Validation of a simple method for measuring cranial deformities (plagiocephalometry)

Craniofacial measuring is essential for diagnosis or evaluation of growth and therapies. Skull deformities in children are mainly caused by craniosynostosis or by external pressure in positional skull deformations. Traditional anthropometry does not sufficiently analyze craniofacial shape. In computed tomography (CT) scanning, radiation loads are considerable. Both CT and magnetic resonance imaging (MRI) scanning require anaesthesia in children for accurate imaging, due to their long acquisition time. This makes CT and MRI unsuitable for long term follow-up of pediatric patients unless there is a compelling reason. Other noninvasive three-dimensional (3D) surface scanners still have limited practical use. van Vlimmeren et al presented plagiocephalometry (PCM) as a simple and versatile instrument to quantify skull deformities with high intrarater and interrater reliability, but no comparison was made with the actual skull shape.At the Erasmus University Medical Center Rotterdam, Sophia Children's Hospital PCM was compared to 3D-CT scanning in 21 children with craniosynostosis early in life. The PCM ring proved to fit closely to the skin with mean differences less than 1 mm (P < 0.05). The shape of the PCM ring was not significantly changed when taken off the head (P > 0.05). Finally, no significant differences are shown between measurements on the skull (CT-scan) and PCM ring off the head (P > 0.05).This study proves that PCM is a reliable method for analysis of skull deformities. The measurements are in agreement with 3D-CT scanning as golden standard. Although only 2-dimensional measurements are performed by PCM, the combination of simplicity, reliability, and validity make it a promising tool for daily practice.     

Accuracy of cranial coplanar beam therapy using an oblique, stereoscopic x-ray image guidance system

A system for measuring two-dimensional (2D) dose distributions in orthogonal anatomical planes in the cranium was developed and used to evaluate the accuracy of coplanar conformal therapy using ExacTrac image guidance. Dose distributions were measured in the axial, sagittal, and coronal planes using a CIRS (Computerized Imaging Reference Systems, Inc.) anthropomorphic head phantom with a custom internal film cassette. Sections of radiographic Kodak EDR2 film were cut, processed, and digitized using custom templates. Spatial and dosimetric accuracy and precision of the film system were assessed. BrainScan planned a coplanar-beam treatment to conformally irradiate a 2-cm-diameter x 2-cm-long cylindrical planning target volume. Prior to delivery, phantom misalignments were imposed in combinations of +/- 8 mm offsets in each of the principal directions. ExacTrac x-ray correction was applied until the phantom was within an acceptance criteria of 1 mm/1 degrees (first two measurement sets) or 0.4 mm/0.4 degrees (last two measurement sets). Measured dose distributions from film were registered to the treatment plan dose calculations and compared. Alignment errors, displacement between midpoints of planned and measured 70% isodose contours (Deltac), and positional errors of the 80% isodose line were evaluated using 49 2D film measurements (98 profiles). Comparison of common, but independent measurements of Deltac showed that systematic errors in the measurement technique were 0.2 mm or less along all three anatomical axes and that random error averaged [formula: see text] 0.29+/-0.06 mm for the acceptance criteria of 1 mm/1 degrees and 0.15 +/- 0.02 mm for the acceptance criteria of 0.4 mm/0.4 degrees. The latter was consistent with independent estimates that showed the precision of the measurement system was 0.3 mm (2sigma). Values of Deltac were as great as 0.9, 0.3, and 1.0 mm along the P-A, R-L, and I-S axes, respectively. Variations in Deltac along the P-A axis were correlated to misalignments between laser isocenter and radiation isocenter as documented by daily clinical Lutz tests. Based on results of comparisons of measured with calculated positions of the 80% dose lines along the major anatomical axes, a 1.25, 1.0, and 1.0 mm (0.75, 0.5, and 0.25 mm) gross tumor volume (GTV)-planning target volume (PTV) margin to account for delivery error would be appropriate for the P-A, R-L, and I-S axes, respectively, for an acceptance criteria of 1 mm/1 degrees (0.4 mm/0.4 degrees). It typically took 2 (3) ExacTrac x-ray image sets to achieve and verify acceptance criteria of 1 mm/1 degrees (0.4 mm/0.4 degrees). Our results demonstrated a measurement technique using a CIRS anthropomorphic head phantom with a modified film cassette, radiographic film (Kodak EDR2) with a custom film cutting template, and film dosimetry software has been developed and successfully applied to our clinic. It is recommended that a third party offer this service. Our goal of achieving accuracy of delivery of 1 mm or better in each of the three major anatomical axes was almost, but not quite achieved, not because of the accuracy of the image guidance system, but likely due to inaccuracy of laser isocenter and other systematic errors.     

