Dosimetrie an HDR-Afterloading-Geräten mit Ir-192- und Co-60-Strahler: Vergleich verschiedener internationaler Dosimetrieprotokolle

The air kerma rate in air at a reference distance of 1 meter from the source is the recommended quantity for the specification of gamma ray source in brachytherapy. The absorbed dose for the patients is directly proportional to the air kerma rate. Therefore the air kerma rate should be determined before the first use of the source on patients by a medical physicist who is independent from the source manufacturer. The air kerma rate will then be applied in the calculation of the dose delivered to patients.In practice, high dose rate (HDR) Ir-192 afterloading machines are mostly used in brachytherapy treatment. Currently HDR-Co-60 increasingly come into operation, too. The essential advantage of the use of Co-60 sources is its longer half-life compared to Ir-192. In addition, the purchasing and disposal costs are lower. The use of HDR-Co-60- afterloading machines is also quite interesting for developing countries.This work describes the dosimetry at HDR afterloading machines according to the protocols DIN 6809-2 (1993) in relation to the DGMP-Report 13 (2006), IAEA-TECDOC-1274 (2002) and AAPM Report 41 (1993) with the nuclides Ir-192 and Co-60. We have used 3 different measurement methods (with a cylindrical chamber in solid phantom and in free air and with a well chamber) in dependence of each of the protocols.We have shown that the standard deviations of the measured air kerma rate for the Co-60 source are generally larger than those of the Ir-192 source. The measurements with the well chamber had the lowest deviation from the certificate value. In all protocols and methods the deviations stood for both nuclides by a maximum of about 1.2% for Ir-192 and 2.5% for Co-60-sources respectively.     

Association between fragile X premutation and premature ovarian failure: a case–control study and meta-analysis

Aim

The aim of the present study was to investigate the association between FMR1 premutation and premature ovarian failure (POF) patients in Indian population, and a meta-analysis of published results was undertaken to clarify whether FMR1 premutation consistently contributed to the susceptibility.

Methods

A total of 289 POF samples and 360 control samples were included in the study. Repeat variation was checked using GeneScan technique. Results were analyzed with GeneMapper software. Meta-analysis was performed using the Open Meta-Analyst and STATA 12.0 software. The crude odds ratio with 95 % confidence interval (CI) was computed to assess the strength of the associations.

Results

The assayed case and control population showed 29 different CGG repeat sizes (alleles), ranging from 7 to 40. Within this population, we found that the CGG repeat length polymorphisms were within the normal range of 6–55 in both patients as well as control samples. Eleven case–control studies were included in the meta-analysis with a total of 1,313 POF cases and 3,132 control subjects. Our meta-analysis revealed that there was a significant difference in the incidence of FMR1 premutation between POF cases and control subjects with p value <0.001 (OR 5.41; 95 % CI 2.53, 11.61).

Conclusions

We found no significant association between FMR1 CGG repeat premutation and POF in Indian population. However, the meta-analysis showed an increased risk of POF associated with a premutation, especially among populations from European descent. Further functional research should be performed to explain the inconsistent results in different ethnicities and POF susceptibility.     

Isolated arterioportal fistula presenting with variceal hemorrhage

We report a case of life-threatening hematemesis due to portal hypertension caused by an isolated arterioportal fistula (APF). Intrahepatic APFs are extremely rare and are a cause of presinusoidal portal hypertension. Etiologies for APFs are comprised of precipitating trauma, malignancy, and hereditary hemorrhagic telangiectasia, but these were not the case in our patient. Idiopathic APFs are usually due to congenital vascular abnormalities and thus usually present in the pediatric setting. This is one of the first cases of adult-onset isolated APF who presented with portal hypertension and was successfully managed through endoscopic hemostasis and subsequent interventional radiological embolization.     

ADad 2: The Validation of the Screen for Child Anxiety Related Emotional Disorders for Anxiety Disorders Among Adolescents in a Rural Community Population in India

Objective

Screen for Child Anxiety Related Emotional Disorders (SCARED), a measure found useful in different settings and cultures has not been validated in the subcontinent. This study validated this measure for identifying Anxiety Disorder (AD) among adolescents in an Indian community context.

Methods

Five hundred adolescents were assessed with SCARED and DSM-IV-TR reference standard for diagnosis of AD. The interviewers were experienced raters who were further trained to interview participants using Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL). Sensitivity, specificity, likelihood ratios and predictive values for various SCARED cut-off scores were calculated. Test-retest reliability and inter-rater reliability of SCARED were examined. The dichotomized SCARED score was correlated with the DSM-IV-TR clinical diagnosis of AD to establish the criterion validity of SCARED as a measure of AD.

Results

A SCARED total score of ≥21(Sn?=?84.62 %, Sp?=?87.36 %; AUC?=?90 %) is suggested for diagnostic use in Indian population. Specific threshold scores were identified for the Panic Disorder, Generalized Anxiety Disorder, Separation Anxiety Disorder and Social Anxiety Disorder subscales. The inter-rater reliability (ICC?=?0.87) and test-retest reliability (ICC?=?0.90) for SCARED is good. Besides the adequate face and content validity, SCARED demonstrates good internal consistency (Cronbach’s α?=?0.89) and item-total correlation. There is a high concordance rate with the reference standard, DSM-IV-TR diagnosis [81 %; Cohen’s κ?=?0.42 (95 % CI?=?0.31 to 0.52); P?=?0.001] in classifying AD.

Conclusions

SCARED has adequate psychometric properties and is now available for clinical and research work in India.

     

Brain Metastases in Women With Epithelial Ovarian Cancer: Multimodal Treatment Including Surgery or Gamma-Knife Radiation Is Associated With Prolonged Survival

ObjectiveTo explore the impact of treatment modality on survival in patients with brain metastases from epithelial ovarian cancer.MethodsWe conducted a retrospective review of cases of ovarian cancer with brain metastases treated at institutions in three countries (Canada, China, and India) and conducted a search for studies regarding brain metastases in ovarian cancer reporting survival related to treatment modality. Survival was analyzed according to treatment regimens involving (1) some form of surgical excision or gamma-knife radiation with or without other modalities, (2) other modalities without surgery or gamma-knife radiation, or (3) palliation only.ResultsTwelve patients (mean age 56 years) with detailed treatment/outcome data were included; five were from China, four from Canada, and three from India. Median time from diagnosis of ovarian cancer to brain metastasis was 19 months (range 10 to 37 months), and overall median survival time from diagnosis of ovarian cancer was 38 months (13 to 82 months). Median survival time from diagnosis of brain metastasis was 17 months (1 to 45 months). Among patients who had multimodal treatment including gamma-knife radiotherapy or surgical excision, the median survival time after the identification of brain metastasis was 25.6 months, compared with 6.0 months in patients whose treatment did not include this type of focused localized modality (P = 0.006). Analysis of 20 studies also indicated that use of gamma-knife radiotherapy and excisional surgery in multi-modal treatment resulted in improved median survival interval (25 months vs. 6.0 months, P < 0.001).ConclusionIn the subset of patients with brain metastases from ovarian cancer, prolonged survival may result from use of multidisciplinary therapy, particularly if metastases are amenable to localized treatments such as gamma-knife radiotherapy and surgical excision.