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1.
Khaled Adil Marija Popovic Fabio L. Cury Sergio L. Faria Marie Duclos Luis Souhami 《Practical radiation oncology》2019,9(1):24-28
Purpose
This study aimed to investigate 3 planning target volume (PTV) margin expansions and determine the most appropriate volume to be used in bladder preservation therapy when using daily cone beam computed tomography (CBCT). We aimed to establish whether a smaller PTV expansion is feasible without risking geographical miss.Methods and materials
The study included patients with bladder cancer who were treated with a hypofractionated course of radiation therapy delivered with intensity modulated radiation therapy. The clinical target volume (CTV) was the whole empty bladder, and the PTV consisted of a 1.5-cm margin around the bladder (PTV1.5 cm). Patients underwent daily CBCT imaging before treatment to assess the bladder volume and ensure accurate positioning. We investigated 2 additional smaller PTV margin expansions to determine the most appropriate volume to be used with CBCT as a daily image guided radiation therapy modality. These margins were created retrospectively on every CBCT. The first additional volume was a uniform PTV margin of the surrounding 1 cm (PTV1 cm). When considering that the majority of the internal bladder movement was due to the variation in filling that occurs in the superior and anterior directions, a second volume of an anisotropic PTV margin with a 1.5-cm superior/anterior and 1 cm in other directions (PTV1/1.5 cm) was created. We recorded the frequency and measured the volume of bladder falling out of each PTV based on the daily CBCT.Results
For the purpose of this study, we considered an arbitrary 5 cm3 of CTV falling out of the designated PTV as a clinically significant volumetric miss. The frequency of such a miss when applying the uniform PTV1 cm was 1%. However, when applying the uniform PTV1.5 cm and anisotropic PTV1/1.5 cm margins, the frequency was 0.5% and 0.5%, respectively.Conclusions
The anisotropic PTV expansion of 1.5 cm superiorly and anteriorly and 1 cm in all other directions around the bladder (CTV) provides a safe PTV approach when daily CBCT imaging is used to localize an empty bladder. 相似文献2.
Increased arterial stiffness in young normotensive patients with Turner syndrome: associations with vascular biomarkers
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4.
Hidir Esme MD Huseyin Fidan MD Ahmet Cekirdekci MD 《Indian Journal of Thoracic and Cardiovascular Surgery》2006,22(2):137-140
Background Hydatid disease is the most severe helminthic zoonosis, with an important public health problem especially in rural areas
in Turkey. The aim of this study was to review the problems and advantages encountered in surgical treatment of 43 patients
who were ventilated with one-lung ventilation during last four years.
Methods Patients, operated with one-lung ventilation, constitute the study group. Data related to symptoms, radiographic findings,
performed surgical procedures, perioperative and postoperative morbidity, hospitalization time, and cyst recurrence were collected
from each individual's records.
Results Cystotomy and capitonnage were performed in all cases. Perioperative complications were seen in 5 patients. Four of these
5 patients had double-lumen endotracheal tube malpositioning. In one patient hypoxemia developed. The most common postoperative
complication was atelectasis. One patient had recurrent cysts. There was no perioperative or postoperative death.
Conclusions We prefer cystotomy and capitonnage because it is a fast and effective technique with limited postoperative complications.
One-lung ventilation prevents the exposure of lower lung areas from massive aspiration, which may cause acute obstruction
of airways, and contamination by cyst contents from the operative part of the lung that causes recurrent disease. One-lung
ventilation in pulmonary hydatid cyst surgery may be preferred owing to lower mortality and morbidity rates. 相似文献
5.
Dr. Menon Raj Gopal M.Ch. AlDelamie Taha FRCS Valliathu John FRCS Zacharias Sunny FRCS Lawati Al Adil FRCS Venkatraman M.Ch. 《Indian Journal of Thoracic and Cardiovascular Surgery》2006,22(3):173-177
Background Despite improving surgical techniques, treatment of heart valve disease in children remains controversial. Somatic growth
and adequate anticoagulation are of concern when children undergo valve replacement. We conducted this study to evaluate the
performance of valves in this age group.
Methods 42 children under the age of 13 years who underwent valve replacement were included in this study. Totally, 50 valves were
implanted in 42 patients: 48 were mechanical prostheses, two were bioprosthetic both in pulmonary position. 37 (74%) valves
were implanted in mitral position, 10 (20%) in aortic position, 1 (2%) in tricuspid position and 2 (4%) in pulmonary position.
Preoperatively, 14 (33,3%) patients were in New York Heart Association (NYHA) class IV, while 27 (64.2%) were in NYHA class
III.
Results There were 2 (4.7%) hospital deaths and 2 (4.7%) late deaths while 2 (4.7%) patients were lost to follow up. The mean follow
up period was 9.4 yrs. 35 (83.3%) patients are in NYHA Class I and free of all medications except warfarin. 3 (7.1%) patients
have undergone 5 successful pregnancies. The median INR was 2.23. Major thrombo-embolic episode occurred in 1 (2.3%) patient.
