Sciatic nerve division: a cadaver study in the Indian population and review of the literature

<p><b>INTRODUCTION</b>The sciatic nerve is the largest nerve, with a long course in the inferior extremity. Its division into the tibial and common peroneal nerves can occur at any level from the sacral plexus to the inferior part of the popliteal space. These anatomical variations may contribute to clinical conditions such as piriformis syndrome, sciatica and coccygodynia.</p><p><b>METHODS</b>This study was performed on cadavers in order to study the level of sciatic nerve division. The inferior extremities of 43 cadavers were classified into six groups depending on the level of sciatic nerve division in the gluteal region, the upper, middle and lower parts of the back of the thigh, and the popliteal fossa.</p><p><b>RESULTS</b>The highest incidence of sciatic nerve division (40.7 percent) was observed in the lower part of the posterior compartment of the thigh. In 34.9 percent of the specimens, the sciatic nerve was divided into tibial and common peroneal nerves in the popliteal fossa. 16.3 percent of extremities showed sciatic nerve division proximal to its entrance in the gluteal region.</p><p><b>CONCLUSION</b>In sciatic nerve neuropathies, the extent of neurological deficits depends on the level of sciatic nerve division. Sciatic nerve division into tibial and common peroneal components at a higher level can result in the involvement of only one out of the two divisions from sciatic neuropathy. It can also result in a failure of the sciatic nerve block while performing popliteal block anaesthesia.</p>

3-Dimensional conformal radiotherapy versus intensity modulated radiotherapy for localized prostate cancer: dosimetric and radiobiologic analysis

To analyze the dosimetric and radio biologic advantages between intensity modulated radiotherapy [IMRT] and 3 dimensional conformal radiotherapy [3DCRT] and selection of optimal photon energy for IMRT treatments. 24 patients with localized prostate carcinoma were planned for 3DCRT and IMRT techniques. Radiation dose of 54 Gy with 2 Gy/fraction, was planned to Planning target volume [PTV1] [prostate + seminal vesicle + 1 cm margin] and 72 Gy to PTV2 [prostate + 1 cm margin] respectively. 3DCRT planning was done using 15 MV photon beam while IMRT plans were created using 6 MV and 15MV photons. Treatment plans were analyzed using mean, median, dose maximum and cumulative dose volume histogram for PTV1, PTV2, bladder, and rectum. Tumor control probability [TCP] was calculated for prostate. Normal tissue complication probability [NTCP] was calculated for bladder, rectum, and head of femur. Mean dose to prostate was 72.79 +/- 0.18 Gy for IMRT 15 MV, 72.16 +/- 0.27 Gy for 3DCRT and 72.48 +/- 0.19 Gy for IMRT 6 MV. TCP was greater for IMRT 15 MV followed by IMRT 6 MV. The mean value of NTCP was significantly lower [p = 0.0015] for IMRT 6 MV compared to 3DCRT for rectum while for bladder all were comparable. IMRT techniques shows superiority in sparing surrounding critical organs, thus reducing normal tissue complication rates while maintaining the same or higher tumor control probability. No significant difference was observed between IMRT 6 MV and IMRT 15 MV techniques.

Accelerated proliferation correction factors in linear-quadratic and multiple-component models

Study in design to incorporate accelerated proliferation correction factors into linearquadratic and multiple-component models. Accelerated proliferation rate correction factor has been incorporated into the linearquadratic and the multiple component models by applying accelerated exponential cell growth to explain the tumor cell kinetics and estimates proper treatment results. Biological effectiveness and tumor control probability, in terms of BED [LQ model], BRD [MC model], TCP[LQ model] and TCP[MC model], were computed for three conventional and two accelerated hyperfractionated radiation therapy treatment schedules with using a range of accelerated proliferation rate constants to demonstrate the effect of the proliferation process. The results of the study show that the accelerated proliferation rate reduces the effectiveness of a treatment schedule delivered in a prolonged period of time. Care should be taken in the selection of a treatment protocol for a patient of head and neck cancer with an account of the cell kinetics of the tumor