Development and validation of a new set-up simulator dedicated to ocular proton therapy at CNAO.

An Eye Tracking System (ETS) is used at CNAO for providing a stable and reproducible ocular proton therapy (OPT) set-up, featuring a fixation light (FL) and monitoring stereo-cameras embedded in a rigid case. The aim of this work is to propose an ETS set-up simulation algorithm, that automatically provides the FL positioning in space, according to patient-specific gaze direction and avoiding interferences with patient, beam and collimator. Two configurations are provided: one in the CT room for acquiring images required for treatment planning with the patient lying on a couch, and one related to the treatment room with the patient sitting in front of the beam. Algorithm validation was performed reproducing ETS simulation (CT) and treatment (room) set-up for 30 patients previously treated at CNAO. The positioning accuracy of the device was quantified through a set of 14 control points applied to the ETS case and localizable both in the CT volume and in room X-ray images. Differences between the position of ETS reference points estimated by the algorithm and those measured by imaging systems are reported. The corresponding gaze direction deviation is on average 0.2° polar and 0.3° azimuth for positioning in CT room and 0.1° polar and 0.4° azimuth in the treatment room. The simulation algorithm was embedded in a clinically usable software application, which we assessed as capable of ensuring ETS positioning with an average accuracy of 2 mm in CT room and 1.5 mm in treatment room, corresponding to gaze direction deviations consistently lower than 1°.

Analyses of several seed viability markers in individual recalcitrant seeds of Eugenia stipitata McVaugh with totipotent germination.

The use of biochemical seed viability markers is often compromised by the unknown partitioning of analytes in bulk seed lots consisting of inseparable populations of viable and nonviable seeds. We took advantage of an unusual morphological syndrome found in the recalcitrant, undifferentiated seeds of Eugenia stipitata: one seed can be cut into several parts, each of which can germinate and develop into seedlings. We used four seed parts from one individual seed to analyse seed moisture content (MC), seed viability and the antioxidant glutathione (γ-glutamyl-cysteinyl-glycine; GSH), glutathione disulphide (GSSG) and intermediates of glutathione synthesis and breakdown. Seeds were exposed to different environmental MC to induce various levels of desiccation stress. Upon storage at high seed MC, seed viability was maintained, while GSH concentration increased and the glutathione half-cell reduction potential (EGSSG/2GSH ) was less negative than -215 mV, indicating GSH production and highly reducing conditions. Storage at low seed MC led to loss of GSH, resulting in a shift in EGSSG/2GSH , and seed death. In contrast, the cyst(e)ine half-cell reduction potential (ECySS/2CYS ) could not distinguish between the viability categories. Previous studies on seed populations revealed that the probability for a seed being alive is 50% at EGSSG/2GSH values between -180 and -160 mV. The single seed approach revealed that the window in which seed viability was lost could be slightly shifted towards more negative values. We discuss the contribution of cellular pH to EGSSG/2GSH and recommend E. stipitata as a recalcitrant seed model to study stress response on a single seed basis.

Systemic hyperthermia in the treatment of HIV-related disseminated Kaposi's sarcoma. Long-term follow-up of patients treated with low-flow extracorporeal perfusion hyperthermia.

Treatment of HIV and related malignancies with pharmacologic and biologic agents has not appreciably modified the course of disease. Immunologic impairment remains the critical factor in response. We report the long-term results of a single session of low-flow (0.3 L/min) extracorporeal perfusion hyperthermia on 29 men and 2 women with disseminated Kaposi's sarcoma and profound immunologic impairment. Any antiretroviral drug employed by the patient was stopped 72 hours prior to treatment and withheld during the period of follow-up. Core temperature was raised to 42 degrees C and held for 1 hour with extracorporeal perfusion and ex vivo blood heating to 49 degrees C as the means of temperature control. Of 31 patients, 2 died of complications secondary to treatment (cardiac arrhythmia; CNS bleed). There were two cases of intravascular coagulopathy. Pressure point skin damage may occur despite adequate cushioning. At 30 days posttreatment complete or partial regressions were seen in 20/29 of those treated, with regressions persisting in 14/29 of those treated by 120 days posttreatment. At 360 days, 4/29 maintain tumor regressions with 1 in complete remission (at 26 months). The patient in complete remission remains culture-negative and PCR-negative for HIV. CD4+ counts rose from around 250 to, and remain around, 800 in this man. Selected healed lesions were biopsied to demonstrate tumor absence. Patients were selected for treatment if pretreatment testing of the tumor showed regression in vitro with heat exposure. Analysis of the early and midterm failures showed little sustained rise of the CD4+ cells if presenting total CD4+ counts were below 50 and had been at such low levels for extended periods, although other surrogate markers of HIV activity declined (semiquantitative PCR) during this period and is felt to support the hypothesis of apoptosis proposed in this illness. Analysis of the tumors of the few men not responding demonstrated elevated levels of IL-6 as compared to responders (12 vs < 1 pg/ml). At 120 days 29/31 patients remained alive (expected, 20). At 360 days, 21/31 remained alive (expected, 11). In no patient was HIV activity stimulated with heat exposure. CMV retinitis did clear in some patients treated (both techniques), but treatment alone did not prevent later development of retinopathy. EBV parameters were markedly altered in the short term with heat exposure in some patients. Few patients showed herpes simplex activation. Varicella-zoster virus remitted in some patients. There is utility in the use of systemic hyperthermia to control HIV and related malignancy.(ABSTRACT TRUNCATED AT 400 WORDS)

