Effects of radiotherapy planning with a dedicated combined PET-CT-simulator of patients with non-small cell lung cancer on dose limiting normal tissues and radiation dose-escalation: a planning study.

BACKGROUND AND PURPOSE: To investigate the effect of radiotherapy planning with a dedicated combined PET-CT simulator of patients with locally advanced non-small cell lung cancer. PATIENTS AND METHODS: Twenty-one patients underwent a pre-treatment simulation on a dedicated hybrid PET-CT-simulator. For each patient, two 3D conformal treatment plans were made: one with a CT based PTV and one with a PET-CT based PTV, both to deliver 60Gy in 30 fractions. The maximum tolerable prescribed radiation dose for CT versus PET-CT PTV was calculated based on constraints for the lung, the oesophagus, and the spinal cord, and the Tumour Control Probability (TCP) was estimated. RESULTS: For the same toxicity levels of the lung, oesophagus and spinal cord, the dose could be increased from 55.2+/-2.0Gy with CT planning to 68.9+/-3.3Gy with the use of PET-CT (P=0.002), with corresponding TCP's of 6.3+/-1.5% for CT and 24.0+/-5.6% for PET-CT planning (P=0.01). CONCLUSIONS: The use of a combined dedicated PET-CT-simulator reduced radiation exposure of the oesophagus and the lung, and thus allowed significant radiation dose escalation whilst respecting all relevant normal tissue constraints.     

Ability and willingness to pay for family planning services in low resource settings: evidence from an operational research

ObjectiveThis paper establishes levels and patterns of ability and willingness to pay (AWTP) for contraceptives, and associated factors.Study designA three-stage cluster and stratified sampling was applied in selection of enumeration areas, households and individuals in a baseline survey for a 5-year Family planning programme. Multivariable linear and modified Poisson regressions are used to establish factors associated with AWTP.ResultsAbility to pay was higher among men (84%) than women (52%). A high proportion of women (96%) and men (82%) were able to pay at least Ug Shs 1000 ($0.27) for FP services while 93% of women and 83% of men who had never used FP services will in future be able to pay for FP services costed at least Shs 2000 ($0.55). The factors independently associated with AWTP were lower age group (<25 years), residence in urban areas, attainment of higher education level, and higher wealth quintiles.ConclusionAWTP for FP services varied by different measures. Setting the cost of FP services at Shs 1000 ($0.27) will attract almost all women (96%) and most of men (82%). Key determinants of low AWTP include residence in poor regions, being from rural areas and lack of/low education.Implications statement: Private providers should institute price discrimination for FP services by region, gender and socioeconomic levels. More economic empowerment for disadvantaged populations is needed if the country is to realise higher contraceptive uptake. More support for total market approach for FP services needed.     

The resilience of the inner ear—vestibular and audiometric impact of transmastoid semicircular canal plugging

Journal of Neurology - Certain cases of superior semicircular canal dehiscence or benign paroxysmal positional vertigo can be treated by plugging of the affected semicircular canal. However, the...     

Laparoscopic cholecystectomy under segmental thoracic spinal anaesthesia: a feasibility study

Background: Laparoscopic surgery is normally performed under general anaesthesia,but regional techniques have been found beneficial, usuallyin the management of patients with major medical problems. Encouragedby such experience, we performed a feasibility study of segmentalspinal anaesthesia in healthy patients. Methods: Twenty ASA I or II patients undergoing elective laparoscopiccholecystectomy received a segmental (T10 injection) spinalanaesthetic using 1 ml of bupivacaine 5 mg ml^–1 mixedwith 0.5 ml of sufentanil 5 µg ml^–1. Other drugswere only given (systemically) to manage patient anxiety, pain,nausea, hypotension, or pruritus during or after surgery. Thepatients were reviewed 3 days postoperatively by telephone. Results: The spinal anaesthetic was performed easily in all patients,although one complained of paraesthesiae which responded toslight needle withdrawal. The block was effective for surgeryin all 20 patients, six experiencing some discomfort which wasreadily treated with small doses of fentanyl, but none requiringconversion to general anaesthesia. Two patients required midazolamfor anxiety and two ephedrine for hypotension. Recovery wasuneventful and without sequelae, only three patients (all forsurgical reasons) not being discharged home on the day of operation. Conclusions: This preliminary study has shown that segmental spinal anaesthesiacan be used successfully and effectively for laparoscopic surgeryin healthy patients. However, the use of an anaesthetic techniqueinvolving needle insertion into the vertebral canal above thelevel of termination of the spinal cord requires great cautionand should be restricted in application until much larger numbersof patients have been studied.     

Presymptomatic and predictive genetic testing in minors: a systematic review of guidelines and position papers

The objective of this study is to review ethical and clinical guidelines and position papers concerning the presymptomatic and predictive genetic testing of minors. The databases Medline, Philosopher's Index, Biological Abstracts, Web of Science and Google Scholar were searched using keywords relating to the presymptomatic and predictive testing of children. We also searched the websites of the national bioethics committees indexed on the websites of World Health Organization (WHO) and the German Reference Centre for Ethics in the Life Sciences, the websites of the Human Genetics Societies of various nations indexed on the website of the International Federation of Human Genetics Societies and related links and the national medical associations indexed on the website of the World Medical Association. We retrieved 27 different papers dealing with guidelines or position papers that fulfilled our search criteria. They encompassed the period 1991-2005 and originated from 31 different organizations. The main justification for presymptomatic and predictive genetic testing was the direct benefit to the minor through either medical intervention or preventive measures. If there were no urgent medical reasons, all guidelines recommend postponing testing until the child could consent to testing as a competent adolescent or as an adult. Ambiguity existed for childhood-onset disorders for which preventive or therapeutic measures are not available and for the timing of testing for childhood-onset disorders. Although the guidelines covering presymptomatic and predictive genetic testing of minors agree strongly that medical benefit is the main justification for testing, a lack of consensus remains in the case of childhood-onset disorders for which preventive or therapeutic measures are not available.     

Validation of confocal microscopy through focusing for corneal sublayer pachymetry

PURPOSE: To evaluate the accuracy and precision of confocal microscopy through focusing (CMTF) for corneal sublayer pachymetry. METHODS: A tandem scanning confocal microscope equipped with a nonapplanating contact objective was used to perform CMTF. The accuracy of CMTF measurements was evaluated using nine custom-made calibration contact lenses (PMMA) with varying thickness (300-600 microm) and radius of curvature (7.0-9.0 mm). The influence of immersion fluid stabilization and the consequence of prolonged corneal examination were assessed by performing CMTF in rabbits. Additionally, factors related to the instrumental setup and to sedation of experimental animals were examined. RESULTS: For all calibration contact lenses, the thickness measured by CMTF was within +/-1.0 microm of the certified value. Varying the target thickness or radius of curvature had no consistent impact on the high accuracy of CMTF. When performing CMTF in vivo, z-axis motion was readily identified by sampling and comparing both in- and out-scans. Apart from involuntary eye movements, z-axis motion was due to initial thinning of the immersion fluid with stabilization obtained after approximately 1.5 minutes. Continued confocal examination led to slight but significant swelling of both the stroma (0.5 microm/min) and epithelium (0.1 microm/min). CONCLUSIONS: CMTF is an accurate and precise technique for corneal sublayer pachymetry with concurrent display of cellular morphology. The precision of CMTF can be improved by allowing time for methylcellulose stabilization and by performing repeated two-way (in and out) scans to account for z-axis motion.