3D printing of biomedically relevant polymer materials and biocompatibility.

ABSTRACT: Research on polymer materials for additive manufacturing technology in biomedical applications is as promising as it is numerous, but biocompatibility of printable materials still remains a big challenge. Changes occurring during the 3D-printing processes itself may have adverse effects on the compatibility of the completed print. This prospective will put emphasis on the different additives and processes that can have a direct impact on biocompatibility during and after 3D printing of polymer materials.

Preliminary survey of 3D image-guided brachytherapy for cervical cancer at representative hospitals in Asian countries.

3D image-guided brachytherapy (3D-IGBT) has become a standard therapy for cervical cancer. However, the use of 3D-IGBT is limited in East and Southeast Asia. This study aimed to clarify the current usage patterns of 3D-IGBT for cervical cancer in East and Southeast Asia. A questionnaire-based survey was performed in 11 countries within the framework of the Forum for Nuclear Cooperation in Asia. The questionnaire collected the treatment information of patients with cervical cancer who underwent 3D-IGBT. The cumulative external beam radiotherapy and 3D-IGBT doses were summarized and normalized to a biological equivalent dose of 2 Gy per fraction (EQD2) using a linear-quadratic model. Of the 11 institutions representing the participating countries, six (55%) responded to the questionnaire. Overall, data of 36 patients were collected from the six institutions. Twenty-one patients underwent whole-pelvic irradiation and 15 underwent whole-pelvic irradiation with central shielding. Patients received a median of four treatment sessions of 3D-IGBT (range, 2-6). All 3D-IGBT sessions were computed tomography (CT)-based and not magnetic resonance image-based. The median doses to the high-risk clinical target volume D90, bladder D2cc, rectum D2cc and sigmoid colon D2cc were 80.9 Gy EQD2 (range, 58.9-105.9), 77.7 Gy EQD2 (range, 56.9-99.1), 68.0 Gy EQD2 (range, 48.6-90.7) and 62.0 Gy EQD2 (range, 39.6-83.7), respectively. This study elucidated the current patterns of 3D-IGBT for the treatment of cervical cancer in East and Southeast Asia. The results indicate the feasibility of observational studies of CT-based 3D-IGBT for cervical cancer in these countries.

Evaluation of platelet activity by multiple electrode impedance aggregometry in acute coronary syndromes: pilot study in a Brazilian tertiary-care public hospital.

There is no definite recommendation for testing platelet aggregation (PA) in acute coronary syndromes (ACS) due to inconclusive evidence on the usefulness of platelet function tests to guide therapy and improve clinical outcomes. The evaluation of PA with multiple electrode impedance platelet aggregometry (MEA) may be useful to manage antiplatelet therapy and possibly influence patient outcome. The primary aim of this study was to measure PA with MEA in Brazilian patients with ACS and evaluate the association between PA and adverse clinical outcomes. Forty-seven consecutive patients admitted with ACS to a Brazilian tertiary-care public hospital were studied and PA was evaluated using MEA. Patients were followed for six months for the occurrence of all-cause death, acute myocardial infarction, or stroke. Suboptimal inhibition of PA was found in 7 patients (14.9%); 5 (10.6%) in response to ASA (acetylsalicylic acid), 2 (5.0%) to clopidogrel, and none to ticagrelor. Inadequate PA inhibition in response to ASA was significantly associated with the composite end point, but there was no significant association for insufficient PA inhibition in response to clopidogrel. This study suggested that the evaluation of PA in ACS using MEA may identify non-responders to ASA. Larger studies are necessary to define, in a public health scenario, the value of MEA in the management of ACS.

