Unicortical Bone Necrosis of the Fibula Free Flap Associated to the Fixation with a Nonlocking 2.0-mm Reconstruction Plate and Screws.

The authors present a unique case of osteonecrosis of a cortical half of a fibula free flap that has not been reported in the literature yet. This complication was associated with the impairment of the vascularization of periosteum in the cortical half of fibula that was fixated with a nonlocking reconstructive 2.0-mm plate and screws but other factors could have been involved. The patient was submitted to excision of a cemento-ossifying fibroma that resulted in a left hemimaxilectomy mesoinfrastructure defect classified as the Cordeiro type 2B. The 42-year-old female patient was submitted to reconstruction with an osteomusculocutaneous fibula free flap plus a segment of fibula graft. The two bone segments of the free flap used to reconstruct the anterior and left alveolar crest were fixated with a reconstructive 2.0-mm plate of matrixMANDIBLE system. The only reported complication was an oronasal fistula that healed with conservative treatment and the referred osteonecrosis of the external cortical half of the fibula free flap with plate exposure at 2.5 years postoperatively. Surgical excision of the osteonecrosed cortical half of the fibula with the plate and screws was performed, while the other cortical underwent bone union as corroborated by computed tomography scans.

Dataset for predicting single-spot proton ranges in proton therapy of prostate cancer.

The number of radiotherapy patients treated with protons has increased from less than 60,000 in 2007 to more than 220,000 in 2019. However, the considerable uncertainty in the positioning of the Bragg peak deeper in the patient raised new challenges in the proton therapy of prostate cancer (PCPT). Here, we describe and share a dataset where 43 single-spot anterior beams with defined proton energies were delivered to a prostate phantom with an inserted endorectal balloon (ERB) filled either with water only or with a silicon-water mixture. The nuclear reactions between the protons and the silicon yield a distinct prompt gamma energy line of 1.78 MeV. Such energy peak could be identified by means of prompt gamma spectroscopy (PGS) for the protons hitting the ERB with a three-sigma threshold. The application of a background-suppression technique showed an increased rejection capability for protons hitting the prostate and the ERB with water only. We describe each dataset, document the full processing chain, and provide the scripts for the statistical analysis.

Towards real-time PGS range monitoring in proton therapy of prostate cancer.

Proton therapy of prostate cancer (PCPT) was linked with increased levels of gastrointestinal toxicity in its early use compared to intensity-modulated radiation therapy (IMRT). The higher radiation dose to the rectum by proton beams is mainly due to anatomical variations. Here, we demonstrate an approach to monitor rectal radiation exposure in PCPT based on prompt gamma spectroscopy (PGS). Endorectal balloons (ERBs) are used to stabilize prostate movement during radiotherapy. These ERBs are usually filled with water. However, other water solutions containing elements with higher atomic numbers, such as silicon, may enable the use of PGS to monitor the radiation exposure of the rectum. Protons hitting silicon atoms emit prompt gamma rays with a specific energy of 1.78 MeV, which can be used to monitor whether the ERB is being hit. In a binary approach, we search the silicon energy peaks for every irradiated prostate region. We demonstrate this technique for both single-spot irradiation and real treatment plans. Real-time feedback based on the ERB being hit column-wise is feasible and would allow clinicians to decide whether to adapt or continue treatment. This technique may be extended to other cancer types and organs at risk, such as the oesophagus.

Equilíbrio em idosos institucionalizados e não institucionalizados e sua relação com a qualidade de vida / Balance in institutionalized and non-institutionalized elderly and their relationship with quality of life

Introdução: o envelhecimento gera alterações no equilíbrio que podem impactar a qualidade de vida do idoso. Objetivo: avaliar o equilíbrio de idosos institucionalizados e não institucionalizados e sua relação com a qualidade de vida. Metodologia: estudo transversal, realizado com 20 idosas, das quais 10 institucionalizadas (G1) e 10 não institucionalizadas (G2). Foram aplicados a Escala Motora para Terceira Idade (EMTI) e o SF-12. Os dados foram analisados por meio dos testes Shapiro-Wilk, correlação de Pearson e t de student (p < 0,05). Resultados: não foi encontrada diferença significativa (p > 0,05) no equilíbrio entre os grupos. Observou-se que a correlação entre qualidade de vida e equilíbrio no G1 (0,757) é forte, ao passo que no G2 (0,448) é moderada (p < 0,05). Conclusão: não há diferença no equilíbrio entre idosos institucionalizados e não institucionalizados no estudo realizado, porém a relação entre essa variável e a qualidade de vida é significativa e forte em idosos institucionalizados, e moderada em idosos não institucionalizados.

Introduction: aging generates changes in balance, which can impact the quality of life of the elderly. Objective: to evaluate the balance of institutionalized and non-institutionalized elderly and its relationship with quality of life. Methodology: cross-sectional study, conducted with 20 elderly women, 10 institutionalized (G1) and 10 non-institutionalized (G2). The Third Age Motor Scale (EMTI) was applied and, for quality of life, the SF-12. Data were analyzed using Shapiro-Wilk tests, Pearson correlation and student's t-test (p < 0.05). Results: no significant difference (p > 0.05) was found in the balance between the groups. The correlation between quality of life and balance in G1 (0.757) is strong, while in G2 (0.448) it is moderate (p < 0.05). Conclusion: there is no difference in balance between institutionalized and non-institutionalized elderly in this study. However, the relationship between this variable and quality of life is significant and strong in institutionalized elderly and moderate in non-institutionalized elderly.

Giant Malignant Peripheral Nerve Sheath Tumor of the Scalp: Case Report and Review of the Literature.

BACKGROUND: Malignant peripheral nerve sheath tumors (MPNSTs) are rare nervous system tumors that rarely appear on the scalp. About half of the scalp MPNSTs described in the literature have reached giant dimensions at the time of diagnosis. The surgical treatment is the gold standard for this type of tumor. Some authors suggest adjuvant radiotherapy for local tumor control, although there is uncertainty about its advantages and its use is not without risks. CASE DESCRIPTION: We present the case of a 31-year-old man who presented with a large necrotic scalp tumor of the left frontoparietal convexity. magnetic resonance imaging showed a large extra-axial tumor, measuring 17 x 17 x 8 cm, centered on the soft tissues, with skull erosion and signs of dural invasion, although with no intradural component. The tumor was surgically removed and the osteocutaneous defect was reconstructed with a latissimus dorsi muscle free flap. The anatomopathologic diagnosis was MPNST. The patient then underwent adjuvant radiotherapy. After 7 months he developed a progressive right hemiparesis and magnetic resonance imaging showed results compatible with cerebral radiation necrosis. This motor deficit improved with corticotherapy. After 9 months the patient went back to his home country and was subsequently lost to follow-up. CONCLUSIONS: Giant MPNSTs of the scalp are highly aggressive lesions that should primarily be treated in a surgical fashion. Although adjuvant radiotherapy has been used routinely for local tumor control, there is uncertainty about its advantages.