Master Breast Radiation Planning: Simple Guide for Radiation Oncology Residents.

This article focuses on various aspects of breast radiation treatment planning, from simulation to field design. It covers the most common techniques including tangents, mono isocentric, dual isocentric, electron-photon match, and VMAT. This can serve as a guide for radiation oncology residents and medical students to advance their understanding of key aspects of breast radiation treatment and planning processes.

Updating and Optimizing Anatomic Atlases for Elective Radiation of Para-Aortic Lymph Nodes in Cervical Cancer.

Purpose: Previous studies have proposed 2 different contouring guidelines for the prophylactic radiation of para-aortic lymph nodes (PANs) for locally advanced cervical cancer. Because PAN-mapping atlases in current literature are limited to small patient samples and nodal populations, we updated the PAN atlas with a large data set of positron emission tomography (PET)-positive PANs on PET/computed tomography (CT) from patients with cervical cancer.

Methods And Materials: We identified 176 PET-positive PANs on pretreatment PET/CT of 47 patients with diagnosed International Federation of Gynecology and Obstetrics stage IB to IVA cervical cancer.

Scapular Dyskinesis Is Not an Isolated Risk Factor for Shoulder Injury in Athletes: A Systematic Review and Meta-analysis.

Background: Scapular dyskinesis has been considered a risk factor for athletic shoulder injury; however, findings in the prospective literature have demonstrated mixed results.

Purpose: To determine if scapular dyskinesis increases the risk of shoulder injury in athletes.

Study Design: Meta-analysis.

Right lateral position for laparoscopic splenic flexure mobilization.

Aim: Standard laparoscopic splenic flexure mobilization is often hampered by redundant small bowel and usually necessitates additional ports. The retraction required runs the risk of inadvertent injury to the surrounding structures including the spleen.

Method: We present a new technique that permits a safe, rapid and complete mobilization of the splenic flexure even for the more difficult patients.

Effect of radial artery harvest on collateral forearm blood flow and digital perfusion.

Background: Changes describing digital and forearm circulation after radial artery harvest have been reported infrequently.

Methods: This prospective study examined digital perfusion and forearm collateral circulation preoperatively and postoperatively in patients who underwent coronary artery bypass grafting with radial artery free grafts. Noninvasive evaluation was conducted with digital photoelectric plethysmography and color flow and pulsed Doppler studies.

Loss of cytomegalovirus-specific CD4+ T cell responses in human immunodeficiency virus type 1-infected patients with high CD4+ T cell counts and recurrent retinitis.

Clinical histories are reported for 2 patients treated with highly active antiretroviral therapy (HAART) who experienced multiple relapses of cytomegalovirus (CMV) retinitis, despite suppression of human immunodeficiency virus type 1 (HIV-1) viremia and improvement in CD4+ T cell counts (to >400 cells/microL). CMV-specific CD4+ T cell immune reconstitution was measured directly, using cytokine flow cytometry, which revealed persistent deficits in CMV-specific CD4+ T cell responses in both patients. CMV-specific T cells constituted 0.

Routine myocardial revascularization with the radial artery: a multicenter experience.

Background: Current literature documents use of the radial artery (RA) for myocardial revascularization only as an alternative conduit in cases where the saphenous veins have been previously harvested or are unsuitable for use. Large-scale routine clinical use of the RA as the conduit of choice has not been reported.

Methods: This prospective study evaluated the harvest of the RA from 933 patients and the subsequent use of the conduit as a preferred coronary artery bypass graft second only to the left internal thoracic artery in 930 of these patients.

Removal of infected pacemaker leads with deep hypothermic circulatory arrest and open surgical exploration of the superior vena cava and innominate veins.

Despite the use of transvenous methods for extraction of infected leads, failed attempts may result in retained lead fragments. Retained lead fragments may be a focus of continued infection leading to sepsis. We present two patients in which conversion from cardiopulmonary bypass to hypothermic circulatory arrest allowed direct visualization, using venotomies in the superior vena cava and innominate vein to achieve complete removal of retained pacemaker lead fragments.

Pathology of the radial and internal thoracic arteries used as coronary artery bypass grafts.

Background: This investigation compared the incidence and the degree of atherosclerosis present in radial artery (RA) and internal thoracic artery segments remaining after coronary artery bypass grafting.

Methods: One hundred seventy specimens from 102 patients were histologically analyzed, including 106 RA specimens.