[Videolaparoscopic oncologic surgery of the right colon: our experience]. / Chirurgia oncologica videolaparoscopica del colon destro: nostra esperienza.

The authors present their experience in videolaparoscopic surgery for right colon cancer after two years of videolaparoscopic surgery for approach to colorectal cancer. In the period between March 2002 and March 2003 they have practiced 11 right emicolectomy by videolaparoscopic technique for neoplasms: 7 were males and 4 were females with age of about 70 years old. These case included: 7 right colon's cancers, 2 cecal cancers and two hepatic flexure cancers. One postoperative complications has been observed (9%) for bowel's occlusion for early adhesion syndrome. On the base of their experience the authors perform usually videolaparoscopic surgery (M.I.S.) for the approach to right colon cancer.

[Videolaparoscopic oncologic surgery of the left and right colon: our experience]. / Chirurgia oncologica videolaparoscopica del colon sinistro e del retto: nostra esperienza.

The authors present their experience in videolaparoscopic surgery for colorectal cancer. In the period between November 2000 and march 2003 they have treated 31 patients by videolaparoscopic surgery for colorectal cancer: 17 were males and 14 were females with age included between 41 and 93 y.o. These case included: 15 rectal cancers, 12 sigmoid cancer, 3 cases of lineal flexura's cancers and I case of transverse cancer. Postoperative complications has been observed in three cases (9.6%) in the first 14 operations practiced, then confirming the learning curve. The authors perform usually mini-invasive surgery (MIS) for the approach to colorectal cancer surgery.

[An uncommon complication: cryptorchidism in an adult]. / Una complicanza particolare: criptorchidismo nell'adulto.

This unusual pathology has not been described in the medical literature of the last ten years. A 39-year-old patient, affected by unilateral cryptorchidism, on the right side, and congenital inguinal hernia, reached the operating theatre suffering from occlusive intestinal syndrome, due to a clogged hernial sac. This clog was caused by a retracting testicle which in turn stopped the ileal ansa from slipping back in to the peritoneum. Through this case we can underline the excursus of such pathology, which isn't very frequent in the adult but can, nevertheless create a fairly serious pathology, often leading to neoplan.

[Orthodontic treatment in adults]. / Il trattamento ortodontico dell'adulto.

The characteristic problems of an orthodontic treatment of the adult must be well known and analyzed with greatest attention by the specialist. It is, first of all, necessary to try to respect and, if possible, to meet the particular psychological requirements which the adult presents. This will help the relation between the orthodontist and the patient for the whole period of the treatment and will allow the orthodontist to make the most of the necessary collaboration that the patient can give. It is, therefore, necessary to consider the physiological limitations imposed by the age of the patient whose growth has come to an end. Only by means of analysis and application of such therapeutic requirements will it be possible to reach the success of our intervention.

[Seasonal variations in hematochemical and urine parameters in a group of professional cyclists]. / Analisi delle variazioni stagionali dei parametri ematochimici ed urinari in un gruppo di ciclisti professionisti (c.p.).

Purpose of this study was to evaluate the modification of some biohumoral parameters in a group of road-race cyclists during a sporting season. The following conclusions can be drawn: at the beginning of physical exercise, an inverse relationship between serum iron and haemoglobin content can be found. This can be probably attributed to the physiological response to fatigue. Hepatic and renal functions were normal during continuous and severe physical stress like Giro d'Italia. This can be due either to correct alimentary and hydric intake and to an appropriate pharmacological therapy.

[Althesin in urologic surgery]. / L'althesin in chirurgia urologica.

Results obtained with Althesin as anaesthetic in 100 patient subjected to urological surgery are presented. The continuous perfusion of Althesin gave a level of stable and flexible anaesthesia that, like the return to consciousness, was particularly appreciated by aged patients. Stress is laid on the fact that the harm caused by volatile anaesthetics is avoided.