Conclusions In view of the problems of sizing, anticoagulation and need for re-operation at an early age, there is a reluctance to replace
valves in children. This study shows that despite these problems, valve replacement can be undertaken safely and successfully
in children, when repair has failed or not technically feasible. 相似文献
6.
U I Esen 《Ultrasound in obstetrics & gynecology》2005,26(2):201; author reply 201-201; author reply 202
7.
8.
Mehmet Oguz Yenidunya Mustafa Erol Demirseren Serdar Gorkem Bulent Adil Tasbas Candemir Ceran 《European journal of plastic surgery》2007,29(7):327-330
Nonunion in the forearm following a radioulnar fracture is one of the nightmares of the orthopedic surgeon. Fortunately, it
is rare. We treated a large bone defect of the forearm, using a vascularized fibular graft after excision of the unhealed
bone segment in a 10-year-old boy with neurofibromatosis. This situation followed a double fracture that had been operated
on several times using conventional methods. Following the debridement of the unhealthy tissues in the pseudoarthrotic region,
the vascularized fibula was placed on the dorsal surface of the proximal radius fragment. The distal fragment of the radius
was inserted into the fibular cavity and fixation was established with a Kirschner wire distally and with a plate proximally.
Only two screws were used to fix the plate. The peroneal artery was anastomosed with the radial artery; one of its venae comitantes
was anastomosed with the cephalic vein in an end-to-end fashion. After surgery, the elbow was immobilized at 90 degrees of
flexion with a splint for 6 weeks. One year after surgery, forearm stabilization and elbow and hand functions were very satisfactory.
However, because the distal epiphyses of the bones were destroyed following the repeated surgery and the original trauma itself,
a very prominent difference between the two forearms occurred, suggesting the need for bone lengthening in the future. By
presenting this case we would like to conclude that one can expect good bone healing with a vascularized bone transfer in
these cases when there is not enough space to place screws, but support can be provided by an external splint and K wire. 相似文献
9.
Dr. Adil Kabeer M.B.B.Ch. Sigurdur Gunnlaugsson M.D. Charles Coren M.D. 《Diseases of the colon and rectum》1995,38(8):866-872
PURPOSE: A retrospective, 12-year review of neonatal necrotizing enterocolitis was undertaken at a county hospital, with emphasis on presentation signs and symptoms. METHODS: Eighty-two patients with presence of intramural air were included in the study. The following signs and symptoms were studied: evidence of respiratory distress, use of umbilical catheters, white blood cell count and temperature at presentation, time interval from birth to diagnosis and time interval from diagnosis to operative intervention, presence of intramural air, air in biliary tree or free air, changes in abdominal girth, and presence of occult or gross blood in stools. Comparison was done among infants who had surgical or medical treatment, premature and full-term infants, and infants who had neonatal necrotizing enterocolitis less than or more than 20 days after birth. RESULTS: Eleven patients had a fatal outcome, with an overall survival of 87 percent. Sixty-four patients were treated medically and 18 had operative treatment. Mortality of the surgically treated group was 44 percent. Neonates who had surgical intervention had a left shift of the white blood cell count more commonly present, and all had documented abdominal distention. There were 62 premature and 20 full-term neonates in the group. Full-term neonates developed neonatal necrotizing enterocolitis earlier after birth (5.3 days compared with 15.3 days in the premature neonate group). Full-term neonates had a better prognosis in our series. Presentation of symptoms more than 20 days after birth did not change outcome. CONCLUSION: Our results reflect the experience of a community-based hospital. Clinical acumen remains the cornerstone of diagnosis and management. 相似文献
10.
Nurzat Elmali Nevzat Elmali Irfan Esenkaya Ahmet Harma 《European Journal of Trauma》2005,31(6):586-589
Abstract Traumatic knee dislocations are relatively rare and almost always respond to closed reduction; however, a small percentage
of knee dislocations are irreducible and in these cases open reduction is frequently required. A 65-year-old man with an unreduced
posterolateral knee dislocation with laterally dislocated patella was seen 3 weeks after a motor vehicle accident. Medial
femoral condyle was found buttonholed through the medial capsule together with the medial collateral ligament and lying in
the medial joint space that allowed posterior rotary dislocation of the joint. Both cruciate ligaments and medial meniscus
were torn. There was no evidence of any vascular or nerve injury. Reduction was accomplished by removal of the capsuloligamentous
structures which were incarcerated in the trochlea and intercondylar notch and by excision of meniscal tear. Following posterior
cruciate ligament reconstruction with patellar tendon autograft, lateral patellar release, vastus medialis advancement, and
gracilis transfer were done. 相似文献