Prospective correlation of the radiological, surgical and pathological findings in patients undergoing cytoreductive surgery for colorectal peritoneal metastases: implications for the preoperative estimation of the peritoneal cancer index.

AIM: The peritoneal cancer index (PCI) is one of the strongest prognostic factors in patients undergoing cytoreductive surgery (CRS) for colorectal peritoneal metastases. Using pathological evaluation, however, the disease extent differs in a large proportion of patients. Our aim was to study the correlation between the radiological (rPCI), surgical (sPCI) and pathological (pPCI) PCI in order to determine factors affecting the discordance between these indices and their potential therapeutic implications. METHOD: From July 2018 to December 2019, 128 patients were included in this study. The radiological, pathological and surgical findings were compared. A protocol for pathological evaluation was followed at all centres. RESULTS: All patients underwent a CT scan and 102 (79.6%) had a peritoneal MRI. The rPCI was the same as the sPCI in 81 (63.2%) patients and the pPCI in 93 (72.6%). Concordance was significantly lower for moderate-volume (sPCI 13-20) and high-volume (sPCI > 20) disease than for low-volume disease (sPCI 0-12) (P < 0.001 for sPCI; P = 0.001 for pPCI). The accuracy of imaging in predicting presence/absence of disease upon pathological evaluation ranged from 63% to 97% in the different regions of the PCI. The pPCI concurred with the sPCI in 86 (68.8%) patients. Of the nine patients with sPCI > 20, the pPCI was less than 20 in six. CONCLUSION: The rPCI and sPCI both concurred with pPCI in approximately two thirds of patients. Preoperative evaluation should focus on the range in which the sPCI lies and not its absolute value. Radiological evaluation did not overestimate sPCI in any patient with high/moderate-volume disease. The benefit of CRS in patients with a high r/sPCI (> 20) who respond to systemic therapies should be prospectively evaluated.

Tc-99m MAG3 scintigraphy in unusually dilated bilateral extrarenal pelves.

The authors report the findings of a radionuclide diuretic renogram in a patient with markedly dilated pelves bilaterally that filled most of the abdominal cavity. With the patient in the sitting position, at the end of the furosemide injection, there was good delineation and filling of the dilated calyces. These findings are unusual because of the extensive pelvicaliceal dilatation, and they emphasize the importance of the sitting position.

Unusual presentation of solitary bone metastasis from breast carcinoma mimicking acute osteomyelitis of the left midtibial shaft.

The authors report an unusual presentation of a solitary bone metastasis in the left midtibial shaft with no other skeletal involvement in a patient with breast carcinoma. The incidence of solitary bone metastasis below the knees is rare. Clinically, the lesion was tender when palpated. A bone scan revealed increased blood flow and blood pool activity, with intense midtibial bony uptake in delayed images. These findings are similar to those of acute osteomyelitis. Biopsy revealed bony metastasis from the patient's breast carcinoma.

Discrepancy between Ga-67 citrate and F-18 fluorodeoxyglucose positron emission tomographic scans in pulmonary infection.

The authors describe a patient with the acquired immunodeficiency syndrome who had active pulmonary tuberculosis and was receiving anti-tuberculosis treatment. High-grade fever and a right-sided pleural effusion had recently developed. Results of a Ga-67 scan were negative for any focal infection in the chest. Fluorine-18 fluorodeoxyglucose positron emission tomography showed increased uptake in the right lower lung field, which correlated with the diagnosis of concomitant bacterial pneumonia. Anti-tuberculosis treatment can decrease the sensitivity of the Ga-67 scan and could have contributed to this discrepancy. The authors predict that the fluorine-18 fluorodeoxyglucose positron emission tomographic scan will play an important diagnostic role in the management of such a selected group of patients.

Effects of the status of women on the first-birth interval in Indian urban society.

