An early report on outcomes from computed tomographic-based high-dose-rate brachytherapy for locally advanced cervix cancer: A single institution experience.

Purpose: To report our experience using high-dose-rate (HDR) brachytherapy with computed tomographic (CT) imaging for locally advanced cervix cancer, using available resources to optimize the treatment.

Methods And Materials: Fifty-seven women with cervix cancer were treated between September 2004 and March 2008. Patients received external radiotherapy, HDR brachytherapy (7 Gy x4) and concurrent chemotherapy.

Feasibility of using cone-beam CT to verify and reposition the optically guided target localization of linear accelerator based stereotactic radiosurgery.

Purpose: The optically guided target localization had been developed for linear accelerator based stereotactic radiosurgery (SRS). Unlike the traditional laser localization, the optical guided target localization utilizes a digital system to position patient. Although the system has been proven accurate and robust, it takes away the capability of physicist to directly double check the target position prior to irradiation.

Staging of renal cell carcinoma: Current concepts.

The most important and widely utilized system for providing prognostic information following surgical management for renal cell carcinoma (RCC) is currently the tumor, nodes, and metastasis (TNM) staging system. An accurate and clinically useful staging system is an essential tool used to provide patients with counseling regarding prognosis, select treatment modalities, and determining eligibility for clinical trials. Data published over the last few years has led to significant controversies as to whether further revisions are needed and whether improvements can be made with the introduction of new, more accurate predictive prognostic factors.

Laparoscopic antireflux procedures with hepatic shoulder technique for the surgical management of large paraesophageal hernias and gastroesophageal reflux disease.

Background: Large paraesophageal hernias are notoriously difficult to manage via laparoscopy and are associated with a significant recurrence rate. A novel laparoscopic approach was used to close the diaphragmatic defect in four patients diagnosed with large, paraesophageal hernias and gastroesophageal reflux disease symptomatology.

Methods: All procedures were performed via laparoscopy.

Practice audit of nutrition support certification.

The National Board of Nutrition Support Certification (NBNSC) is an independent credentialing board responsible for administering certification programs in nutrition support. The NBNSC conducted a study (practice audit) of Nutrition Support Professionals (NSP), with the purposes of defining the role of the nutrition support professional and determining the current elements (knowledge or functions) required for competent NSP practice. This article describes the development of the study, results of the study, and use of the information for future certification in nutrition support.

Ultrasound of the knee.

Ultrasound of the knee is best suited for the evaluation of tendons, fluid collections and effusion, synovitis, periarticular soft tissue masses, muscles, and the collateral ligaments. Advantages of sonographic evaluation include the lack of ionizing radiation, the noninvasive nature of the examination, focused evaluation correlated with the specific site of pain, multiplanar capability, and utility in patients for whom magnetic resonance imaging (MRI) is contraindicated. The ability to visualize the microanatomy of tendons, ligaments, nerves, and muscles is also an advantage over MRI.

Mandibular osteotomies in orthognathic surgery.

Bilateral sagittal split osteotomy is the most commonly used osteotomy of the mandible in orthognathic surgery. The authors describe their experience in evaluating the orthognathic patient with a mandibular deformity. The bilateral sagittal split osteotomy surgical technique used by the authors is reviewed along with postoperative management.

Malnutrition in chronic obstructive pulmonary disease.

Malnutrition in patients with COPD is associated with an impaired pulmonary status, reduced diaphragmatic mass, lower exercise capacity, and higher mortality rate when compared with adequately nourished individuals with COPD. Deterioration in patients with COPD may be the result of malnutrition. In addition, malnutrition could be a sign of other factors directly altered by the disease.

Consensus statement on negative pressure wound therapy (V.A.C. Therapy) for the management of diabetic foot wounds.

Unlabelled: In 2004, a multidisciplinary expert panel convened at the Tucson Expert Consensus Conference (TECC) to determine appropriate use of negative pressure wound therapy as delivered by a Vacuum Assisted Closure device (V.A.C.

Generation of wedge-shaped dose distributions through dynamic multileaf collimator dose delivery.