Results: The mean degree of pathology for the RA was 0.

Use of a free radial artery graft for correction of Bland-White-Garland syndrome.

A radial artery free graft was used to create a two-coronary artery system for a 15-month-old child with Bland-White-Garland syndrome. The anomalous left main coronary artery originated from the proximal right pulmonary artery.

Routine use of unilateral and bilateral radial arteries for coronary artery bypass graft surgery.

Objectives: This study sought to evaluate the routine use of radial artery (RA) grafts in patients undergoing coronary artery revascularization.

Background: Previous long-term studies have documented poor patency of saphenous vein grafts compared with internal thoracic artery (ITA) grafts.

Methods: We performed a prospective review of 175 of 249 consecutive patients.

Early postoperative angiographic assessment of radial grafts used for coronary artery bypass grafting.

Unlabelled: Despite a revival of interest in using the radial artery as an alternative conduit for myocardial revascularization, little angiographic documentation of early postoperative results has been presented, particularly in North America. Accordingly, 60 of 150 patients who underwent coronary artery bypass with radial arteries from November 1993 to July 1995 have had postoperative cardiac catheterization at our institution. The patency rate of the radial artery grafts was 95.

Atrial natriuretic peptide replacement therapy in rats subjected to biatrial appendectomy.

The postoperative fluid retention found in some patients after the Cox maze procedure has been attributed to surgically induced loss of atrial natriuretic peptide. We postulated that exogenous atrial natriuretic peptide could reverse this antidiuresis. A rat model was used to investigate this hypothesis.

Technique for harvesting the radial artery as a coronary artery bypass graft.

The radial artery was proposed and then abandoned as a coronary artery bypass graft in the 1970s. Development of new pharmacologic antispasmodic agents and minimally traumatic harvesting techniques has led to a revival of the use of the radial artery in coronary artery bypass procedures. Unlike the saphenous vein in the lower extremities, the radial artery in the volar forearm is not a subcutaneous structure.

Comparison of defibrillator therapy and other therapeutic modalities for sustained ventricular tachycardia or ventricular fibrillation associated with coronary artery disease.

Outcomes of 282 patients referred to the arrhythmia service at Montefiore Medical Center for sustained ventricular tachycardia (n = 214) or ventricular fibrillation (n = 68) associated with coronary artery disease were analyzed retrospectively. All patients underwent serial drug trials by electrophysiologic testing and Holter monitoring. Sixty-eight patients who did not respond to drug therapy were treated with implantable cardioverter-defibrillators (ICD group), and 214 patients were treated with other methods guided by electrophysiologic testing and Holter monitoring (non-ICD group).

Wound healing after harvesting of the internal thoracic and the superior and inferior epigastric arteries.

Wound healing of sternal incisions and midline or paramedian abdominal incisions was studied at 2 weeks postoperatively in three groups of dogs. Group 1, 10 dogs, had harvesting of bilateral internal thoracic arteries, superior epigastric arteries, and inferior epigastric arteries. Group 2, 5 dogs, had removal of the same arteries, but the superior and inferior epigastric arteries were harvested through paramedian rather than midline incisions.

Ultrasound evaluation of the inferior epigastric artery.

Color-flow Doppler ultrasound was used to assess the anatomic characteristics of the inferior epigastric artery (IEA) bilaterally in 20 nonatherosclerotic (group I; mean age, 28 years) and 20 atherosclerotic (group II; mean age, 57 years) subjects. Forty-nine percent of the IEAs were located laterally within the rectus sheath with 34% in a mid and 17% in a medial location. Seventeen percent had a large branch within 5 cm of the origin.

Use of neurosurgical techniques for removal of a cardiac tumor.

A 6-week-old male infant with a capillary hemangioma of the right atrioventricular groove adjacent to the right coronary artery and conduction system underwent successful resection with the aid of microneurosurgical instrumentation. The technical challenge was thought to be analogous to that encountered by microneurosurgeons in their dissection of brain tumors.

ICD implantation via thoracoscopy, "mailslot" thoracotomy, and subxiphoid incision.

An improved method of thoracoscopic implantable cardioverter defibrillators implantation is described. "Mailslot" thoracotomy is more expeditious than thoracoscopic implantation via multiple ports. If required for adequate defibrillation thresholds, subxiphoid, subdiaphragmatic implantation of a defibrillator patch may be performed.