Evaluation of platelet activity by multiple electrode impedance aggregometry in acute coronary syndromes: pilot study in a Brazilian tertiary-care public hospital

There is no definite recommendation for testing platelet aggregation (PA) in acute coronary syndromes (ACS) due to inconclusive evidence on the usefulness of platelet function tests to guide therapy and improve clinical outcomes. The evaluation of PA with multiple electrode impedance platelet aggregometry (MEA) may be useful to manage antiplatelet therapy and possibly influence patient outcome. The primary aim of this study was to measure PA with MEA in Brazilian patients with ACS and evaluate the association between PA and adverse clinical outcomes. Forty-seven consecutive patients admitted with ACS to a Brazilian tertiary-care public hospital were studied and PA was evaluated using MEA. Patients were followed for six months for the occurrence of all-cause death, acute myocardial infarction, or stroke. Suboptimal inhibition of PA was found in 7 patients (14.9%); 5 (10.6%) in response to ASA (acetylsalicylic acid), 2 (5.0%) to clopidogrel, and none to ticagrelor. Inadequate PA inhibition in response to ASA was significantly associated with the composite end point, but there was no significant association for insufficient PA inhibition in response to clopidogrel. This study suggested that the evaluation of PA in ACS using MEA may identify non-responders to ASA. Larger studies are necessary to define, in a public health scenario, the value of MEA in the management of ACS.

CFD simulation of fluid dynamic and biokinetic processes within activated sludge reactors under intermittent aeration regime.

Due to the aeration system, biological reactors are the most energy-consuming facilities of convectional WWTPs. Many biological reactors work under intermittent aeration regime; the optimization of the aeration process (air diffuser layout, air flow rate per diffuser, aeration length …) is necessary to ensure an efficient performance; satisfying the effluent requirements with the minimum energy consumption. This work develops a CFD modelling of an activated sludge reactor (ASR) which works under intermittent aeration regime. The model considers the fluid dynamic and biological processes within the ASR. The biological simulation, which is transient, takes into account the intermittent aeration regime. The CFD modelling is employed for the selection of the aeration system of an ASR. Two different aeration configurations are simulated. The model evaluates the aeration power consumption necessary to satisfy the effluent requirements. An improvement of 2.8% in terms of energy consumption is achieved by modifying the air diffuser layout. An analysis of the influence of the air flow rate per diffuser on the ASR performance is carried out. The results show a reduction of 14.5% in the energy consumption of the aeration system when the air flow rate per diffuser is reduced. The model provides an insight into the aeration inefficiencies produced within ASRs.

Tree root dynamics in montane and sub-alpine mixed forest patches.

Background and Aims: The structure of heterogeneous forests has consequences for their biophysical environment. Variations in the local climate significantly affect tree physiological processes. We hypothesize that forest structure also alters tree root elongation and longevity through temporal and spatial variations in soil temperature and water potential. Methods: We installed rhizotrons in paired vegetation communities of closed forest (tree islands) and open patches (canopy gaps), along a soil temperature gradient (elevations of 1400, 1700 and 2000 m) in a heterogeneous mixed forest. We measured the number of growing tree roots, elongation and mortality every month over 4 years. Key Results: The results showed that the mean daily root elongation rate (RER) was not correlated with soil water potential but was significantly and positively correlated with soil temperature between 0 and 8 °C only. The RER peaked in spring, and a smaller peak was usually observed in the autumn. Root longevity was dependent on altitude and the season in which roots were initiated, and root diameter was a significant factor explaining much of the variability observed. The finest roots usually grew faster and had a higher risk of mortality in gaps than in closed forest. At 2000 m, the finest roots had a higher risk of mortality compared with the lower altitudes. Conclusions: The RER was largely driven by soil temperature and was lower in cold soils. At the treeline, ephemeral fine roots were more numerous, probably in order to compensate for the shorter growing season. Differences in soil climate and root dynamics between gaps and closed forest were marked at 1400 and 1700 m, but not at 2000 m, where canopy cover was more sparse. Therefore, heterogeneous forest structure and situation play a significant role in determining root demography in temperate, montane forests, mostly through impacts on soil temperature.

Differences in globus pallidus neuronal firing rates and patterns relate to different disease biology in children with dystonia.

