Elemental analysis of sage (herb) using calibration-free laser-induced breakdown spectroscopy.

In this work, laser-induced breakdown spectroscopy (LIBS) has been used for the quantitative and qualitative analysis of the sage sample using the calibration-free LIBS (CF-LIBS) technique. The sage plasma is generated by focusing the second harmonics (532 nm) of a Q-switched Nd:YAG laser with a repetition rate of 10 Hz and pulse duration of 5 ns. The emission spectra are recorded using a LIBS 2000 detection system spectrometer consisting of five high-resolution spectrometers covering a wavelength range from 200 to 720 nm. The optical emission spectra of the sage sample reveal the spectral lines of Fe, Ca, Ti, Co, Mn, Ni, and Cr. The plasma temperature and electron number density of the neutral spectral lines of the pertinent elements have been deduced using the Boltzmann plot and Stark-broadening line profile method, with average values 8855±885K and 3.89×1016cm-3, respectively. The average values of the plasma parameters were used for the quantification of the detected elements in the sample. Based on the calibration-free method, the measured results demonstrate that Fe is the major constituent in the sample, having a percentage concentration of 48.1%, while the remaining elements are Ca, Ti, Co, Mn, Ni, and Cr, with percentage concentrations 0.7%, 5.3%, 8%, 11%, 12.3%, and 14.6%, respectively. This study demonstrates the feasibility of LIBS for the compositional analysis of major and trace elements present in the plant samples and its further applications in medicine.

Kinetics of volatile impurity removal from silicon by electron beam melting for photovoltaic applications.

A full domain control model is established for impurity transportation in the liquid phase, gas-liquid interface and gas phase of silicon to analyze the dynamic mechanics of impurity removal. The results show that the overall mass transfer coefficient mainly depends on the temperature and the chamber pressure. Its value increases with the increase of temperature or the decrease of chamber pressure. Under the same melting condition, the order of the overall mass transfer coefficients for P, Al and Ca is kP > kAl > kCa, indicating that P is easier to remove by evaporation. Mass transfer in the gas phase is the rate-controlling step for volatile impurity removal at the temperature above the melting point of silicon. The rate-controlling step transits to evaporation on the gas-liquid interface then to mass transfer in the liquid boundary layer as the temperature increases. During electron beam melting, the removal of P is controlled by both evaporation on the gas-liquid interface and mass transfer in the liquid boundary layer, and the removal of Al and Ca is controlled by evaporation on the gas-liquid interface.

Implementation of a mentored professional development programme in laboratory leadership and management in the Middle East and North Africa.

Laboratories need leaders who can effectively utilize the laboratories' resources, maximize the laboratories'capacity to detect disease, and advocate for laboratories in a fluctuating health care environment. To address this need, the University of Washington, USA, created the Certificate Program in Laboratory Leadership and Management in partnership with WHO Regional Office for the Eastern Mediterranean, and implemented it with 17 participants and 11 mentors from clinical and public health laboratories in 10 countries (Egypt, Iraq, Jordan, Lebanon, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, and Yemen) in 2014. Designed to teach leadership and management skills to laboratory supervisors, the programme enabled participants to improve laboratory testing quality and operations. The programme was successful overall, with 80% of participants completing it and making impactful changes in their laboratories. This success is encouraging and could serve as a model to further strengthen laboratory capacity in the Region.

Contribution of laboratories in the WHO Eastern Mediterranean Region to the selection of candidate seasonal influenza vaccine, 2010-2015.

The World Health Organization (WHO) formulates recommendations for viruses to be included in vaccines for the influenza seasons in the northern and southern hemispheres on the basis of analyses by its collaborating centres (CCs). This report describes the contribution of influenza laboratories and national influenza centres in countries in the WHO Region for the Eastern Mediterranean to the selection process of seasonal and pre-pandemic influenza virus subtypes. Data submitted by 22 countries to FluNet and FluID between September 2010 and June 2015 were analysed. National Influenza Centres (NICs) in 12 countries (55%) reported data, 5 (23%) to both FluNet and FluID and 7 (32%) only to FluNet. The WHO CC in London characterized 78% of the samples, and the CC in Atlanta, characterized 21%. The contribution of influenza laboratories and NICs from this Region to global influenza surveillance is appreciable. However, enhancing the contribution through initiatives such as the Pandemic Influenza Preparedness Framework is still needed.

