Fluence map analyzer reduces low dose volume in locally advanced post mastectomy breast cancer patients.

Multi-leaf collimator dose leakage in intensity-modulated radiotherapy (IMRT) plans causes higher low dose volume which increases the long-term risks of radiotherapy. We have developed Fluence Map Analyzer (FMA) program that suggests the ideal field geometry to reduce low dose volume in locally advanced breast cancer IMRT plans. In this comparative experimental study, FMA has been applied to standard IMRT plans (STD-IMRT) of randomly selected 15 left and 15 right-sided locally advanced breast cancer patients. All patients underwent a modified radical mastectomy. The chest wall, IMN, axillary, and supraclavicular lymph nodes are included in planning target volume (PTV). The heart, lungs, contralateral breast, and medulla spinalis were delineated as organs at risk (OARs). Two sets of plans, namely STD-IMRT and FMA-IMRT, were generated for each patient. The dosimetric analysis was performed using dose-volume histogram (DVH) and standard evaluation parameters of PTV and OARs. No differences could be observed among the two techniques for PTV coverage. However, FMA-IMRT plans achieved significantly lower V5volumes and mean doses of the heart, lungs, contralateral breast, and body contours. FMA-IMRT used a smaller number of sub-fields and fewer monitor units (MU). FMA automizes the field geometry determination process for locally advanced breast cancer IMRT planning while reducing low dose volume significantly.

Diode lasers for the treatment of genital warts.

Human papillomavirus (HPV) infections are the most common sexually transmitted diseases leading to genital warts. Developing lesions start off as small papules, which then grow larger and protrude, eventually coalescing into plaque-like formations. The aim of this study was to evaluate the efficacy of diode laser coagulation as a treatment for genital warts relative to their number, size, localisation, and recurrence rate. Altogether, 45 patients were evaluated in this study. Patients were initially assigned to one of two groups, depending on the size and number of their genital warts, and received a maximum of two laser treatments. Patients were assessed up to three months after intervention. A cure was defined as the complete removal of condylomata. In Group I, 84% of the patients (21/25) were free of recurrence after three months (last follow-up visit). In Group II, 60% of the patients were free of recurrence after three months (12/20 patients); 25% after the first and 35% after the second treatment. Overall, a cure rate of 73% was achieved (33/45 patients). By splitting the laser treatment for multiple, extensive, and/or coalescing genital warts into two sessions, thereby being less destructive to the surrounding tissue, it was possible to achieve comparable cure rates between the two groups. This study indicates that laser treatment is an effective therapy option. Further studies including larger patient cohorts are necessary to ultimately confirm the advantages of laser treatment.

Treatment of genital lesions with diode laser vaporization.

BACKGROUND: Genital warts caused by human papillomavirus (HPV) infection are the most common sexually transmitted disease leading to anogential lesions. Although the laser therapy has been shown to be effective in a number of conditions, the use of laser diode vaporization in urological applications and the understanding on its effectiveness as a treatment for various urological conditions is limited. Therefore, the aim of this study was to evaluate the efficacy of diode laser vaporization as a treatment for genital lesions. METHODS: Patients presenting with genital lesions at the urology outpatient clinic at Coronel Mota Hospital, between March 2008 and October 2014, were enrolled into the study. Data collected included age, gender, duration of the lesion, site of the lesion and numbers of the lesions, length of follow-up, recurrence of lesions after treatment and whether there were any complications. RESULTS: A total of 92 patients were enrolled in the study; 92.4% (n = 85) male; mean age (± SD) 27.92 ± 8.272 years. The patients presented with a total of 296 lesions, with a median of 3 lesions each, including penis (n = 78), urethra (n = 4) lesions, and scrotum (n = 2) lesions. Lesions ranged in size from 0.1 to 0.5 cm(2), most commonly 0.3 cm(2) (n = 38; 41.3%), 0.4 cm(2) (n = 21; 22.8%) or 0.5 cm(2) (n = 20; 21.7%). Patients most commonly reported that they had their lesions for a duration of 12 (n = 29; 31.5%) or 6 months (n = 23; 25.0%). Eighteen patients (19.6%) had a recurrence after their 1(st)/conventional treatment. There were no incidences of post-operative infection or complications from the laser diode vaporization. CONCLUSIONS: Laser diode vaporization can be considered as an alternative method for treating genital lesions in urology, with satisfactory results in terms of pain, aesthetic and minimal recurrence.

Management of sexually transmitted disease by surgeons.

The management of 63 patients diagnosed by surgeons as having sexually transmitted disease (STD) was audited. A diagnosis of STD was made in 51 (81%) of patients without taking a sexual history. Only 2 (3%) patients were referred to genitourinary medicine (GUM). Appropriate microbiological specimens were obtained from only two of 52 (4%) patients diagnosed with either pelvic inflammatory disease (PID) or epididymo-orchitis. Reliance was placed on inappropriate specimens in 22 (42%). There was widespread use of inappropriate antibiotics. The management of sexually transmitted disease by surgeons was very poor. These patients should all be referred to genito-urinary medicine.

Ambulatory procedures in anorectal surgery.

In view of the broad spectrum of conventional and unconventional STDs in the homosexual man, the following diagnostic workup is recommended: History. Physical examination, including proctosigmoidoscopy with biopsy. Urethral, pharyngeal, and rectal cultures. Darkfield examination of any genital ulceration. Stool cultures for bacteria and parasites. Serologic analysis, including VDRL and, where indicated, for Chlamydia trachomatis and amebiasis. It is an essential part of proctologic practice for the surgeon to be able to recognize, diagnose, and treat sexually transmitted diseases.

Bowenoid papulosis: a recent entity in sexually transmitted diseases.

Bowenoid papulosis is a recent phenomenon of multiple lesions with a histology of carcinoma in situ appearing on the genitals of young men. We report 6 male patients with this condition presenting with warty and/or lichen planus like lesions on the genitals. The histology shows carcinoma in situ. Three (50%) showed spontaneous regression, and the rest had persistence and recurrence. Repeat biopsy of one recurrent lesion showed a verruca. The evidence for a possible viral aetiology will be discussed. Long term studies are required to assess any oncogenic potential. As it is thought to be presently a viral infection with epidermal atypia, effective conservative management is sufficient.

CO2 laser surgery of the cervix, vagina, and vulva.

The gynecologic laser surgeon must be an expert colposcopist and skilled in the use of the surgical microscope. Surgical protocols for CO2 laser surgery of the cervix, vagina, and vulva are outlined and techniques discussed. Indications for its use, including treatment of cervical intraepithelial neoplasia, condylomata acuminata, and genital herpes are described and illustrated.

[The laser in dermatology. Critical study of 63 cases]. / Le laser en dermatologie. Etude critique de soixante-trois observations.

With reference to their personal experience in sixty-three patients, the authors try to specify the indications of laser treatment in dermatology: evenly-colored flat angiomas, especially those of the face, which should not be treated before the age of fourteen. Vasoconstriction induced by the application of ice prior to treatment seems helpful. Widespread anal or vaginal venereal warts are another good indication. In common warts laser treatment is indicated only in some specific cases. The authors do not advocate laser treatment in malignant tumors. Results in tattoos are often unsatisfactory.