BACKGROUND: The pathophysiology underlying different types of dystonia is not yet understood. We report microelectrode data from the globus pallidus interna (GPi) and globus pallidus externa (GPe) in children undergoing deep brain stimulation (DBS) for dystonia and investigate whether GPi and GPe firing rates differ between dystonia types. METHODS: Single pass microelectrode data were obtained to guide electrode position in 44 children (3.3-18.1 years, median 10.7) with the following dystonia types: 14 primary, 22 secondary Static and 8 progressive secondary to neuronal brain iron accumulation (NBIA). Preoperative stereotactic MRI determined coordinates for the GPi target. Digitised spike trains were analysed offline, blind to clinical data. Electrode placement was confirmed by a postoperative stereotactic CT scan. FINDINGS: We identified 263 GPi and 87 GPe cells. Both GPi and GPe firing frequencies differed significantly with dystonia aetiology. The median GPi firing frequency was higher in the primary group than in the secondary static group (13.5 Hz vs 9.6 Hz; p=0.002) and higher in the NBIA group than in either the primary (25 Hz vs 13.5 Hz; p=0.006) or the secondary static group (25 Hz vs 9.6 Hz; p=0.00004). The median GPe firing frequency was higher in the NBIA group than in the secondary static group (15.9 Hz vs 7 Hz; p=0.013). The NBIA group also showed a higher proportion of regularly firing GPi cells compared with the other groups (p<0.001). A higher proportion of regular GPi cells was also seen in patients with fixed/tonic dystonia compared with a phasic/dynamic dystonia phenotype (p<0.001). The GPi firing frequency showed a positive correlation with 1-year outcome from DBS measured by improvement in the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS-m) score (p=0.030). This association was stronger for the non-progressive patients (p=0.006). INTERPRETATION: Pallidal firing rates and patterns differ significantly with dystonia aetiology and phenotype. Identification of specific firing patterns may help determine targets and patient-specific protocols for neuromodulation therapy. FUNDING: National Institute of Health Research, Guy's and St. Thomas' Charity, Dystonia Society UK, Action Medical Research, German National Academic Foundation.

Long-term follow-up results of a multi-institutional phase 2 study of concurrent chemoradiation therapy for locally advanced cervical cancer in east and southeast Asia.

PURPOSE: To report the long-term survival and toxicity of a multi-institutional phase 2 study of concurrent chemoradiation therapy (CCRT) for locally advanced cervical cancer in east and southeast Asia. METHODS AND MATERIALS: Ten institutions from 8 Asian countries participated in the study. Between April 2003 and March 2006, 120 patients (60 with bulky stage IIB and 60 with stage IIIB) were treated with CCRT. Radiation therapy consisted of pelvic external beam radiation therapy and either high-dose-rate or low-dose-rate intracavitary brachytherapy. Five cycles of weekly cisplatin (40 mg/m(2)) were administered during the course of radiation therapy. Treatment results were evaluated by the rates of local control, overall survival, and late toxicities. RESULTS: Median follow-up was 63.7 months, and the follow-up rate at 5 years was 98%. The 5-year local control and overall survival rates for all patients were 76.8% and 55.1%, respectively. The 5-year rates of major late toxicities of the rectum and bladder were 7.9% and 0%, respectively. CONCLUSIONS: The long-term results have suggested that CCRT is safe and effective for patients with locally advanced cervical cancer in east and southeast Asia. However, further efforts are needed to improve overall survival.

Cryopreservation of Arachis pintoi (leguminosae) somatic embryos.

In this study, we successfully cryopreserved cotyledonary somatic embryos of diploid and triploid Arachis pintoi cytotypes using the encapsulation-dehydration technique. The highest survival rates were obtained when somatic embryos were encapsulated in calcium alginate beads and precultured in agitated (80 rpm) liquid establishment medium (EM) with daily increasing sucrose concentration (0.50, 0.75, and 1.0 M). The encapsulated somatic embryos were then dehydrated with silica gel for 5 h to 20% moisture content (fresh weight basis) and cooled either rapidly (direct immersion in liquid nitrogen, LN) or slowly (1 degree C per min from 25 degree C to -30 degree C followed by immersion in LN). Beads were kept in LN for a minimum of 1 h and then were rapidly rewarmed in a 30 degree C water-bath for 2 min. Finally, encapsulated somatic embryos were post-cultured in agitated (80 rpm) liquid EM with daily decreasing sucrose concentration (0.75 and 0.5 M) and transferred to solidified EM. Using this protocol, we obtained 26% and 30% plant regeneration from cryopreserved somatic embryos of diploid and triploid cytotypes. No morphological abnormalities were observed in any of the plants regenerated from cryopreserved embryos and their genetic stability was confirmed with 10 isozyme systems and nine RAPD profiles.