Zika virus: no cases in the Eastern Mediterranean Region but concerns remain.

Following the WHO declaration on 1 February 2016 of a Public Health Emergency of International Concern (PHEIC) with regard to clusters of microcephaly and neurological disorders potentially associated with Zika virus, the WHO Regional Office for the Eastern Mediterranean conducted three rounds of emergency meetings to address enhancing preparedness actions in the Region. The meetings provided up-to-date information on the current situation and agreed on a set of actions for the countries to undertake to enhance their preparedness and response capacities to Zika virus infection and its complications. The most urgent action is to enhance both epidemiological and entomological surveillance between now and the coming rainy seasons in countries with known presence of Aedes mosquitoes. Zika virus like other vector-borne diseases poses a particular challenge to the countries because of their complex nature which requires multidisciplinary competencies and strong rapid interaction among committed sectors. WHO is working closely with partners and countries to ensure the optimum support is provided to the countries to reduce the risk of this newly emerged health threat.

Neuroanatomical location of brain metastases from solid tumours based on pathology: An analysis of 511 patients with a comparison to the provided clinical history.

Brain metastases are a frequent occurrence in neuropathology practices. The literature on their neuroanatomical location is frequently derived from radiological analyses. This work examines brain metastases through the lens of pathology specimens. All brain surgical pathology reports for cases accessioned 2011-2020 were retrieved from a laboratory. Specimens were classified by neuroanatomical location, diagnosis and diagnostic category with a hierarchical free text string-matching algorithm (HFTSMA) and also subsequently audited. All reports classified as probable metastasis were reviewed by a pathologist. The provided history was compared to the final categorization by a pathologist. The cohort had 4,625 cases. The HFTSMA identified 854 cases (including metastases from a definite primary, metastases from primary not known and improperly classified cases). 514/854 cases had one definite primary site per algorithm and on report review 538/854 cases were confirmed as such. The 538 cases originated from 511 patients. Primaries from breast, gynecologic tract, and gastrointestinal tract not otherwise specified were most frequently found in the cerebellum. Kidney metastases were most frequently found in the occipital lobe. Lung, metastatic melanoma and colorectal primaries were most commonly found in the frontal lobe. The provided clinical history predicted the primary in 206 cases (40.3%), was discordant in 17 cases (3.3%) and non-contributory in 280 cases (54.8%). The observed distribution of the metastatic tumours in the brain is dependent on the primary site. In the majority (54.8%) of cases, the provided clinical history was non-contributory; this suggests surgeon-pathologist communication may have the potential for optimization.

Association of hemoglobin trend and outcomes in aneurysmal subarachnoid hemorrhage: A single center cohort study.

BACKGROUND: Anemia has been linked to delayed cerebral ischemia (DCI) and worse outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, the association of hemoglobin (Hb) trend and outcomes is not well studied. We investigated predictors of Hb trend and its association with outcomes in patients with aSAH. Our hypothesis was that a negative Hb trend is associated with poorer outcomes independent of Hb values. METHODS: We conducted a retrospective study of a prospectively collected cohort of consecutive patients with aSAH who were admitted to an academic center (2016-2021). We tested the association of Hb trend and values with measures including DCI and poor functional outcome defined as modified Rankin scale 4-6 at 3 months after discharge. Multiple linear regression analysis was used to identify factors associated with Hb difference from admission to discharge. RESULTS: We included 310 patients with confirmed aneurysmal etiology (mean age 57 years, SD13.6; 62 % female). Greater Hb decrement from admission to discharge was independently associated with higher likelihood of both DCI (OR 1.28 per 1 g/dl decrease in Hb, 95 % CI 1.08-1.47; p = 0.003) and poor functional outcome (OR 1.27 per 1 g/dl decrease in Hb, 1.03-1.53; p = 0.026) independent of any absolute Hb values. Predictors of Hb decrement from admission to discharge were hospital length of stay, Hunt and Hess grades, female sex and age. CONCLUSION: Greater Hb decrement can be associated with higher likelihood of DCI and poor functional outcome in aSAH. More evidence is needed to use Hb trend to guide transfusion threshold in aSAH patients.

Removal of mercaptans from a gas stream using continuous adsorption-regeneration.

