Simultaneous integrated boost to intraprostatic lesions using different energy levels of intensity-modulated radiotherapy and volumetric-arc therapy.

OBJECTIVE: This study compared the dosimetry of volumetric-arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) with a dynamic multileaf collimator using the Monte Carlo algorithm in the treatment of prostate cancer with and without simultaneous integrated boost (SIB) at different energy levels. METHODS: The data of 15 biopsy-proven prostate cancer patients were evaluated. The prescribed dose was 78 Gy to the planning target volume (PTV78) including the prostate and seminal vesicles and 86 Gy (PTV86) in 39 fractions to the intraprostatic lesion, which was delineated by MRI or MR-spectroscopy. RESULTS: PTV dose homogeneity was better for IMRT than VMAT at all energy levels for both PTV78 and PTV86. Lower rectum doses (V30-V50) were significantly higher with SIB compared with PTV78 plans in both IMRT and VMAT plans at all energy levels. The bladder doses at high dose level (V60-V80) were significantly higher in IMRT plans with SIB at all energy levels compared with PTV78 plans, but no significant difference was observed in VMAT plans. VMAT plans resulted in a significant decrease in the mean monitor units (MUs) for 6, 10, and 15 MV energy levels both in plans with and those without SIB. CONCLUSION: Dose escalation to intraprostatic lesions with 86 Gy is safe without causing serious increase in organs at risk (OARs) doses. VMAT is advantageous in sparing OARs and requiring less MU than IMRT. ADVANCES IN KNOWLEDGE: VMAT with SIB to intraprostatic lesion is a feasible method in treating prostate cancer. Additionally, no dosimetric advantage of higher energy is observed.

Congenital infiltrating lipomatosis of the face with hemimegalencephaly.

Congenital infiltrating lipomatosis of the face (CILF) is a rare disorder, causing unilateral facial asymmetry characterized by enlargement of the cheek or chin. Hemimegalencephaly is a unique malformation characterized by enlargement of a cerebral hemisphere. The association of CILF and hemimegalencephaly has rarely been reported. We present a case of unilateral facial swelling in a 1.5-year-old boy in whom magnetic resonance imaging and computed tomography revealed CILF associated with unilateral megalencephaly.

Brain SPECT findings in long-term inhalant abuse.

This study evaluates brain perfusion in long-term inhalant abusers of toluene, acetone, benzene and derivatives. Ten patients in the age range 16-18 years (mean, 17.3+/-0.67 years), who had been inhalant dependent for a mean period of 48.3+/-6.2 months, but who had stopped using inhalants for 1-11 months (mean, 5.4+/-2.1 months), and ten controls (mean age, 17.3+/-0.67 years) were included in the study. Psychiatric tests, biochemical tests and Tc-99m-hexamethylpropyleneamine oxime (Tc-99m-HMPAO) brain single photon emission computed tomography (SPECT) were performed on all patients. Brain SPECT images were evaluated qualitatively and quantitatively. The mean IQ level was found to be 84 (by psychological tests). Brain SPECT showed non-homogeneous Tc-99m-HMPAO uptake and hypoperfusion areas in all patients (five left temporal, one right temporal, two left temporal plus bilateral parietooccipital, one biparietal and one left temporoparietal). Seven patients had hyperperfused foci (unifocal in five patients and multifocal in two patients). Six hyperperfused foci were in a parietal and one in a temporoparietal location. This study suggests that inhalant dependents exhibit serious abnormalities in brain SPECT images, including hypo-hyperperfusion foci and non-homogeneous uptake of the radiopharmaceutical. A further study with a larger number of patients and long-term follow-up may help to reach a more specific conclusion.

Evaluation of cardiac functions in patients with thalassemia major.