Divertículo calicial. Técnica quirúrgica: nuestra casuística / Caliceal diverticula. Surgical technique: report of cases

Objetivo: evaluar la tasa libre de cálculo y de obliteración del divertículo, con la técnica percutánea, en el tratamiento quirúrgico de los divertículos caliciales asociados a litiasis. Materiales y Métodos: se revisaron las historias clínicas de pacientes operados por divertículo calicial asociado a litiasis en su interior de 2004 a 2010. Fueron evaluados con Urocultivo, Rx simple de árbol urinario, Urograma Excretor y Tomografía de abdomen y pelvis. Se determinó la presencia del divertículo, su asociación a litiasis y su proyección anterior o posterior. Se realizó nefrolitotricia percutánea (NLPC) más dilatación del cuello del divertículo en todos los casos. Con respecto a la técnica quirúrgica, en decúbito ventral, previa colocación de un catéter ureteral tipo "open end". Se accedió directamente al divertículo, con dilatación hasta 30 Fr. Luego de realizar la litotricia neumática y extraer los fragmentos litiásicos, se dilató el cuello del divertículo hasta 18 Fr, dejando luego un catéter doble jota o un tubo de nefrostomía a través del cuello del mismo hasta la pelvis renal. Los resultados respecto a los restos litiásicos y al divertículo se evaluaron en el postquirúrgico inmediato con Rx árbol urinario y urocultivo, a los 6 meses con Urograma Excretor y luego anualmente con ecografía. Resultados: 11 pacientes fueron tratados con NLPC por divertículos caliciales asociados a litiasis. La edad promedio fue de 41,8 años (14-58). El seguimiento medio fue de 29,7 meses (12-70). Los 11 divertículos tenían proyección posterior y estaban asociados a liltiasis renal. En todos los casos se pudo identificar el cuello diverticular y se realizó la dilatación del mismo. En 8 pacientes se dejó un catéter doble J desde el divertículo hasta la vejiga y en 3 un tubo de nefrostomía (K-11) desde el divertículo hasta la pelvis renal. Ninguno de los pacientes presentó sangrado con requerimiento de transfusión, neumotórax ni hemotórax. La tasa libre de cálculo fue del 10%...

Objective: Assessing the stone-free rate and diverticulum obliteration with percutaneous technique in the managment of the caliceal diverticula associated with stones. Material and methods: We reviewed medical records of patients undergoing surgery for calyceal diverticulum associated with lithiasis from 2004 to 2010. They were evaluated by urine culture, simple urinary Rx, intravenous urography and CT. Percutaneous nephrolithotomy (PCNL) plus dilatation of the diverticular neck was performed in all cases. First an ureteral catheter open end type was placed. In prone position the diverticulum was accessed directly. After pneumatic lithotripsy and extraction of fragments, diverticular neck was dilated to 20 Fr, leaving a double J catheter or a nephrostomy tube. The results were evaluated immediately after surgery with urinary Rx and urien culture, at 6 months with intravenous urography and annual follow-up with ultrasound. Results: 11 patients were treated with PCNL for caliceal diverticula with stones. The mean age was 41,8 years (range 14-58). The mean follow up was 29,7 months (range 12-70). All caliceal diverticulum had a posterior projection. In all cases the diverticular neck was identify and the dilation was performed. None of the patients experienced pneumothorax or hemothorax and blood transfusions were not required. The stone-free rate was 100%, all patients had complete remission of symptoms. No recurrence of the diverticulum was observed during the follow up. Conclusions: the results proves that percutaneous management with dilation of the diverticular neck is secure, effective and mini invasive technique for the treatment of the caliceal diverticula associated with stones

Multi-institutional phase II clinical study of concurrent chemoradiotherapy for locally advanced cervical cancer in East and Southeast Asia.