The removal of the mercaptan, 1-methyl-1-propanethiol, from aqueous solutions using a non-porous, electrically conducting carbon-based adsorbent (Nyex 1000) was investigated. The adsorption process was found to be rapid (equilibrium capacity achieved within 5 minutes) with low adsorptive capacity (of the order of 0.4 mg g(-1)) when compared with activated carbon. Electrochemical regeneration of the Nyex 1000 in a simple divided electrochemical cell within a sequential batch treatment unit restored 100% of the adsorbent's adsorptive capacity using treatment times as low as 20 minutes by passing a current of 0.5 A. The sorptive characteristics of a Nyex-water slurry were also modelled and investigated both in a bubble column and in a continuous adsorption-regeneration treatment system. It was demonstrated that the continuous removal-destruction system could achieve a step reduction in challenge gas concentration of approximately 75% for a period of 35 minutes with a current of 5 Amps. This was attributed to mass transfer enhanced by a combination of adsorption and chemical reaction with free chlorine species generated in the electrochemical process.

Inducing salt tolerance in mung bean through coinoculation with rhizobia and plant-growth-promoting rhizobacteria containing 1-aminocyclopropane-1-carboxylate deaminase.

Twenty-five strains of plant-growth-promoting rhizobacteria (PGPR) containing 1-aminocyclopropane-1-carboxylate (ACC) deaminase and 10 strains of rhizobia were isolated from rhizosphere soil samples and nodules of mung bean. They were screened in separate trials under salt-stressed axenic conditions. The three most effective strains of PGPR (Mk1, Pseudomonas syringae ; Mk20, Pseudomonas fluorescens ; and Mk25, Pseudomonas fluorescens biotype G) and Rhizobium phaseoli strains M1, M6, and M9 were evaluated in coinoculation for their growth-promoting activity at three salinity levels (original, 4 dS·m(-1), and 6 dS·m(-1)) under axenic conditions. The results showed that salinity stress significantly reduced plant growth but inoculation with PGPR containing ACC deaminase and rhizobia enhanced plant growth, thus reducing the inhibitory effect of salinity. However, their combined application was more effective under saline conditions, and the combination Mk20 × M6 was the most efficient for improving seedling growth and nodulation. The effect of high ethylene concentrations on plant growth and the performance of these strains for reducing the negative impact of saline stress was also evaluated by conducting a classical triple-response bioassay. The intensity of the classical triple response decreased owing to inoculation with these strains, with the root and shoot lengths of inoculated mung bean seedlings increasing and stem diameter decreasing, which is a typical response to the dilution in a classical triple response bioassay. Thus, coinoculation with PGPR containing ACC deaminase and Rhizobium spp. could be a useful approach for inducing salt tolerance and thus improving growth and nodulation in mung bean under salt-affected conditions.

Omental caking: a rare manifestation of malignant peripheral nerve sheath tumour.

Malignant peripheral nerve sheath tumour (MPNST) is a very rare tumour with an incidence of one per 100,000 and constitutes between 3 to 10% of all soft tissue sarcomas. Most of the sarcoma involve the extremities and retroperitoneal regions. However, this case presented with mass in left inguinal region and then spread rapidly to omentum, assuming the appearance of an omental cake. Mass responded well to chemotherapy comprising of Ifosfamide and Doxorubicin.

Porocarcinoma: a rare sweat gland malignancy.

Eccrine Porocarcinoma (ECP) is a malignant tumour arising from the intraepithelial ductal parts of the sweat gland. It has also been described as malignant hidroacanthoma simplex, sweat gland carcinoma, malignant intra-epidermal eccrine poroma, eccrine poroepithelioma, dysplastic poroma, malignant syringo acanthoma and porocarcinoma. Treatment with wide local excision but metastatic lesions can be treated with chemotherapy. Here, we present a case report of 52 years old male who presented with a fungating growth on left pre-auricular region that came out to be a case of ECP on histopathological examination.

Hepatic and skeletal metastases from primary intracranial atypical meningioma.

Meningioma constitutes 27% of primary CNS tumours. It rarely metastasizes to distant sites (< 0.1%). Here, we present a case report of primary atypical intracranial meningioma metastasizing to liver and bone after 4 years of surgery and postoperative radiotherapy presenting with multiple episodes of hypoglycemia.

