Balloon-Assisted Corpus Callosotomy. Reducing the Impact of Transcallosal Approaches.

Background: The interhemispheric transcallosal approach is widely used to remove intraventricular lesions. Corpus callosotomy gives immediate access to the ventricular chambers but is invasive in nature. Loss of callosal fibers, although normally tolerate, may cause disturbances ranging from a classical disconnection syndrome up to minor neuropsychological changes.

Mini-craniotomy for intra-axial brain tumors: a comparison with conventional craniotomy in 306 patients harboring non-dural based lesions.

The use of a mini-craniotomy approach involving linear skin incision and a bone flap of about 3 cm has been reported for several neurosurgical diseases, such as aneurysms or cranial base tumors. More superficial lesions, including intra-axial tumors, may occasionally raise concerns due to insufficient control of the tumor boundaries. The convenience of a minimally invasive approach to intrinsic brain tumors was evaluated by comparing 161 patients who underwent mini-craniotomy (MC) for intra-axial brain tumors with a group of 145 patients operated on by the same surgical team through a conventional craniotomy (CC).

Quantifying risk using FMEA: An alternate approach to AAPM TG-100 for scoring failures and evaluating clinical workflow.

Purpose: Renovation of the brachytherapy program at a leading cancer center utilized methods of the AAPM TG-100 report to objectively evaluate current clinical brachytherapy workflows and develop techniques for minimizing the risk of failures, increasing efficiency, and consequently providing opportunities for improved treatment quality. The TG-100 report guides evaluation of clinical workflows with recommendations for identifying potential failure modes (FM) and scoring them from the perspective of their occurrence frequency O, failure severity S, and inability to detect them D. The current study assessed the impact of differing methods to determine the risk priority number (RPN) beyond simple multiplication.

Interhemispheric contralateral approach: the falx as a retractor.

The contralateral transfalcine approach is a valuable option to access lesions around the mesial surface of the brain hemispheres. Despite a favourable perspective, surgical manoeuvres within the interhemispheric fissure carry a risk of inadvertent injury to the healthy cortex on the craniotomy side. To overcome this drawback, a new method of brain retraction was developed.

Novel and programmatic improvements to the workflow associated with the AccuBoost breast brachytherapy procedure.

Purpose: While the noninvasive breast brachytherapy (NIBB) treatment procedure, known as AccuBoost, for breast cancer patients is well established, the treatment quality can be improved by the efficiency of the workflow delivery. A formalized approach evaluated the current workflow through failure modes and effects analysis and generated insight for developing new procedural workflow techniques to improve the clinical treatment process.

Methods And Materials: AccuBoost treatments were observed for several months while gathering details on the multidisciplinary workflow.

Electronic intracavitary brachytherapy quality management based on risk analysis: The report of AAPM TG 182.

Purpose: The purpose of this study was to provide guidance on quality management for electronic brachytherapy.

Materials And Methods: The task group used the risk-assessment approach of Task Group 100 of the American Association of Physicists in Medicine. Because the quality management program for a device is intimately tied to the procedure in which it is used, the task group first designed quality interventions for intracavitary brachytherapy for both commercial electronic brachytherapy units in the setting of accelerated partial-breast irradiation.

Indocyanine Green Videoangiography in the Surgical Treatment of Spinal Dural Arterovenous Fistula: A Useful Application.

Background: Indocyanine green videoangiography (ICG-V) is used with increasing frequency in neurovascular surgery. ICG-V use in spinal dural arteriovenous fistulas (DAVFs) allows visualization of the hemodynamics of the fistula and to confirm its exclusion after ligation of the feeder. Here, we illustrate how ICG-V is useful for centering the surgical exposure during mini-invasive approaches to spinal DAVFs.

Transpedicular Approach to Thoracic Disc Herniaton Guided by 3D Navigation System.

Background: The choice of surgical approach for thoracic disc herniation should consider the location on the axial plane and the consistency of the herniated disc. Calcified midline disc herniations are difficult to remove with a transpedicular approach because of limitations due to blind spots; so they are usually treated via a transthoracic approach, although this entails a high risk of thoracopulmonary injuries.

