Acute Side Effects during 3-D-Planned Conformal Radiotherapy of Prostate Cancer

BACKGROUND: Radiotherapy-induced side effects are often scored retrospectively according to the EORTC/RTOG scores for organs at risk by reviewing the medical records. Some studies could prove an over- or underestimation of side effects as assessed by the medical professionals. The aim of this study was to prospectively evaluate differences in side effects as described by the doctors and the patients. PATIENTS AND METHODS: 47 patients with prostate cancer were questioned about their side effects by a radiotherapist and asked to fill in a questionnaire at the start, in the middle and at the end of radiotherapy. The data of this questionnaire and the doctor's report were scored according to the German version of the EORTC/RTOG scores for gastrointestinal (GI) and genitourinary (GU) side effects and subsequently compared. We distinguished between "moderate" disagreement (better/worse by one grade, assessed by the doctor) and "pronounced" disagreement (better/worse by two grades, assessed by the doctor). RESULTS: The number of GI and GU side effects increased during radiotherapy both according to data obtained from the doctor and the patient questionnaire. Comparing doctors' reports with patients' questionnaires, for GI side effects an agreement was found in 22/47 patients, "moderately better" scores by the doctor's report were found in 13/47 patients, and "moderately worse" scores in 9/47 patients on average. "Pronouncedly better and worse" scores were found in 2/47 patients. For GU side effects an agreement was seen in 22/47 patients, "moderately better" scores in 17/47 patients and "moderately worse" scores in 3/47 patients. Regarding GU side effects, only pronouncedly better scores, as assessed by the doctor, were found in a mean of 4/47 patients. If the EORTC/RTOG score is used in its original English version, a difference is found, particularly in the assessment of GU side effects, resulting in an higher amount of agreement concerning GU side effects and a minor amount of "pronounced disagreement". CONCLUSION: In order to evaluate radiation-induced side effects, a patient's self-reported questionnaire should be included in the analysis of morbidity, above all for grade 0, 1, and 2 side effects. The validity of data seems to be questionable, particularly in the assessment of grade 0, 1 and 2 side effects, if only data from the doctors' reports are taken into account. The German version of the EORTC/RTOG score--not including the pretreatment status--leads to different results, particularly in the assessment of grade 0, 1, and 2 urinary side effects, which asks for a revision.     

Vaginal reflux during miction-cystourethrography in girls (author's transl)

The cases of 57 girls with reflux of radioopaque iodin solution into the vagina during mictioncystourethrography are reported. In 52.6% (30 cases) no signs of anomalies of the urinary tract or of pyelonephritis were found. For this group of 30 girls pyuria (leucocyturia) was typical (in 86.6%). In contrast, a urinarty-tract infection was found only in a few cases (16.6%). The authors discuss the clinical importance of vaginal reflux and its role in the pathogenesis of urinary-tract infections.     

Escherichia coli O157:H7 generates a unique biochemical profile on MicroScan conventional gram-negative identification panels.

More than 90% of the strains of Escherichia coli O157:H7 that were identified on a MicroScan gram-negative dried conventional (overnight) panel gave one of two unique biochemical profile numbers that were not detected in other d-sorbitol-negative E. coli or in other strains isolated from pathogenic processes. This suggests that the panel has the capability of being used as a preliminary screening tool for O157:H7 strains involved in hemorrhagic colitis when MacConkey-sorbitol agar is not available.     

Thrombosis of the inferior vena cava with successive lung embolization in a 15-year-old boy with nephrotic syndrome

The authors report on a boy with typical course of recent nephrotic syndrome, who developed massive thrombosis involving the iliac inferior holden veins during the standard therapy with corticosteroid. The first sign of this complication was pulmonary embolism. Thrombosis was treated by surgery, during which 3 large thrombi from veins were removed. The patient developed recurrent thrombosis occurring at the previous sites in the later stage and he died 23 days after the first sign of thromboembolic complication. Autopsy showed only minimal glomerular changes. The cause of the death was massive pulmonary embolisation. The aethiopathogenesis of the complication and preventive approach in children with nephrotic syndrome are discussed.     

The effect of the zeolite clinoptilolite on serum chemistry and hematopoiesis in mice.

Zeolites are natural or synthetic crystalline alumosilicates with ion exchanging properties. Supplied in fodder, they promote biomass production and animal health. Our aim was to assess the effects of the natural zeolite, clinoptilolite, on hematopoiesis, serum electrolytes and essential biochemical indicators of kidney and liver function in mice. Two preparations differing in particle size were tested: a powderized form obtained by countercurrent mechanical treatment of the clinoptilolite (MTCp) and normally ground clinoptilolite (NGCp). Young adult mice were supplied with food containing 12.5, 25 or 50% clinoptilolite powder. Control animals received the same food ration without the clinoptilolite. After 10, 20, 30 and 40 days, six animals from each group were exsanguinated to obtain blood for hematological and serum for biochemical measurements as well as to collect femoral bone marrow for determination of hematopoietic activity. Clinoptilolite ingestion was well tolerated, as judged by comparable body masses of treated and control animals. A 20% increase of the potassium level was detected in mice receiving the zeolite-rich diet, without other changes in serum chemistry. Erythrocyte, hemoglobin and platelet levels in peripheral blood were not materially affected. NGCp caused leukocytosis, with concomitant decline of the GM-CFU content in the bone marrow, which was attributed to intestinal irritation by rough zeolite particles. The mechanically treated clinoptilolite preparation caused similar, albeit less pronounced, changes. In a limited experiment, mice having transplanted mammary carcinoma in the terminal stage showed increased potassium and decreased sodium and chloride levels, severe anemia and leukocytosis, decreased bone marrow cellularity and diminished content of hematopoietic progenitor cells in the marrow. The clinoptilolite preparations ameliorated the sodium and chloride decline, whereas the effects on hematopoiesis were erratic.     

In vitro susceptibilities of Edwardsiella tarda to 22 antibiotics and antibiotic-beta-lactamase-inhibitor agents

The in vitro susceptibilities of 22 isolates of Edwardsiella tarda were studied with 22 antibiotics and antibiotic-beta-lactamase-inhibitor agents. Results indicated that all isolates were susceptible to the aminoglycosides, cephalosporins, penicillins, imipenem, aztreonam, ciprofloxacin, and antibiotic-beta-lactamase-inhibitor agents. Each strain produced a beta-lactamase even though no resistance was detected to the beta-lactams.     

Ocular trauma. Triage and treatment

Many types of ocular trauma can be diagnosed and treated in the primary care office, particularly if a slit lamp is available. Treatment for corneal abrasions consists of applying a cycloplegic medication, antibiotic ointment, and a patch (unless a corneal ulcer is suspected). Iritis can be treated with cycloplegics and topical corticosteroids; the prescribing physician should be familiar with the potential ocular side effects and complications. Hyphemas are treated with bed rest, topical atropine sulfate drops and topical corticosteroids, as well as measures to prevent rebleeding. A slit lamp, topical anesthesia, and a foreign-body spud greatly facilitate the removal of foreign bodies from the cornea. Acid and alkali burns should be irrigated until the pH is normal and then should be treated like a corneal abrasion. Lid lacerations must be repaired with care to preserve proper functioning of the lid. Ruptures of the globe are serious injuries requiring surgical repair and long-term follow-up.