Calcium pyrophosphate dihydrate deposition disease (CPPD)/Pseudogout of the temporomandibular joint - FNA findings and microanalysis.

We report a case of a Calcium pyrophosphate dihydrate deposition disease (CPPD) presenting as a mass in the parotid and temporomandibular joint (TMJ) that simulated a parotid tumor. A 35 year-old man presented with pain in the left ear area. A CT Scan of the area showed a large, calcified mass surrounding the left condylar head, and extending into the infratemporal fossa. FNA of the mass showed birefringent crystals, most of which were rhomboid with occasional ones being needle shaped, embedded in an amorphous pink substance. Scanning electron microscopy (SEM) with energy dispersive x-ray spectroscopy (EDS) of these crystals showed peaks corresponding to calcium and phosphorus. SEM/EDS is a rapid method of diagnosing calcium pyrophosphate dihydrate deposition disease (CPPD) and an alternative to more commonly used method of special staining of cell block sections coupled with polarizing microscopy.

Effectiveness of rhizobacteria containing ACC deaminase for growth promotion of peas (Pisum sativum) under drought conditions.

A series of experiments were conducted to assess the effectiveness of rhizobacteria containing 1-aminocyclopropane- 1-carboxylate (ACC) deaminase for growth promotion of peas under drought conditions. Ten rhizobacteria isolated from the rhizosphere of different crops (peas, wheat, and maize) were screened for their growth promoting ability in peas under axenic condition. Three rhizobacterial isolates, Pseudomonas fluorescens biotype G (ACC-5), P. fluorescens (ACC-14), and P. putida biotype A (Q-7), were selected for pot trial on the basis of their source, ACC deaminase activity, root colonization, and growth promoting activity under axenic conditions. Inoculated and uninoculated (control) seeds of pea cultivar 2000 were sown in pots (4 seeds/pot) at different soil moisture levels (25, 50, 75, and 100% of field capacity). Results revealed that decreasing the soil moisture levels from 100 to 25% of field capacity significantly decreased the growth of peas. However, inoculation of peas with rhizobacteria containing ACC deaminase significantly decreased the "drought stress imposed effects" on growth of peas, although with variable efficacy at different moisture levels. At the lowest soil moisture level (25% field capacity), rhizobacterial isolate Pseudomonas fluorescens biotype G (ACC-5) was found to be more promising compared with the other isolates, as it caused maximum increases in fresh weight, dry weight, root length, shoot length, number of leaves per plant, and water use efficiency on fresh and dry weight basis (45, 150, 92, 45, 140, 46, and 147%, respectively) compared with respective uninoculated controls. It is highly likely that rhizobacteria containing ACC deaminase might have decreased the drought-stress induced ethylene in inoculated plants, which resulted in better growth of plants even at low moisture levels. Therefore, inoculation with rhizobacteria containing ACC deaminase could be helpful in eliminating the inhibitory effects of drought stress on the growth of peas.

Pulmonary Intravascular B-Cell Lymphoma with Angiotropism/Angioinvasion Mimicking Interstitial Lung Disease: A Clinical Dilemma and Potential Diagnostic Challenge.

Intravascular large B cell lymphoma (IVLBCL) is a rare type of extranodal diffuse large B-cell lymphoma. Patients typically present with nonspecific findings, particularly bizarre neurologic symptoms, fever, and skin lesions. IVLBCL with primary lung presentation is very rare and difficult to diagnose. The authors report a case of a 75-year-old male who presented with neurological symptoms and showed diffuse pulmonary ground glass opacities on computed tomography scan (CT scan). Surgical lung biopsy was performed. Light microscopic examination of the specimen showed diffuse alveolar septal widening caused by neoplastic lymphocytes, which were positive for CD20. These atypical lymphoid cells also demonstrated angiotropism/angioinvasion of the medium sized pulmonary vessels. The patient was diagnosed with IVLBCL and underwent chemotherapy. The patient is still alive 12 months after diagnosis.

Dosimetric, Radiobiological and Secondary Cancer Risk Evaluation in Head-and-Neck Three-dimensional Conformal Radiation Therapy, Intensity-Modulated Radiation Therapy, and Volumetric Modulated Arc Therapy: A Phantom Study.

