Histosurgical mapping of endoscopic endonasal surgery of sinonasal tumours to improve radiotherapy guidance.

PURPOSE: Endoscopic endonasal surgery (EES) is becoming a standard for most malignant sinonasal tumours. Margin analysis after piecemeal resection is complex and optimally relies on accurate histosurgical mapping. Postoperative radiotherapy may be adapted based on margin assessment mapping to reduce the dose to some sinonasal subvolumes. We assessed the use of histosurgical mapping by radiation oncologists (RO). MATERIAL AND METHODS: A French practice survey was performed across 29 ENT expert RO (2 did not answer) regarding integration of information on EES, as well as quality of operative and pathology reportsto refine radiotherapy planning after EES. This was assessed through an electronic questionnaire. RESULTS: EES was ubiquitously performed in France. Operative and pathology reports yielded accurate description of EES samples according to 66.7% of interviewed RO. Accuracy of margin assessment was however insufficient according to more than 40.0% of RO. Additional margins/biopsies of the operative bed were available in 55.2% (16/29) of the centres. In the absence of additional margins, quality of resection after EES was considered as microscopically incomplete in 48.3% or dubious in 48.3% of RO. As performed, histosurgical mapping allowed radiotherapy dose and volumes adaptation according to 26.3% of RO only. CONCLUSIONS: Standardized histosurgical mapping with margin and additional margin analysis could be more systematic. Advantages of accurate EES reporting could be dose painting radiotherapy to further decrease morbidity in sinonasal tumours.

Postoperative radiotherapy after flap reconstructive surgery in patients with head and neck cancer: A retrospective monocentric study with flap delineation to assess toxicity and relapse.

PURPOSE: Flaps are increasingly used during reconstructive surgery of head and neck cancers to improve functional outcomes. There are no guidelines as to whether the whole flap or its anastomotic border should be included in the primary tumour target volume of postoperative radiotherapy to prevent local relapses. Relapse and toxicity rates can increase substantially if the whole flap received full dose. Our aim was to determine whether flaps were included in the primary tumour target volume and to report the patterns of relapse and toxicity. MATERIALS AND METHODS: Consecutive patients in 2014 through 2016, with or without a flap, receiving postoperative radiotherapy were selected in a retrospective monocentric control study. Flaps were homogenously delineated blind to treating radiation oncologists using a flap-specific atlas. Tumour recurrence, acute and late toxicity were evaluated using univariate and propensity score analyses. RESULTS: A hundred patients were included; 54 with a flap. Median flap volume included in the tumour volume was 80.9%. Twelve patients experienced local recurrences: six with a flap, among whom two within their flap (3.7%). Patients with flaps had larger median tumour volumes to be irradiated (25cm3 versus 58cm3, p<0.001) and higher acute/late toxicity rates (p<0.001) even after adjustment on biases (more advanced T stage, oral cavity, active smoking in patients with flaps). Locoregional recurrence and survival rates were similar between patients with/without a flap. CONCLUSION: Recurrences within a flap were rare in this series when including the whole flap body in the 60Gy-clinical target volume but inclusion of the flap in the primary tumour target volume increased toxicity. Multicentric studies are warranted.

[Construction of radiobiological models as TCP (tumor control probability) and NTCP (normal tissue complication probability): from dose to clinical effects prediction]. / Construction des modèles radiobiologiques de type TCP (tumor control probability) et NTCP (normal tissue complication probability) : de la dose à la prédiction des effets cliniques.

In radiotherapy, the dose prescription is currently based on discretized dose-effects records that do not take into fully account for the complexity of the patient-dose-response relationship. Their predictive performance on both anti-tumour efficacy and toxicity can be optimized by integrating radiobiological models. It is with this in mind that the calculation models TCP (Tumor Control Probability) and NTCP (Normal Tissue Complication Probability) have been developed. Their construction involves several important steps that are necessary and important to understand. The first step is based on radiobiological models allowing to calculate according to more or less complexity the rate of surviving cells after irradiation. Two additional steps are required to convert the physical dose into an equivalent biological dose, in particular a 2Gy equivalent biological dose (EQD2): first to take into account the effect of the fractionation of the dose for both the target volume and the organs at risk; second to convert an heterogeneous dose to an organ into an homogeneous dose having the same effect (Niemierko generalized equivalent uniform dose (gEUD)). Finally, the process of predicting clinical effects based on radiobiological models transform doses into tumour control (TCP) or toxicity (NTCP) probabilities using parameters that reflect the radiobiological characteristics of the tissues in question. The use of these models in current practice is still limited, but since the radiotherapy softwares increasingly integrate them, it is important to know the principle and limits of application of these models.

