Surgical outcomes for occluded venous thoracic outlet syndrome following transaxillary first rib resection.

Objective: Surgical decompression via transaxillary first rib resection (TFRR) is often performed in patients presenting with venous thoracic outlet syndrome (VTOS). We aimed to evaluate the outcomes of TFRR based on chronicity of completely occluded axillosubclavian veins in VTOS.

Methods: We performed a retrospective institutional review of all patients who underwent TFRR for VTOS and had a completely occluded axillosubclavian vein between 2003 and 2022.

Reassessing the Safety of Pill-in-the-Pocket Propafenone.

The current guidelines state that propafenone can be used in combination with a beta-blocker or a calcium channel blocker for pharmacologic cardioversion of recent-onset atrial fibrillation in patients without structural heart disease. To prevent the conversion from atrial fibrillation to atrial flutter with a rapid ventricular rate, it is recommended to administer propafenone following the administration of a beta-blocker or a calcium channel blocker. However, this combination carries the potential risk of cardiogenic shock.

The Sensitive Care of the Elder Orphan in Critical Care Environments.

All patients within critical care units are vulnerable and many of them are unable to communicate their wishes and needs to the caregivers treating their acute critical illness. This inability to communicate is why interdisciplinary intensive care teams across the country heavily rely on spouses, children, siblings, parents, other next of kin, or other designated medical durable power of attorneys to advocate for those who cannot advocate for themselves. Unfortunately, there is a growing population of elder orphans who lack this support system when they need it the most.

Shoulder structure and function: The impact of osteoarthritis and rehabilitation strategies.

Study Design: Invited review.

Background: Shoulder osteoarthritis can result in significant functional deficits. To improve diagnosis and treatment, we must better understand the impact of osteoarthritis on shoulder biomechanics and the known mechanical benefits of currently available treatments.

Patient with Lobular Carcinoma of the Breast and Activating AKT1 E17K Variant.

Objective: To present the characteristics of the AKT1E117K gene variant and a description of the clinical application in a patient with metastatic breast cancer.

Results: 63 y/o woman with Stage IV Invasive lobular carcinoma at diagnosis was treated with Palbociclib and aromatase inhibitors (AI). At progression, tissue was sent for comprehensive genomic profiling to Foundation Medicine (FM) which revealed AKT1E17K mutation.

Clinical considerations in the use of missing tissue compensators for head and neck cases.

The irregular shape or contour of the patient's surface in the treatment field can alter the dose distribution resulting in non-uniformity of dose in the treatment volume. Missing tissue compensators have been most commonly used to improve this non-uniformity, especially in head & neck, breast, lung and supraclavicular regions. Two or three dimensional compensators have been typically designed to make the dose uniform at a specific depth.

Clinical considerations in the use of missing tissue compensators for thoracic cases.

The irregular shape or contour of the patient's surface in the treatment field can alter the dose distribution resulting in non-uniformity of dose in the treatment volume. Missing tissue compensators have been most commonly used to improve this non-uniformity, especially in head and neck, breast, lung and supraclavicular regions. Two or three dimensional compensators have been typically designed to make the dose uniform at a specific depth.

A comparison of surface doses for two immobilizing systems.

To achieve accurate and reproducible treatments, many types of immobilizing systems have been used. Two of these systems: Alpha Cradle and VacFix, conform around the patient to improve day-to-day treatment repositioning. The Alpha Cradle system has been in clinical use for several years.

Recommendations for measurement of tray and wedge factors for high energy photons.

Transmission factors for beam modifers such as wedges and blocking trays in dosimetry calculations are very common, but various methods have been used in measuring these factors. A systematic study to measure these factors as a function of field size and point of measurement was carried out. The beam modifiers were a blocking tray and the standard wedges supplied with a cobalt-60 unit and a medical electron accelerator (6- and 18-MV x rays).

Surface dose perturbation due to air gap between patient and bolus for electron beams.

The effect of air gaps under bolus material on the surface dose for electron beams is investigated. Dose measurements were performed for air gaps from 0.0 to 3.

Photon beam attenuation for a patient support assembly during arc therapy for a medical linear accelerator.

Arc therapy is one of the treatment techniques for small, centrally located deep-seated tumors. However, care must be taken to remove any components that would interfere with the beam as the gantry rotates around the patient. One such component that may interfere with the beam is the patient support assembly (PSA) or treatment table.

A new design of Delclos dome cylinders using standard Cs-137 sources.

Surface dose rates around the currently-marketed Delclos uterine-vaginal afterloading dome (hemispherical) cylinders were calculated and measured for linear standard 3M cesium tube sources. Measurements were carried out using thin thermoluminescent lithium fluoride Chips on the surface of the cylinder and calculations at the same points were generated using a treatment planning computer. Wide surface dose variations were found for 2 to 3.

Electron beam effective source surface distances for a high energy linear accelerator.

The design of the Varian Clinac 1800 linear accelerator electron applicator system does not allow clearance for all head and neck patients to be treated at the standard calibration distance of 100 cm. Discrepancies have been found between dose calculations using the inverse square law for extended distances and their measured data. A 4 X 4 cm2 applicator at an energy of 9 MeV, for example, had dose differences of 13 and 23% at distances of 105 and 110 cm SSD.

Acute lymphoblastic leukemia with a unique rearrangement between chromosomes 4 and 11.

A case of pre-B cell acute lymphoblastic leukemia (pre-B ALL) with a dir ins(11;4)(q23;q21q31) chromosome rearrangement is presented. The patient's clinical findings and history were similar to those described for the t(4;11)(q21;q23) subgroup of childhood ALL. These findings suggest that the interfacing of the distal breakpoint at band 4q21 to the proximal breakpoint of band 11q23 represents the primary cytogenetic change observed in this subgroup of ALL.