PURPOSE: To evaluate the toxicity and efficacy of concurrent chemoradiotherapy using weekly cisplatin for patients with locally advanced cervical cancer in East and Southeast Asia, a multi-institutional Phase II clinical study was conducted among eight Asian countries. METHODS AND MATERIALS: Between April 2003 and March 2006, 120 patients (60 with bulky Stage IIB and 60 with Stage IIIB) with previously untreated squamous cell carcinoma of the cervix were enrolled in the present study. Radiotherapy consisted of pelvic external beam radiotherapy (total dose, 50 Gy) and either high-dose-rate or low-dose-rate intracavitary brachytherapy according to institutional practice. The planned Point A dose was 24-28 Gy in four fractions for high-dose-rate-intracavitary brachytherapy and 40-45 Gy in one to two fractions for low-dose-rate-intracavitary brachytherapy. Five cycles of weekly cisplatin (40 mg/m(2)) were administered during the radiotherapy course. RESULTS: All patients were eligible for the study. The median follow-up was 27.3 months. Of the 120 patients, 100 (83%) received four or five cycles of chemotherapy. Acute Grade 3 leukopenia was observed in 21% of the patients, and Grade 3 gastrointestinal toxicity was observed in 6%. No patient failed to complete the radiotherapy course because of toxicity. The 2-year local control and overall survival rate for all patients was 87.1% and 79.6%, respectively. The 2-year major late rectal and bladder complication rate was 2.5% and 0%, respectively. CONCLUSION: The results have suggested that concurrent chemoradiotherapy using weekly cisplatin is feasible and effective for patients with locally advanced cervical cancer in East and Southeast Asia.

Atypical recurrent vulvar neurofibromatosis (von Recklinghausen's disease) with invasion / Philippine Journal of Obstetrics and Gynecology

Neurofibromatosis is defined by tumors called neurofibromas that grow along nerves in the body, or under the skin. It is an autosomal dominant disorder probably a neural crest origin, that affects all three germ layers therefore it can involve any organ system. Although eight subtypes have been proposed to date, the National Institutes of Health Consensus Development Conference has defined 2 distinct types: Neurofibromatosis type 1 or von Recklinghausen disease which affects 85 percent of patients, and Neurofibromatosis type 2, or bilateral acoustic neuroma/vestibular schwannomas which affects 10 percent of patients. Neurofibromatosis 1 is one of the most common genetic disorders that affect all races and both sexes equally. The estimated incidence rate of Neurofibromatosis in the Philippines has not yet been established due to lack of data. The clinical expression of Neurofibromatosis 1 is extremely variable bbut neurocutaneous manifestation is the most commonly observed. The cutaneous manifestation ranges from a small nodular to a giant pedunculated dermal lesion. Although recurrence of neurofibroma is common, the involvement of the female genital tract in neurofibromatosis 1 is uncommon and vulva is the most frequent genital location, but vaginal, cervical, uterine and ovarian neurofibromas have rarely been reported. This paper presents a case of the 47 year old nulligravid with recurrent vulvar neurofibroma for four times compounded by noticeable involvement of the abdomino-pelvic organs from which she underwent series of surgical excisions in order to preserve the normal appearance and much so to optimize the function of the organ affected.

Rectovestibular fistula as neovagina in congenital cervico-vaginal agenesis associated with imperforate anus.