中耳乳突结核8例分析

目的对中耳乳突结核的诊疗方案进行探讨.方法回顾性分析我科自1986～2003年共收治的中耳乳突结核8例(9耳).其中手术加抗痨治疗6例(7耳),单纯抗痨治疗2例(2耳),均有病理诊断.结果随访6个月～3年,8例(9耳)耳漏均停止,听力改善不明显,手术的6例(7耳)术腔均上皮化,耳漏停止.结论正规抗痨治疗是中耳乳突结核的基本方案,而手术可以清除中耳乳突炎性肉芽及死骨.     

Long-term health-related quality of life in head and neck cancer survivors: A large multinational study

Head and neck cancer (HNC) patients suffer from a range of health-related quality of life (HRQoL) issues, but little is known about their long-term HRQoL. This study explored associations between treatment group and HRQoL at least 5 years' post-diagnosis in HNC survivors. In an international cross-sectional study, HNC survivors completed the European Organization for Research and Treatment of Cancer (EORTC) quality of life core questionnaire (EORTC-QLQ-C30) and its HNC module (EORTC-QLQ-H&N35). Meaningful HRQoL differences were examined between five treatment groups: (a) surgery, (b) radiotherapy, (c) chemo-radiotherapy, (d) radiotherapy ± chemotherapy and neck dissection and (e) any other surgery (meaning any tumour surgery that is not a neck dissection) and radiotherapy ± chemotherapy. Twenty-six sites in 11 countries enrolled 1105 survivors. They had a median time since diagnosis of 8 years, a mean age of 66 years and 71% were male. After adjusting for age, sex, tumour site and UICC stage, there was evidence for meaningful differences (10 points or more) in HRQoL between treatment groups in seven domains (Fatigue, Mouth Pain, Swallowing, Senses, Opening Mouth, Dry Mouth and Sticky Saliva). Survivors who had single-modality treatment had better or equal HRQoL in every domain compared to survivors with multimodal treatment, with the largest differences for Dry Mouth and Sticky Saliva. For Global Quality of Life, Physical and Social Functioning, Constipation, Dyspnoea and Financial Difficulties, at least some treatment groups had better outcomes compared to a general population. Our data suggest that multimodal treatment is associated with worse HRQoL in the long-term compared to single modality.     

Stimulated neovascularization, inflammation resolution and collagen maturation in healing rat cutaneous wounds by a heparan sulfate glycosaminoglycan mimetic, OTR4120

Heparan sulfate glycosaminoglycans (HS-GAGs) are not only the structural elements of tissue architecture but also regulate the bioavailability and transduction pathways of heparan sulfate-bound polypeptides released by cells or the extracellular matrix. Heparan sulfate-bound polypeptides include inflammatory mediators, chemokines, angiogenic factors, morphogens, and growth-promoting factors that induce cell migration, proliferation, and differentiation in wound healing. OTR4120, a polymer engineered to mimic the properties of HS-GAGs, is used to replace the natural HS-GAGs that are degraded during wound repair, and enhance the tissue regeneration by preserving the cellular microenvironment and the endogenous signals needed for tissue regeneration. We previously demonstrated that OTR4120 treatment had a long-term effect on increasing breaking strength and vasodilation in healing rat full-thickness excisional wounds. The present study investigates the underlying mechanisms of the effects of OTR4120 treatment in improving the quality of cutaneous wound repair. We found that OTR4120 treatment stimulated inflammation resolution and increased neovascularization. OTR4120 treatment also promoted epidermal migration and proliferation during reepithelialization. Moreover, the granulation tissue formation and collagen maturation were improved in OTR4120-treated wounds. Three months after wounding, the effects of OTR4120 treatment on vascularization and inflammation resolution were normalized, except for an improved neodermis. We conclude that OTR4120 is a potential matrix therapeutic agent that ensures the quality of normal cutaneous wound repair and may restore impaired wound healing characterized by deficient angiogenesis and prolonged inflammation.