This analysis estimated secondary cancer risks after volumetric modulated arc therapy (VMAT) and compared those risks to the risks associated with other modalities of head-and-neck (H&N) radiotherapy. Images of H&N anthropomorphic phantom were acquired with a computed tomography scanner and exported via digital imaging and communications in medicine (DICOM) standards to a treatment planning system. Treatment plans were performed using a VMAT dual-arc technique, a nine-field intensity-modulated radiation therapy (IMRT) technique, and a four-field three-dimensional conformal therapy (3DCRT) technique. The prescription dose was 66.0 Gy for all three techniques, but to accommodate the range of dosimeter responses, we delivered a single dose of 6.60 Gy to the isocenter. The lifetime risk for secondary cancers was estimated according to National Council on Radiation Protection and Measurements (NCRP) Report 116. VMAT delivered the lowest maximum doses to esophagus (23 Gy), and normal brain (40 Gy). In comparison, maximum doses for 3DCRT were 74% and 40%, higher than those for VMAT for the esophagus, and normal brain, respectively. The normal tissue complication probability and equivalent uniform dose for the brain (2.1%, 0.9%, 0.8% and 3.8 Gy, 2.6 Gy, 2.3 Gy) and esophagus (4.2%, 0.7%, 0.4% and 3.7 Gy, 2.2 Gy, 1.8 Gy) were calculated for the 3DCRT, IMRT and VMAT respectively. Fractional esophagus OAR volumes receiving more than 20 Gy were 3.6% for VMAT, 23.6% for IMRT, and 100% for 3DCRT. The calculations for mean doses, NTCP, EUD and OAR volumes suggest that the risk of secondary cancer induction after VMAT is lower than after IMRT and 3DCRT.

Verification of the pure alanine in PMMA tube dosimeter applicability for dosimetry of radiotherapy photon beams: a feasibility study.

Alanine dosimeters in the form of pure alanine powder in PMMA plastic tubes were investigated for dosimetry in a clinical application. Electron paramagnetic resonance (EPR) spectroscopy was used to measure absorbed radiation doses by detection of signals from radicals generated in irradiated alanine. The measurements were performed for low-dose ranges typical for single-fraction doses often used in external photon beam radiotherapy. First, the dosimeters were irradiated in a solid water phantom to establish calibration curves in the dose range from 0.3 to 3 Gy for 6 and 18 MV X-ray beams from a clinical linear accelerator. Next, the dosimeters were placed at various locations in an anthropomorphic pelvic phantom to measure the dose delivery of a conventional four-field box technique treatment plan to the pelvis. Finally, the doses measured with alanine dosimeters were compared against the doses calculated with a commercial treatment planning system (TPS). The results showed that the alanine dosimeters have a highly sensitive dose response with good linearity and no energy dependence in the dose range and photon beams used in this work. Also, a fairly good agreement was found between the in-phantom dose measurements with alanine dosimeters and the TPS dose calculations. The mean value of the ratios of measured to calculated dose values was found to be near unity. The measured points in the in-field region passed dose-difference acceptance criterion of 3% and those in the penumbral region passed distance-to-agreement acceptance criterion of 3 mm. These findings suggest that the pure alanine powder in PMMA tube dosimeter is a suitable option for dosimetry of radiotherapy photon beams.

Lamivudine for hepatitis B in liver transplantation: a single-center experience.

BACKGROUND: Liver transplantation for hepatitis B virus (HBV) has been associated with a high rate of reinfection and graft failure. Lamivudine, a potent inhibitor of HBV replication, has been shown to prevent viral recurrence after transplantation. METHODS: The effectiveness of lamivudine monotherapy for the management of HBV recurrence after liver transplantation was assessed. Lamivudine was used in three patient groups: (1) patients started before transplantation and continued after transplantation (n = 13); (2) patients treated after transplantation (n = 15); and (3) patients with de novo hepatitis B after transplantation (n = 4). RESULTS: Median follow-up on lamivudine was 24 months. Active viral replication (HBV-DNA+) was seen in 17 (53%) of 32 at treatment initiation. All lost HBV-DNA at a mean of 2.4+/-1.6 months after lamivudine initiation. Twenty-six (81%) patients remain free of viral recurrence. Six (19%) patients have evidence of breakthrough infection with the YMDD mutant of HBV, two of whom progressed to graft failure. All four patients in group 1 who developed breakthrough had evidence of hepatitis B surface antigen expression in the explanted liver by immunohistochemistry despite being serum HBV-DNA negative before transplantation. No difference was observed among the three groups in DNA clearance or breakthrough rates. CONCLUSIONS: Lamivudine achieves viral DNA clearance in almost all patients. Expression of viral antigens in the liver seems to identify patients at risk of developing HBV-DNA recurrence. Disease-free survival of 81% at 22 months is similar to data with hepatitis B immunoglobulin therapy. Given the safe clinical profile and high efficacy in the prevention of disease recurrence, lamivudine will favorably change the outlook of liver transplantation for HBV.