An 18-year-old female presented with primary amenorrhea and progressive cyclic abdominal pain, which prompted emergency exploratory laparotomy. Intraoperative findings revealed absent cervix and vagina, partial bicornuate uterus, hematometra, left tubal endometriosis, ruptured left endometrioma and left renal agenesis. Left salpingectomy, left oophorocystectomy, hysterotomy, evacuation of menstrual blood and transverse loop colostomy were performed. Depo-medroxyprogesterone acetate was administered to suppress menses. On re-exploration, utero-rectovestibular fistula anastomosis was described with the distal rectovestibular fistula functioning as a neovagina. Cyclic menses occurred thereafter. Endorectal pull-through with anoplasty was performed after the fistulous tract healed. To the best of our knowledge, this is the first reported case of cervico-vaginal agenesis associated with imperforate anus and rectovestibular fistula. Early diagnosis and surgery are necessary to avoid complications such as endometriosis. The aim was to preserve fertility with conservative management.

A cryopreservation protocol for immature zygotic embryos of species of Ilex (Aquifoliaceae)

Tropical Ilex species have recalcitrant seeds. This work describes experiments demonstrating the feasibility of long-term conservation of Ilex brasiliensis, I. brevicuspis, I. dumosa, I. intergerrima, I. paraguariensis, I. pseudoboxus, I. taubertiana, and I. theezans through cryopreservation of zygotic rudimentary embryos at the heart developmental stage. The embryos were aseptically removed from the seeds and precultured (7 days) in the dark, at 27 +/- 2 degrees C on solidified (0.8% agar) 1/4MS medium, [consisting of quarter-strength salts and vitamins of Murashige and Skoog (1962) medium] with 3% sucrose and 0.1 mg/l Zeatin.The embryos were then encapsulated in 3% calcium alginate beads and pretreated at 24 h intervals in liquid medium supplemented with progressively increasing sucrose concentrations (0.5, 0.7 5 and 1 M). Beads were dehydrated for 5 h with silicagel to 25% water content (fresh weight basis) and then placed in sterile 5 ml cryovials. Then the beads were either plunged rapidly in liquid nitrogen were they were kept for 1 h (rapid cooling) or cooled at 1 degrees C min(-1) to -30 degrees C. Then the beads were immersed in liquid nitrogen for 1 h (slow cooling). The beads were rewarmed by immersion of the cryovials for 1 min in a water bath thermostated at 30 degrees C. Finally, beads were transferred onto culture medium (1/4MS, 3% sucrose, 0.1 mg/l zeatin, solidified with 0.8% agar) and incubated in a growth room at 27 +/- 2 degrees C under a 14 h light (116 micromol. m(-2) x s(-1))/ 10 h dark photoperiod. Maximum recovery percentages between 15 and 83% (depending on de the species and the treatment) were obtained with the cryopreserved embryos.(AU)

A cryopreservation protocol for immature zygotic embryos of species of Ilex (Aquifoliaceae)

Tropical Ilex species have recalcitrant seeds. This work describes experiments demonstrating the feasibility of long-term conservation of Ilex brasiliensis, I. brevicuspis, I. dumosa, I. intergerrima, I. paraguariensis, I. pseudoboxus, I. taubertiana, and I. theezans through cryopreservation of zygotic rudimentary embryos at the heart developmental stage. The embryos were aseptically removed from the seeds and precultured (7 days) in the dark, at 27 +/- 2 degrees C on solidified (0.8% agar) 1/4MS medium, [consisting of quarter-strength salts and vitamins of Murashige and Skoog (1962) medium] with 3% sucrose and 0.1 mg/l Zeatin.The embryos were then encapsulated in 3% calcium alginate beads and pretreated at 24 h intervals in liquid medium supplemented with progressively increasing sucrose concentrations (0.5, 0.7 5 and 1 M). Beads were dehydrated for 5 h with silicagel to 25% water content (fresh weight basis) and then placed in sterile 5 ml cryovials. Then the beads were either plunged rapidly in liquid nitrogen were they were kept for 1 h (rapid cooling) or cooled at 1 degrees C min(-1) to -30 degrees C. Then the beads were immersed in liquid nitrogen for 1 h (slow cooling). The beads were rewarmed by immersion of the cryovials for 1 min in a water bath thermostated at 30 degrees C. Finally, beads were transferred onto culture medium (1/4MS, 3% sucrose, 0.1 mg/l zeatin, solidified with 0.8% agar) and incubated in a growth room at 27 +/- 2 degrees C under a 14 h light (116 micromol. m(-2) x s(-1))/ 10 h dark photoperiod. Maximum recovery percentages between 15 and 83% (depending on de the species and the treatment) were obtained with the cryopreserved embryos.