[Proton therapy for head and neck squamous cell carcinomas: From physics to clinic]. / Protonthérapie des carcinomes épidermoïdes des voies aérodigestives supérieures : de la physique à la clinique.

Intensity-modulated radiation therapy (IMRT) is presently the recommended technique for the treatment of locally advanced head and neck carcinomas. Proton therapy would allow to reduce the volume of irradiated normal tissue and, thus, to decrease the risk of late dysphagia, xerostomia, dysgeusia and hypothyroidism. An exhaustive research was performed with the search engine PubMed by focusing on the papers about the physical difficulties that slow down use of proton therapy for head and neck carcinomas. Range uncertainties in proton therapy (±3 %) paradoxically limit the use of the steep dose gradient in distality. Calibration uncertainties can be important in the treatment of head and neck cancer in the presence of materials of uncertain stoichiometric composition (such as with metal implants, dental filling, etc.) and complex heterogeneities. Dental management for example may be different with IMRT or proton therapy. Some uncertainties can be somewhat minimized at the time of optimization. Inter- and intrafractional variations and uncertainties in Hounsfield units/stopping power can be integrated in a robust optimization process. Additional changes in patient's anatomy (tumour shrinkage, changes in skin folds in the beam patch, large weight loss or gain) require rescanning. Dosimetric and small clinical studies comparing photon and proton therapy have well shown the interest of proton therapy for head and neck cancers. Intensity-modulated proton therapy is a promising treatment as it can reduce the substantial toxicity burden of patients with head and neck squamous cell carcinoma compared to IMRT. Robust optimization will allow to perform an optimal treatment and to use proton therapy in current clinical practice.

[Modalities and advantages of image guided radiation therapy of breast cancer in adjuvant setting]. / Modalités et intérêt de radiothérapie guidée par l'image pour les cancers du sein en situation adjuvante.

In adjuvant setting, breast cancer radiotherapy volumes include whole mammary gland or chest wall, and when indicated, nodal area such as axilla, supraclavicular, and internal mammary chain. An accurate patients positioning is required due to some geometric complexity of target volumes closed to organs at risk as heart and lung. Image guided radiation therapy allows such accuracy. Here we propose a review on image guided radiotherapy for breast cancer.

Colecistitis aguda en un centro de trauma / Acute cholecystitis in a traumatologic service

El que un traumatizado grave desarrolle una colecistitis aguda (CA) es un hecho cada vez más frecuente. La dificultad diagnóstica que plantea estos enfermos junto a la gravedad de la patología, contribuyen a una alta mortalidad. Se revisan retrospectivamente las historias clínicas de 14 pacientes que desarrollaron una CA durante su hospitalización. Se presenta mayoritariamente en hombres (93 por ciento). La CA se presentó preferentemente entre la segunda y quinta semana de evolución. El diagnóstico fue hecho en todos los enfermos antes de la laparotomía. en 13 casos no se encontraron cálculos y en 9 las paredes estaban necróticas, siendo posible realizar en todos colecistectomía, considerado el procedimiento de elección

Hernia pulmonar de origen traumático / Lung hernia by trauma

La hernia pulmonar traumática (HPT) es un problema clínico inhabitual. Se da a conocer un caso atendido en el Hospital Mutual de Seguridad de Santiago. corresponde a un individuo que cae desde altura resultando con múltiples injurias siendo la torácica una de ellas, la que una vez tratada fue seguida aparentemente de buenos resultados. Sin embargo, diecisiete meses después de su accidente presentó aumento de volumen paraesternal izquierdo el que estudiado con imágenes resultó ser una HPT. Fue sometido a cirugía reparadora con doble método el cual incluyó por primera vez, hasta donde nosotros conocemos, el uso de un segmento de cresta ilíaca. La evolución posterior fue satisfactoria

[Developmental problems and risks of children and adolescents with severe hearing impairment--a challenge for intervention by child and adolescent psychiatrists]. / Entwicklungsprobleme und -risiken stark hörbehinderter Kinder und Jugendlicher--eine Herausforderung zur Einmischung an die Kinder- und Jugendpsychiatrie.