A new method of generating wedge-shaped dose distributions through dynamic multileaf collimator dose delivery rather than computer-controlled jaw motion is presented. The method starts with the calculation of a wedge-shaped beam profile for the desired wedge angle. The resultant wedge beam profile is then passed to the intensity-modulated radiation therapy (IMRT) leaf sequence generation algorithm to create multileaf collimator (MLC) segments for dose delivery.

Defining fetal station.

Objective: This study was undertaken to determine the definitions and beliefs regarding fetal station among pregnancy caregivers.

Study Design: Residents, nurses, and faculty at 5 teaching centers in Denver, Colo, were given surveys to determine what definitions were being used for fetal station and the perceived importance of these definitions.

Results: There were 243 responses from the 453 surveys.

Diagnostic and therapeutic arterial interventions in the ulcerated diabetic foot.

Whether diabetic foot ulcerations arise from an amalgam of neuro-ischemic factors or because of arterial occlusive disease alone, the arterial circulation must be thoroughly evaluated. Clinical evaluation is foremost, but numerous non-invasive diagnostic options such as duplex ultrasonography and MRA are often enlisted. Contrast arteriography remains unrivaled for delineating the causative occlusive lesions and the possibilities for arterial reconstruction.

Acute myocardial infarction as a complication of clonidine withdrawal.

Abrupt withdrawal from clonidine therapy is a well-known cause of hyperadrenergic symptoms, but reports of acute myocardial infarction are extremely rare. We present the case of an 86-year-old woman who developed severe hypertension and a myocardial infarction 36 h after terminating her therapy of clonidine, 0.4 mg/day.

Diagnosis and treatment of rosacea.

Background: Rosacea is a common skin disorder affecting middle-aged and older adults. Many patients mistakenly assume that early rosacea is normally aging skin and are not aware that effective treatments exist to prevent progression to permanent disfiguring skin changes.

Methods: The medical literature was reviewed on the pathophysiology, diagnosis, and treatment of rosacea.

Minimizing risks associated with peripherally inserted central catheters in the NICU.

Peripherally inserted central catheters (PICC lines) provide prolonged venous access, a means of administration of needed medications that would otherwise be irritating to peripheral vessels, and a means of assuring better parenteral nutrition to infants who are unable to tolerate enteral feedings. Not only do these central lines provide life-saving therapy, they are easily inserted, cost effective, and convenient. Although there are many benefits to the use of these catheters, physicians and nurses within the NICU must remain acutely aware of the risks involved with placement of PICC lines so that complications can be minimized.

Laparoscopic inguinal hernia repair: optimal technical variations and results in 1700 cases.

A follow-up series of 1700 laparoscopic inguinofemoral herniorrhaphies by a single surgical team is presented (1381 patients). Two standard techniques were used: transabdominal preperitoneal (1452 cases) and totally extraperitoneal (248 cases). Mean follow-up was 5.

Benign metastasizing leiomyoma of the uterus: histologic and immunohistochemical characterization of primary and metastatic lesions.

Benign uterine leiomyoma metastasizing to the lung is a recognized entity that has been reported infrequently in the medical literature. There is persisting controversy regarding the pathogenesis and biology of these lesions. We report a well-studied and well-characterized case of benign leiomyoma metastasizing to the lung.

Influence of fast-track anesthetic technique on cardiovascular infusions and weight gain.

Objective: To evaluate whether cardiac surgical patients receiving conventional versus fast-track anesthetic management are statistically significantly different with regard to cardiovascular drug infusions, weight gain, cardiac and pulmonary morbidity, length of intubation, and length of stay.

Design: Retrospective, (partially) sequential, cohort design.

Setting: Surgical suite and intensive care unit (ICU) at a community hospital.

Genital incarceration with metal rings: their safe removal.

Strangulation of the genitalia with constricting metal bands presents a difficult problem with removal. We report the easy and safe removal by cutting the metal bands in two places using a hand-held Dremel Moto-Tool [corrected] with a metal cutting disk.