Accelerated hyperfractionated radiotherapy for cervical cancer: multi-institutional prospective study of forum for nuclear cooperation in Asia among eight Asian countries.

PURPOSE: To evaluate the toxicity and efficacy of accelerated hyperfractionated radiotherapy (RT) for locally advanced cervical cancer. METHODS AND MATERIALS: A multi-institutional prospective single-arm study was conducted among eight Asian countries. Between 1999 and 2002, 120 patients (64 with Stage IIB and 56 with Stage IIIB) with squamous cell carcinoma of the cervix were treated with accelerated hyperfractionated RT. External beam RT consisted of 30 Gy to the whole pelvis, 1.5 Gy/fraction twice daily, followed by 20 Gy of pelvic RT with central shielding at a dose of 2-Gy fractions daily. A small bowel displacement device was used with the patient in the prone position. In addition to central shielding RT, intracavitary brachytherapy was started. Acute and late morbidities were graded according to the Radiation Therapy Oncology Group and Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. RESULTS: The median overall treatment time was 35 days. The median follow-up time for surviving patients was 4.7 years. The 5-year pelvic control and overall survival rate for all patients was 84% and 70%, respectively. The 5-year pelvic control and overall survival rate was 78% and 69% for tumors > or = 6 cm in diameter, respectively. No treatment-related death occurred. Grade 3-4 late toxicities of the small intestine, large intestine, and bladder were observed in 1, 1, and 2 patients, respectively. The 5-year actuarial rate of Grade 3-4 late toxicity at any site was 5%. CONCLUSION: The results of our study have shown that accelerated hyperfractionated RT achieved sufficient pelvic control and survival without increasing severe toxicity. This treatment could be feasible in those Asian countries where chemoradiotherapy is not available.

A regional cooperative clinical study of radiotherapy for cervical cancer in east and south-east Asian countries.

PURPOSE: Radiotherapy differed widely in east and south-east Asia because of technical, cultural, and socio-economic differences. With the purpose of standardizing radiotherapy for cervical cancer in the region, an international clinical study was conducted. MATERIALS AND METHODS: Eleven institutions in eight Asian countries participated in the study. Between 1996 and 1998, 210 patients with stage IIIB cervical cancer were enrolled. Patients were treated with a combination of external beam radiotherapy (total dose, 50Gy) and either high-dose-rate (HDR) or low-dose-rate (LDR) intracavitary brachytherapy (ICBT) according to the institutional practice. The planned point A dose was 20-28Gy/4 fractions for HDR-ICBT and 30-40Gy/1-2 fractions for LDR-ICBT. RESULTS: Hundred patients were treated with HDR-ICBT and 110 were treated with LDR-ICBT. The ICBT doses actually delivered to point A ranged widely: 12-32Gy in the HDR group and 26-52.7Gy in the LDR group. The 5-year follow-up rate among the countries differed greatly, from 29% to 100%. The 5-year major complication rates were 6% in the HDR group and 10% in the LDR group. The 5-year overall survival rates were 51.1% in the HDR group and 57.5% in the LDR group. CONCLUSIONS: Although there were several problems with treatment compliance and patients' follow-up, the study suggests that the protocols provided favorable outcomes with acceptable rates of late complications in the treatment of advanced cervical cancer in east and south-east Asia.