Methods: In this work we present two cases of calcified midline thoracic disc herniations treated with a transpedicular approach, improved by using a three-dimensional (3D) neuronavigation system to verify the extent of removal on the blind side.

Does Navigation Improve Pedicle Screw Placement Accuracy? Comparison Between Navigated and Non-navigated Percutaneous and Open Fixations.

Background: The aim of our study was to assess how a preoperative computed tomography (CT)-based navigation system affected the correctness and safety of transpedicular screw insertion, compared with standard techniques.

Method: Between January 2012 and February 2014, 203 patients underwent thoracic and lumbar fixation, with open and percutaneous techniques; 218 screws were implanted through an open navigated technique (1.0 Spine & Trauma 3d ver.

Interface dosimetry for electronic brachytherapy intracavitary breast balloon applicators.

In this study, we evaluate the attenuation of the dose due to barium-impregnation in the region between the surface of an electronic brachytherapy (EBT) balloon applicator for accelerated partial breast irradiation (APBI) and the prescription point at 1 cm depth in tissue. To perform the study, depth dose curves were calculated using a general purpose multi-particle transport code (FLUKA) for a range of balloon wall thicknesses with and without barium impregnation. Numerical data were verified with experimental readings using a parallel plate extrapolation ionization chamber for different wall thicknesses.

Modeling study for optimization of skin dose for partial breast irradiation using Xoft Axxent electronic brachytherapy applicator.

Purpose: Balloon brachytherapy with the MammoSite system (Hologic Inc., Bedford, MA) is a widely used approach for accelerated partial breast irradiation. Inherent to this approach, high skin doses can occur if the balloon to skin distance is small.

Application of holographic display in radiotherapy treatment planning II: a multi-institutional study.

We hypothesized that use of a true 3D display providing easy visualization of patient anatomy and dose distribution would lead to the production of better quality radiation therapy treatment plans. We report on a randomized prospective multi-institutional study to evaluate a novel 3D display for treatment planning.The Perspecta Spatial 3D System produces 360 degrees holograms by projecting crosssectional images on a diffuser screen rotating at 900 rpm.

A commissioning procedure for breast intracavitary electronic brachytherapy systems.

In this work, we report a comprehensive quality assurance (QA) process for the commissioning of an Electronic Brachytherapy (EB) system at one of the first U.S. sites to apply the device clinically.

The loss of entropy circadian rhythm in sinusal R-R intervals of type 1 diabetic pregnant women suggests an indeterministic chaos in cardiac pacing (minimum delirium cordis syndrome). A newly identifiable type of silent cardiac dysautonomia?

Objective: The scope of this study is to detect whether or not the entropy (E) circadian rhythm (CR) is maintained preserved in sinusal R-R intervals (SRRI), its loss being the expression of a transition to an indeterministic chaos in heart rate variability (HRV).

Methods: The E of SRRI was estimated in 14 type I diabetic pregnant women (DPW) in the first trimester of an apparently uncomplicated gestation (7 patients - mean age = 30.3 +/- 4.

Mirasol PRT treatment of donor white blood cells prevents the development of xenogeneic graft-versus-host disease in Rag2-/-gamma c-/- double knockout mice.

Background: Mirasol PRT (Navigant Biotechnologies) treatment utilizes exposure to light in the presence of riboflavin to introduce irreparable lesions to nucleic acids thereby inhibiting pathogen and WBC replication. The ability of Mirasol PRT-treated mononuclear cells (MNCs) to generate xenogeneic graft-versus-host disease (GVHD) responses was used to model transfusion-associated GVHD (TAGVHD).

Study Design And Methods: Pairs of human MNCs from five different individual donors that had or had not received Mirasol PRT treatment and contained 30 x 10(6) CD3+ cells were injected intraperitoneally into sublethally irradiated (350 cGy) Rag2(-/-)gamma c(-/-) double-knockout mice.

Dose-modeling study to compare external beam techniques from protocol NSABP B-39/RTOG 0413 for patients with highly unfavorable cardiac anatomy.