The status of women, which is relative and multidimensional, has an important bearing on any long-term reduction in fertility. In Indian society, where cohabitation and childbearing are socially sanctioned only after marriage, the length of the first-birth interval affects the completed family size by influencing the spacing and childbearing pattern of a family. This study examines the influence of certain aspects of the status of married women--education, employment, role in family decision making, and age at marriage--along with three socioeconomic variables--per capita income of the family, social position of the household, and the caste system--on the duration of the first-birth interval in an urban Hindu society of the north-east Indian state of Assam. The data were analysed by applying life table and hazard regression techniques. The results indicate that a female's age at marriage, education, current age, role in decision making, and the per capita income of the household are the main covariates that strongly influence the length of the first-birth interval of Hindu females of urban Assam. Of all the covariates studied, a female's education appears to be a key mediating factor, through its influence on her probability of employment outside the home and thereby an earned income and on her role in family decision making. Unlike other Indian communities, the effect of the caste system does not have a significant effect on first-birth timing in this urban Hindu society.

PIP: This study examined determinants of first birth intervals (FBIs) among urban Hindu women in the northeastern state of Assam, India. Explanatory factors include women's status (education, employment, marriage age, role in family decision-making) and socioeconomic factors (family income, social position in the household, and caste). Data were obtained from a survey conducted in Guwati, the capital city of Assam, among 1650 eligible couples in 1991-92. Life table techniques and the guidelines of Rindfuss, Palmore, and Bumpass (1982) were followed to correct for censoring and sample selectivity. Analysis was based on Cox's hazard regression model. Findings indicate that mean age of marriage was about 21 years. Higher mean age at marriage was associated with education, wage earners, belonging to a higher monthly income group, having higher social status, and contributions to all household decisions. Marriage age varied more among low income groups, low status groups, those with little or no education, and those who do not take part in all household decisions. Life table techniques reveal that the median length of the FBI was under 16 months. Only 2% failed to give birth within 97 months of their marriage. In the full model with all 8 covariates, female occupation and position in the caste system did not have significant effects on FBI. Hazards of first births were higher when marriage age was under 17 years. Female education was negatively associated with first birth. Education delays marriage and increases the opportunity for paid employment.

Determinants of breast-feeding patterns in an urban society of India.

Breast feeding is the focus of rapidly growing interest in many areas of demographic research. However, relatively few rigorous studies on breast-feeding patterns and correlates in contemporary India have been published. This study uses data from a retrospective survey conducted in 1991-1992 to investigate current breast-feeding patterns and to identify the key factors that influence the duration of exclusive breast feeding and infant's age at the time of weaning in an urban Hindu society of the northeast Indian state of Assam. Applying life table procedures and a hazards regression model, we found evidence that the median duration of exclusive breast feeding and infant's age at the time of weaning were negatively associated with mother's education, per capita income, and social status of the household. Those infants who were breast-fed longer at night than in the daytime were also at greater risk of earlier introduction of non-breast-milk foods and of earlier termination of breast feeding than infants who were breast-fed longer during the day. Gender bias toward males in rearing infants prevails in this urban society, and male infants were found to have a significantly lower risk of early weaning than female infants.

PIP: This study examines breast feeding patterns among Hindu mothers from Guwahati city, Assam state, India. Data were obtained from a 1991-92 household survey and a subsample of 1650 women aged under 50 years who lived in the capital city. 38.0% had less than a primary education (8.9% of wage earners and 29.1% of non-wage earners). 40.6% had some primary education (3.9% of wage earners and 36.7% of non-wage earners). 21.4% graduated from high school (11.7% of wage earners and 9.7% of non-wage earners). 75.5% of the sample were non-wage earners. Findings indicate that among the last two births the median duration of breast feeding was 16 weeks. 75% of infants were introduced to non-breast-milk products by the age of 26 weeks. The median age of weaning was 19 months. 64% of infants were not breast fed at 36 months. As level of mother's education increased, the duration of breast feeding decreased. The longest duration was among mothers with low educational attainment. At 6 months, almost double the infants of highly educated mothers were receiving non-breast-milk foods compared to less educated women. Wage earners did not provide non-breast-milk food earlier than non-wage earners. However, the median age at weaning was 22 months for non-wage earners and 14 months for wage earners. Maternal age was unrelated to median duration of breast feeding. Although older and younger mothers introduced non-breast-milk foods almost at the same time of 4 months, younger mothers breast fed longer. This longer breast feeding pattern suggests its use for birth spacing. Income and caste membership were unrelated to duration of exclusive breast feeding. The hazard analysis indicates that higher educated mothers were at greater risk of early introduction of non-breast-milk foods and an earlier stop to breast feeding. Female children had a higher risk of an earlier stop to breast feeding.

