a wide range of plant protection products is also a parameter that has to be considered.     

Massive intravascular hemolysis: a fatal complication of clostridium perfringens septicemia in a patient with acute myeloid leukemia

We describe a fatal case of a 74-year old man with acute myeloid leukemia complicated by massive intravascular hemolysis due to Clostridium perfringens sepsis.     

Monotherapy in advanced prostate cancer: an overview

Prostate cancer is the second leading malignancy in men associated with an enormous research interest in all aspects of the disease. It is well recognized that the regulation of prostatic growth is a complicated biological process. Further more the androgenic dependence of the advanced prostate cancer is well know and in the last 50 years significant progresses regarding the principle of deprivation of androgens for the treatment of the disease occured. Prostate cancer is now diagnosed in earlier stages and treatment results in increased potential for cure or extension of overall survival. Unfortunately, every treatment for prostate cancer has adverse effects with negative impact in health-related quality of life. Surgical or pharmacological castration has a significant negative impact on quality of life in patients with prostate cancer (loss of sexuality, osteoporosis, and loss of muscle mass, e.g.). Antiandrogen monotherapy is considered to be a treatment in well-informed patients who wish to remain sexually active, can be administered orally, and is well tolerated by patients with prostate cancer. This review is focused on antiandrogen monotherapy in the treatment of advanced prostate cancer.     

Elastic stable intramedullary nailing of midclavicular fractures with a titanium nail

This study presents the results of a minimally invasive operative treatment for markedly displaced midclavicular fractures. In all patients a flexible titanium nail was inserted in an unreamed technique from the sternal end of the clavicle. The result of surgery was determined with clinical and radiographic controls. The clinical outcome was evaluated 12 months after hardware removal using the scoring system of Constant and Murley. Fifty-eight fractures in 55 patients were treated with intramedullary fixation. Postoperatively on Day 3, the mean subjective pain was significantly lower and range of motion was improved compared with the day before surgery. One nonunion occurred. There was no infection and no implant displacement or refracture. Intramedullary nailing of midclavicular fractures with a flexible titanium nail is a safe minimally invasive surgical technique with excellent functional and cosmetic results compared with plate fixation or conservative treatment. Marked pain reduction along with early restoration of shoulder function and early mobilization are advantageous for patients. This technique can be used as an alternative treatment to conservative procedures or plate fixation in patients with markedly displaced midclavicular fractures, multiple trauma, fractures of the lower extremities, or associated shoulder girdle injuries.     

EphA2 as target of anticancer immunotherapy: identification of HLA-A*0201-restricted epitopes

EphA2 (Eck) is a tyrosine kinase receptor that is overexpressed in several human cancers such as breast, colon, lung, prostate, gastric carcinoma, and metastatic melanoma but not in nonmalignant counterparts. To validate EphA2 as a tumor antigen recognized by CD8+ T lymphocytes, we used reverse immunology approach to identify HLA-A*0201-restricted epitopes. Peptides bearing the HLA-A*0201-specific anchor motifs were analyzed for their capacity to bind and stabilize the HLA-A*0201 molecules. Two peptides, EphA2(58) and EphA2(550), with a high affinity for HLA-A*0201 were selected. Both peptides were immunogenic in the HLA-A*0201-transgenic HHD mice. Interestingly, peptide-specific murine CTLs cell lines responded to COS-7 cells coexpressing HLA-A*0201 and EphA2 and to EphA2-positive human tumor cells of various origin (renal cell, lung, and colon carcinoma and sarcoma). This demonstrates that EphA2(58) and EphA2(550) are naturally processed from endogenous EphA2. In addition, EphA2(58) and EphA2(550) stimulated specific CD8(+) T cells from healthy donor peripheral blood mononuclear cells. These T cells recognized EphA2-positive human tumor cells in an HLA-A*0201-restricted manner. Interestingly, EphA2-specific CD8+ T cells were detected in the peripheral blood mononuclear cells of prostate cancer patients. These results show for the first time that EphA2 is a tumor rejection antigen and lead us to propose EphA2(58) and EphA2(550) peptides for a broad-spectrum-tumor immunotherapy.     

Multiple myeloma associated with systemic lupus erythematosus

A case of systemic lupus erythematosus (SLE) complicated by multiple myeloma is presented; the lupus diagnosis was put together with the diagnosis of myeloma but the symptoms had commenced a few years before. The putative mechanisms underlying this unusual combination are discussed.     

Rationale for the clinical development of STn-KLH (Theratope) and anti-MUC-1 vaccines in breast cancer

Mucin-1 (MUC-1) is a high-molecular-weight glycoprotein rich in serine and threonine residues that are O-glycosylated. Expression of MUC-1 is increased in breast, ovarian, and other adenocarcinomas, and altered glycosylation results in exposure of novel peptide epitopes and the expression of tumor-associated carbohydrate residues, such as Thomsen-Freidenreich and sialyl-Tn (STn) antigens. Preclinical studies suggested that induction of immune response to tumor-associated carbohydrate moieties results in inhibition of tumor growth. A synthetic STn-keyhole limpet hemocyanin (KLH) vaccine (Theratope) is currently being evaluated in clinical trials as active specific immunotherapy in the treatment of advanced breast cancer. Two phase II trials in 50 breast cancer patients compared the STn-KLH vaccine with and without a single low-dose infusion of cyclophosphamide used as an immunomodulator prior to initiation of treatment. Humoral immune responses were higher in patients who had received low-dose cyclophosphamide intravenously (I.V.) compared with patients who had received no cyclophosphamide or oral cyclophosphamide. There was a statistically significant survival difference between all patients treated with the STn-KLH vaccine (overall median survival, 19.1 months; n = 50) and the retrospective control patients (overall median survival, 9.2 months; n = 104). Furthermore, patients who received cyclophosphamide I.V. prior to the STn-KLH vaccine had median survival rates close to 3 times that of patients in a retrospective, frequency-matched, control group who received conventional therapies (cyclophosphamide-I.V. group, 26.5 months vs. 9.2 months, control group). The trials reported minimal toxicity profile with local reactions in the injection site and some flu-like symptoms. On the basis of the phase II trial results, a phase III clinical trial of the STn-KLH vaccine is underway. The trial was closed to enrollment in March 2001 with the accrual of 1030 women. The final analysis is event driven and is expected to commence mid 2003.