Purpose: The aim of this study was to select patients with heart anatomy that is specifically unfavorable for tangential irradiation in whole-breast radiotherapy (WBRT), to be used as an experimental cohort to compare cardiac dosimetric and radiobiological parameters of three-dimensional conformal external beam accelerated partial breast irradiation (3D-CRT APBI) to WBRT with techniques as defined by the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39/Radiation Therapy Oncology Group (RTOG) 0413 clinical trial.

Methods And Materials: A dosimetric modeling study that compared WBRT and 3D-CRT APBI was performed on CT planning data from 8 patients with left-sided breast cancer. Highly unfavorable cardiac anatomy was defined by the measured contact of the myocardium with the anterior chest wall in the axial and para-sagittal planes.

Persistent seroma after intraoperative placement of MammoSite for accelerated partial breast irradiation: incidence, pathologic anatomy, and contributing factors.

Purpose: To investigate the incidence of, and possible factors associated with, seroma formation after intraoperative placement of the MammoSite catheter for accelerated partial breast irradiation.

Methods And Materials: This study evaluated 38 patients who had undergone intraoperative MammoSite catheter placement at lumpectomy or reexcision followed by accelerated partial breast irradiation with 34 Gy in 10 fractions. Data were collected regarding dosimetric parameters, including the volume of tissue enclosed by the 100%, 150%, and 200% isodose shells, dose homogeneity index, and maximal dose at the surface of the applicator.

Combined computed tomography-guided radiofrequency ablation and brachytherapy in a child with multiple recurrences of Wilms' tumor.

Background: Treatment of relapsed Wilms' tumor remains a challenge. We describe a case of an 11-year-old girl with multiply relapsed Wilms' tumor in whom combined percutaneous computed tomography (CT)-guided radiofrequency ablation and brachytherapy directed at a retroperitoneal tumor mass resulted in pain palliation and local tumor control.

Observations: Over the course of few weeks, her requirement for narcotic pain medications dramatically decreased.

MammoSite and interstitial brachytherapy for accelerated partial breast irradiation: factors that affect toxicity and cosmesis.

Background: In interstitial brachytherapy (IB), cosmesis and toxicity correlate with volume of tissue irradiated, dose homogeneity index (DHI), and adjuvant doxorubicin/cyclophosphamide based chemotherapy (ACCT). MammoSite brachytherapy (MSB) irradiates smaller volumes than IB, and lower dose homogeneity does not appear to affect toxicity. However, clinical experience suggests that other factors may also play an important role in cosmesis and toxicity with MSB.

[Hepcidin: a key peptide in iron metabolism].

Hepcidin (hepatic bactericidal protein) is a protein synthesised by the hepatocyte belonging to the family of endogenous peptide antimicrobes. It is produced in large quantities by the liver, heart and spinal cord and then is excreted in the urine. This protein, sequenced on human chromosoma 19, can be found in 2 main forms: Hepc 20 and Hepc 25 aminoacids respectively with 8 cystein residues connected by disulphine bridges.

Percutaneous radiofrequency ablation of pulmonary malignancies: combined treatment with brachytherapy.

Objective: The purpose of this article is to report the clinical experience and technical feasibility of percutaneous radiofrequency ablation in conjunction with brachytherapy, a novel approach in the treatment of lung neoplasms. Data from three patients with lung malignancies illustrate the expanding therapeutic indications of this minimally invasive intervention.

Conclusion: Percutaneous radiofrequency ablation in conjunction with brachytherapy is a promising minimally invasive combination modality.

The role of met-enkephalin in silent myocardial ischemia in diabetic patients.

Met-enkephalin plasma levels were evaluated in 20 cardioischemic diabetic patients. All the patients had ECG ischemic signs. Ten patients with diabetic autonomic neuropathy, experienced no pain during myocarial ischemia.

Investigation of the relative surface dose from Lipowitz-metal tissue compensators for 24- and 6-MV photon beams.

Our radiation therapy department has acquired a tissue compensator system for construction of patient-specific Lipowitz-metal tissue compensators. Since the arrival of this apparatus its use has been limited due to the observance of marked skin reactions located directly beneath the area of the compensator. Although there has been extensive literature on the dose distribution of these metal compensators, there is little data on the effects to the skin for energies greater than 10 MV.