Considering special developmental risks and burdens of this group of children the dimensions of the multiaxial classification system prove to be a useful diagnostic framework. Especially severe and multiple communication impairments are important specific abnormal psychosocial circumstances for deaf and severe hard-off hearing children and adolescents. Finally some modest but nevertheless important tasks for child and youth psychiatrists are pointet out.

Health care utilization by older patients with coexisting dementia and depression.

OBJECTIVE: Few studies have examined the course of coexisting dementia and depression. The purpose of this study was to compare elderly patients who had coexisting dementia and depression with elderly patients who had either disorder alone in terms of their utilization of inpatient and outpatient services. METHOD: The study group included 7,115 veterans aged 60 years or older who had been discharged from Department of Veterans Affairs inpatient units in 1992 with diagnoses of major depression, dementia, or both. Outcome measures were analyzed for a 2-year period following the index hospitalization for each diagnostic study group. RESULTS: Patients with coexisting dementia and depression had significantly more psychiatric inpatient days than the other two study groups and more medical inpatient days and nursing home readmissions than patients with depression alone. Patients with coexisting dementia and depression had significantly more total inpatient days than the other two groups. Notably, patients with coexisting dementia and depression did not utilize more outpatient resources than the other study groups; in fact, they had significantly fewer medical, psychiatric, and total visits than patients with depression alone. CONCLUSIONS: The findings suggest that patients with coexisting dementia and depression are high utilizers of inpatient services, with a course of illness that may resemble dementia in terms of nursing home and inpatient medical care utilization and depression in terms of inpatient psychiatric care utilization; however, these patients utilized significantly fewer outpatient resources than the group with depression alone. Aggressive outpatient treatment approaches might reduce utilization of inpatient care for patients with coexisting depression and dementia.

[Evaluation of inpatient adolescent psychiatric therapy--a comparison of the attitudes of adolescents and parents]. / Bewertung stationärer jugendpsychiatrischer Therapie--eine Gegenüber-stellung der Urteile von Jugendlichen und Eltern.

This paper reports methods and findings of a retrospective study on this subject. Remarkable contrasts regarding central aspects of adolescent psychiatric inpatient treatment offer an interesting variety of hypotheses and desire quantitative and qualitative amplifications of the study.

[Prevalence and diagnostic value of so-called neurologic soft signs in a larger sample of severely hearing impaired 10 to 13-year-old children]. / Zur Prävalenz und Aussagekraft sog. neurologischer soft signs bei einer grösseren Stichprobe stark hörgeschädigter 10-13jähriger Kinder.

262 severely hard-off hearing and deaf 10-13 years old children were screened by a short, standardised neurological examination consisting of 7 items. The results showed a high rate of socalled soft signs especially in form of associated movements. It seemed remarkable that the rate of soft signs did not diminish over the age range examined. Statistical relations of these results to other variables of the whole study (gross motor coordination, hyperkinetic behaviour, global psychiatric ratings) support the hypothesis that soft signs are predictors of psychiatric morbidity in general.

Posee Justicia pectoralis las características farmacológicas de los neurolépticos clásicos? / Posee Justicia pectoralis the pharmacological characteristics of classic neuroleptics?