It is known that a blood transfusion is necessary for survival in patients with thalassemia, but it may cause myocardial dysfunction due to myocardial siderosis as in other organs. The aim of this study was to evaluate myocardial perfusion by means of stress thallium scanning (MPS) and left ventricular functions by rest radionuclide ventriculography (RNV). Twenty-one patients at ages 9-16 (mean 12.1 +/- 3.2) who have been diagnosed with thalassemia for 4-15 years (mean 12.7 +/- 4.8) were included in the study. They had blood transfusions 78-318 times (mean 162.1 +/- 71). MPS and RNV was performed within two days after the any transfusion. MPS showed ischemia in 3 patients and normal perfusion in 18 patients. RNV revealed normal systolic parameters (wall motion, EF, PER, TPE) but diminished diastolic parameters (TPF, PFR) compared with normal values (p < 0.05). We conclude that ischemia or fixed defects may be seen in stress MPS as a result of cardiac involvement in patients with thalassemia. But, RNV is an important and preferable test for the early detection of subclinic cardiomyopathy. RNV may therefore show diastolic abnormalities before the systolic abnormalities show up.

Inflammatory fibroid polyp presenting with intestinal invagination: sonographic and correlative imaging findings.

We report a case of a large inflammatory fibroid polyp of the small bowel presenting with intussusception in a 22-year-old man. Sonography demonstrated a solid, mobile, homogeneous, echogenic mass surrounded by the typical mural layers of an invaginated ileum. CT demonstrated a well-defined intraluminal solid mass with an attenuation of 17 HU. The pathologic diagnosis after segmental ileal resection was ileal inflammatory fibroid polyp.

Postoperative goitre recurrence rate in Turkey.

A study was conducted on the incidence of postoperative nontoxic goitre in 206 patients. The mean period of postoperative observation was 7.8 years. The recurrence rate was 30.7% in the 26 patients to whom thyroxine was administered regularly and at doses of 0.15 mg/day or more in the postoperative period, and 46.9% in the 32 patients who received thyroxine regularly at low doses (0.10 mg/day). In contrast, recurrence rate was 71.4% in the 49 patients in whom use of thyroxine was irregular and 81.8% in the 99 patients who received no thyroxine. The recurrence rate was markedly reduced in the patients who used thyroxine regularly at doses of 0.15 mg/day or more as compared with those who used it irregularly or not at all. It was concluded that in Turkey, where iodine deficiency is a major contributory factor of the prevalence of goitre, postoperative administration of thyroxine is necessary in order to reduce the postoperative recurrence rate.

Parasternal lymphoscintigraphy using 99Tcm-dextran.

99Tcm-dextran was evaluated as a lymphoscintigraphic agent in 10 normal volunteers and 24 patients with breast cancer. 99Tcm-dextran (0.5-1 mCi) in a volume of 0.1-0.2 ml was injected into the posterior rectus sheath in the subcostal site on one side. Scintigrams were obtained at 2-2.5 h after injection and the injection was repeated on the other side. The final image was taken at 4.5-5 h after the first injection. The normal distribution of lymph nodes and anatomical variations in scintigraphic images were first determined in normal subjects. In the patient group, eight scintigrams were evaluated as pathological and the rest as normal. In the 25 women whose lymphoscintigrams were normal the mean number of parasternal nodes visualized was six (range: 3-11). Bilateral symmetrical or asymmetrical chain was observed in 20 subjects (80%) and unilateral chain in five subjects (20%). There was cross-drainage in five subjects (20%). Supraclavicular lymph nodes were visualized in 11 subjects (44%). Varying abnormal images were obtained in eight patients. Our results are in good agreement with those reported in the literature, using radiocolloids. It is concluded that 99Tcm-dextran is a promising agent and may well replace radiocolloids because of the simplicity of the labelling procedure, stability of the label, easy availability and low cost.

Influence of cigarette smoking on thyroid hormone levels.

1 Serum triiodothyronine (T3), thyroxine (T4) and thyrotropin (TSH) concentrations and urinary thiocyanate levels were examined in healthy smokers and non-smokers as an indicator of smoking behaviour. Smokers were subdivided into moderate and heavy. 2 Significant differences in urinary thiocyanate levels were apparent between all three groups. For heavy smokers, serum T3 concentrations were significantly above the values found in non-smokers. Increased serum T3 levels were not accompanied by a substantial change in serum T4 and TSH concentrations.