Estenosis traumática de uretra anterior / Anterior urethra traumatic stricture

Objetivos: En pacientes con estenosis traumática por "caída en horcajadas" de uretra anterior: 1) Mencionar las características más relevantes de la estenosis observada, 2) evaluar tipo y frecuencia de los métodos quirúrgicos empleados, 3) describir la incidencia de recurrencia de la estenosis. Material y Métodos: Se trata de una población de 12 pacientes evaluados retrospectivamente, con estenosis traumática de uretra anterior con un seguimiento promedio de 4,5 años. EI 41,6 por ciento fueron derivados sin intento terapéutico alguno. Resultados: La característica patológica intraoperatoria más relevante fue la presencia de espongiofibrosis densa y extendida a todo el espesor uretral, con longitudes inferiores a los 3 cm, y a la altura de la unión penoescrotal. El 58,3 por ciento requirió algún tipo de ampliación uretral frente a un 42.6 por ciento de resecciones anastomosis primaria. El 8,3 por ciento tuvo que ser reintervenido habiéndose realizado 1 uretrotomía interna de la boca proximal de una resección anastomosis ampliada. Conclusiones: 1. En la población estudiada la espongiofibrosis marcada y de no más de 3 cm de longitud fue la característica patológica más relevante. 2. El método quirúrgico más empleado fue algún tipo de ampliación uretral. 3. En la población estudiada la recurrencia observada fue de 8,3 por ciento

Estenosis traumática de uretra anterior / Anterior urethra traumatic stricture

Objetivos: En pacientes con estenosis traumática por "caída en horcajadas" de uretra anterior: 1) Mencionar las características más relevantes de la estenosis observada, 2) evaluar tipo y frecuencia de los métodos quirúrgicos empleados, 3) describir la incidencia de recurrencia de la estenosis. Material y Métodos: Se trata de una población de 12 pacientes evaluados retrospectivamente, con estenosis traumática de uretra anterior con un seguimiento promedio de 4,5 años. EI 41,6 por ciento fueron derivados sin intento terapéutico alguno. Resultados: La característica patológica intraoperatoria más relevante fue la presencia de espongiofibrosis densa y extendida a todo el espesor uretral, con longitudes inferiores a los 3 cm, y a la altura de la unión penoescrotal. El 58,3 por ciento requirió algún tipo de ampliación uretral frente a un 42.6 por ciento de resecciones anastomosis primaria. El 8,3 por ciento tuvo que ser reintervenido habiéndose realizado 1 uretrotomía interna de la boca proximal de una resección anastomosis ampliada. Conclusiones: 1. En la población estudiada la espongiofibrosis marcada y de no más de 3 cm de longitud fue la característica patológica más relevante. 2. El método quirúrgico más empleado fue algún tipo de ampliación uretral. 3. En la población estudiada la recurrencia observada fue de 8,3 por ciento(AU)

Estenosis traumática de uretra anterior / Anterior urethra traumatic stricture

Objetivos: En pacientes con estenosis traumática por "caída en horcajadas" de uretra anterior: 1) Mencionar las características más relevantes de la estenosis observada, 2) evaluar tipo y frecuencia de los métodos quirúrgicos empleados, 3) describir la incidencia de recurrencia de la estenosis. Material y Métodos: Se trata de una población de 12 pacientes evaluados retrospectivamente, con estenosis traumática de uretra anterior con un seguimiento promedio de 4,5 años. EI 41,6 por ciento fueron derivados sin intento terapéutico alguno. Resultados: La característica patológica intraoperatoria más relevante fue la presencia de espongiofibrosis densa y extendida a todo el espesor uretral, con longitudes inferiores a los 3 cm, y a la altura de la unión penoescrotal. El 58,3 por ciento requirió algún tipo de ampliación uretral frente a un 42.6 por ciento de resecciones anastomosis primaria. El 8,3 por ciento tuvo que ser reintervenido habiéndose realizado 1 uretrotomía interna de la boca proximal de una resección anastomosis ampliada. Conclusiones: 1. En la población estudiada la espongiofibrosis marcada y de no más de 3 cm de longitud fue la característica patológica más relevante. 2. El método quirúrgico más empleado fue algún tipo de ampliación uretral. 3. En la población estudiada la recurrencia observada fue de 8,3 por ciento(AU)