Se estudian los efectos producidos por extractos acuosos de Justicia pectoralis sobre la estereotipia inducida por apomorfina en ratas y sobre los enlaces totales del spiperone-3H en sinaptosomas striatales de ratas. Pretratamientos con inyecciones intraperitoneales de extractos acuosos de la planta verde y seca, así como de soluciones del linfilizado del extracto de tilo seco (LT) no antagonizaron la estereotipia apomorfínica en ratas. De igual modo, la incubación de las preparaciones sinaptosomales con soluciones de LT (1-500 microng/mL) no produjo desplazamiento del spiperone-3H de receptores dopaminérgicos striatales. Los resultados indican que Justicia pectoralis no presenta las características antidopaminérgicas de los neurolépticos típicos

Posee Justicia pectoralis las características farmacológicas de los neurolépticos clásicos?

Se estudian los efectos producidos por extractos acuosos de Justicia pectoralis sobre la estereotipia inducida por apomorfina en ratas y sobre los enlaces totales del spiperone-3H en sinaptosomas striatales de ratas. Pretratamientos con inyecciones intraperitoneales de extractos acuosos de la planta verde y seca, así como de soluciones del linfilizado del extracto de tilo seco (LT) no antagonizaron la estereotipia apomorfínica en ratas. De igual modo, la incubación de las preparaciones sinaptosomales con soluciones de LT (1-500 microng/mL) no produjo desplazamiento del spiperone-3H de receptores dopaminérgicos striatales. Los resultados indican que Justicia pectoralis no presenta las características antidopaminérgicas de los neurolépticos típicos (AU)

Suppressive effect of cyclosporin A on the development of Leishmania tropica-induced lesions in genetically susceptible BALB/c mice.

The effect of cyclosporin A (CyA) application on the development of cutaneous lesions was analyzed in genetically susceptible BALB/c mice infected s.c. with Leishmania tropica promastigotes. Daily i.p. injections of CyA, beginning 2 days before or at the day of the infection, dose dependently inhibited the development of parasite-induced lesions; no effect on the lesions was observed, however, if CyA application was started 14 days after the infection. Cessation of CyA administration after having successfully suppressed the cutaneous lesions for a period of 42 days, resulted in the development of lesions within 3 days. CyA had no inhibitory effect on lesions developing in L. tropica infected hypothymic BALB/c nu/nu mice. CyA or CyA-containing mouse serum did not directly affect the viability and the growth rate of L. tropica promastigotes, suggesting that the effect of the agent was imposed on the cells participating in the formation of the cutaneous lesions. Quantitative analysis of the cell distribution in the spleens of infected mice revealed that CyA markedly suppressed the infection-associated numerical increase of splenocytes. Within the Thy-1+ lymphocyte compartment, CyA had its most pronounced effect on the Lyt-1+ T lymphocyte subset. Early in the disease, the frequency of splenic cells proliferating in response to L. tropica antigen in vitro was clearly inhibited by CyA; in the later stages of the infection, however, this effect could not be observed, indicating the presence of L. tropica-inducible T cells being relatively resistant to CyA. Taken together, our findings indicate that CyA reversibly inhibits or delays the parasite-induced expansion of Lyt-1+ splenic T lymphocytes, and thus suppresses the biological function of those T cells that are instrumental for the formation of cutaneous lesions in L. tropica-infected BALB/c mice.

Action of (D-Pro4)-beta-casomorphin1-5 on processes of synaptic transmission.

The peptide (D-Pro4)-beta-casomorphin1-5 is a potent and long acting analgesic. Furthermore it is able to antagonize apomorphine-induced behavioral patterns, which are preferentially used as screening methods to detect dopaminolytic or neuroleptic properties. Because all of these tests do not exclude interaction of drugs with transmission systems other than the dopaminergic, biochemical studies were undertaken to estimate possible influences of the opioid peptide on processes of dopaminergic, serotonergic, and cholinergic transmission systems. In lower concentrations (D-Pro4)-beta-casomorphin1-5 enhances the potassium-stimulated release of acetylcholine from hippocampal slices and the basal overflow of dopamine from striatal slices. In high concentrations an augmentation of the potassium evoked release of dopamine and a reduction of the binding of [3H]spiperone on dopaminergic and serotonergic striatal receptors could be observed. These biochemical findings are discussed with regard to the behavioral patterns induced by this opioid peptide.