The socio-demographic correlates of post-partum amenorrhoea in an urban society of India.

PIP: Studies in different parts of the world have shown duration of breast feeding to be positively correlated with duration of postpartum amenorrhea. Breast feeding is, however, associated with a variable period of amenorrhea among nursing mothers. This study of breast feeding practices demonstrated that socioeconomic and educational status largely determine the pattern of postpartum amenorrhea and, consequently, fertility during lactation. Undernourished nursing mothers were found to have a longer duration of postpartum amenorrhea relative to better nourished peers. These findings suggest that any improvement in maternal education and nutritional status may lead to a faster return of fertility in lactating women. Efforts to improve the educational, health, and nutritional status of nursing mothers should be integrated with services which provide adequate modern contraceptive care. The authors used survey data collected from the Assamese-speaking Hindus in urban Guwahati during 1991-92.^ieng

Scattered radiation from linear accelerator and cobalt-60 collimator jaws.

PURPOSE: Solid state diodes and/or thermoluminescent dosimeters (TLDs) are often used to measure scattered radiation doses to critical organs immediately adjacent to radiation field sites. The energy-dependent response of these commonly used in vivo dosimeters sometimes makes the interpretation of measured values uncertain. This study investigates scattered radiation arising from the collimator jaws of linear accelerators and the treatment head of a cobalt-60 teletherapy unit. METHODS AND MATERIALS: A thin window Markus-type parallel-plate ionization chamber placed in a polystyrene phantom was employed to document the magnitude, energy composition, and sources of scattered radiation at surfaces near radiation fields. Measurements were taken both with and without additional phantom material covering the ionization chamber, as well as with various distances between the ionization chamber and edges of the radiation fields tested. RESULTS: Data was collected, analyzed and compared for treatment units produced by different manufacturers. It was found that the magnitude of scattered radiation to surfaces immediately adjacent to radiation fields ranged from 1% to 15% of the maximum dose along the beam central axis. These values showed a strong dependence upon distance from the edge of the radiation field, beam energy, collimator setting (field size), and the presence of externally mounted accessories. Teletherapy unit differences due to manufacturing firm origins were found to only slightly affect scattered radiation magnitude, while the orientation of upper and lower collimator jaws had absolutely no effect. CONCLUSIONS: Percent depth dose curves of scattered radiation were obtained and analyzed. The shapes of these depth dose curves suggest the presence of complex energy spectra from secondary electrons and scattered x-rays. Because of the presence of these complex energy spectra in areas immediately adjacent to radiation fields, caution should be observed when interpreting patient doses near radiation fields, if dose values have been measured in vivo using thermoluminescent dosimeters (TLDs) or solid state diodes. Many of these on-patient dosimetry devices are strongly energy dependent and may demonstrate large over- or under-responses in areas dominated by scattered radiation. The results of this study, thus, suggest that ionization chambers are preferred for determination of scattered radiation doses in such regions.

Measurement of replacement factors for a parallel-plate chamber.

We have measured the replacement correction factors (Prepl) for a PTW/Markus parallel plate chamber at mean incident electron energies of 3.1, 4.4, 8.9, 13.0, 16.3, and 18.8 MeV. The factors are significantly different from unity at low energies.