Water-borne hepatitis E virus epidemic in Islamabad, Pakistan: a common source outbreak traced to the malfunction of a modern water treatment plant.

During December 1993 and in the first three months of 1994, an explosive water-borne epidemic of hepatitis E virus (HEV) occurred in two sectors of Islamabad, Pakistan. In a survey of a population of 36,705 individuals, a total of 3,827 cases of acute icteric hepatitis were recorded with an overall attack rate (AR) of 10.4%. The etiologic role of HEV in the epidemic was proven by demonstrating anti-HEV IgG and HEV IgM in the tested serum samples. The water-borne nature of the epidemic was suggested by a study of the case distribution according to water supply. Prior to the epidemic, there had been an operational breakdown in a water treatment plant that distributed water to the affected areas while transforming its purification system from slow sand to rapid sand filtration. The primary source of water for the plant was derived from a heavily contaminated stream. The highest AR (16.3%) was observed in the areas where the source of drinking water was exclusively from the purification plant, followed by ARs of 12.4% and 5.3% for those receiving 50% and 30% or less of their water supply from the treatment plant, respectively, while the lowest AR (1.8%) was observed in the neighboring areas that did not receive water from this source. The AR was significantly higher in the group 11-30 years of age (15.3%) as compared with children less than 11 years of age (1.4%) and also relative to the group greater than 30 years of age (10.5%). The AR among the 162 recorded pregnant females was 21.6%, which was higher than that found among nonpregnant females of child-bearing age (10.9%). All four reported adult deaths occurred among females in their third trimester of pregnancy with a case fatality rate of 11.4%, while the other four fatal cases were newborn infants of mothers with acute icteric hepatitis. Although the aggregation of cases within households was significantly related to family size, the temporal relationship between cases in households with two or more cases revealed that 83.7% of 1,463 presumed secondary cases occurred within one month of the first case in the same household, which is not suggestive of person-to-person transmission of disease. The termination of providing water from the source was effected, which was followed by an apparent decrease in cases.

High dose rate intraluminal brachytherapy in combination with external beam radiotherapy for palliative treatment of cancer rectum.

OBJECTIVE: To evaluate the feasibility, efficacy and toxicity of High Dose Rate Intraluminal Brachytherapy (HDRILB) in combination with External Beam Radiotherapy (EBR) used in the palliative treatment of selected patients of adenocarcinoma rectum. DESIGN: A prospective pilot study. PLACE AND DURATION OF STUDY: The study was conducted at the Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar. The study started in April 1996 and the patients accrual was completed in June 1997. PATIENTS AND METHODS: The patients with adenocarcinoma rectum, who refused surgery, had contraindications for surgery or had advanced and/or metastatic disease were treated with HDRILB in combination with external beam radiotherapy (EBR). The apparatus used for HDRILB was Ralstron 20B remote afterloading unit with 60Co stepping source. Indigenously designed rectal applicators were used. The EBR was delivered through Pheonix 60Co teletherapy machine (Theratron AECL). The data for symptom burden and symptomatic relief was analyzed by applying Likert's method of summated scales. RESULTS: Data was analyzed after one week and at the end of the treatment. After one week of treatment, the relief in pain and bleeding per rectum (P/R) was 97%. Excellent palliation was achieved at the end of the treatment when perineal pain and bleeding P/R were relieved in 100%, discharge P/R in 87% and tenesmus in 93% of the cases. CONCLUSION: The use of HDRILB in combination with EBR can provide quick relief of symptoms in selected patients of adenocarcinoma rectum. This combination has an excellent palliative value because of its effectiveness, acceptable toxicity and overall short treatment duration.