Improving obstetric estimation of outcomes of extremely premature neonates: an evolving challenge.

Aims: A clinically useful website at the US National Institutes of Child Health and Human Development (NICHD) uses an algorithm based on a recent publication to estimate peri-viable neonatal outcomes. This algorithm uses gestational age, ultrasound estimated fetal weight (EFW), fetal sex, and the use of antenatal corticosteroids as the basis for estimation of outcomes and when used after birth is superior to such estimation by gestational age alone. Because one might be tempted to use this algorithm with obstetric patients, we tested its clinical applicability.

The potential for dose dumping in normal tissues with IMRT for pelvic and H&N cancers.

The purpose of this study is to understand the potential for dose dumping in normal tissues (>85% of prescription dose) and to analyze effectiveness of techniques used in reducing dose dumping during IMRT. Two hundred sixty-five intensity modulated radiation therapy (IMRT) plans for 55 patients with prostate, head-and-neck (H&N), and cervix cancers with 6-MV photon beams and >5 fields were reviewed to analyze why dose dumping occurred, and the techniques used to reduce dose dumping. Various factors including gantry angles, depth of beams (100-SSD), duration of optimization, severity of dose-volume constraints (DVC) on normal structures, and spatial location of planning treatment volumes (PTV) were reviewed in relation to dose dumping.

Single course IMRT plan to deliver 45 Gy to seminal vesicles and 81 Gy to prostate in 45 fractions.

We treat prostate and seminal vesicles (SV) to 45 Gy in 25 fractions (course 1) and boost prostate to 81 Gy in 20 more fractions (course 2) with Intensity Modulated Radiation Therapy (IMRT). This two-course IMRT with 45 fractions delivered a non-uniform dose to SV and required two plans and two QA procedures. We used Linear Quadratic (LQ) model to develop a single course IMRT plan to treat SV to a uniform dose, which has the same biological effective dose (BED) as that of 45 Gy in 25 fractions and prostate to 81 Gy, in 45 fractions.

Case studies in acute aortic dissection: strategies to avoid a catastrophic outcome.

Aortic dissection is a catastrophic illness that is a significant source of liability for hospitals if diagnosis and treatment are not done promptly. The diagnosis is often difficult to make because not all dissections have the typical presentation of sudden severe chest pain radiating to the back. Symptoms often include abdominal pain, flu-like complaints, vomiting and diarrhea, low back pain, stroke syndromes and syncope.