Accuracy of the dose delivery in prostate cancer patients-using an electronic portal imaging device [EPID]

Background: To correct patient positioning errors [setup errors] during prostate cancer treatment using EPID and fiducial gold markers, to improve the accuracy of the dose delivery in these patients

Materials and Methods: Fifteen patients with localized prostate carcinoma after implantation of fiducial gold markers in their prostate gland underwent the five-field IMRT planning technique. The plan was prepared in accordance with ICRU 50 guidance [PTV to receive 95-107% dose]. The software program reconstructed the three-dimensional position of the markers from the different Beams Eye Views [BEV]. The discrepancies of the seeds' positions [prostate surrogate] between plan and daily images were calculated three dimensionally. Then, necessary corrections were applied to match the prostate fiducial markers in the portal image with the BEV image in the planned one by moving the couch in the X, Y and Z directions

Results: Data from 15 patients and 469 fractions of radiotherapy were analyzed in this study. Two sets of data were available from EPID software before and after 3D set-up corrections. The mean of the population displacement in Left /Right [L/R], Anterior/Posterior [A/P] and Crania/Caudal [C/C] directions were 0.5, -1.0 and 2.4mm before, and -0.1, -0.5 and 0.9mm after corrections, respectively. The systematic and random errors for the measured populations in the three mentioned directions were 2.4, 2.7 and 2mm and 6.4, 5.9 and 6.1mm before corrections, and 1.1, 2.4 and 1.4mm and 3.8, 3.9 and 3.6mm after corrections, correspondingly

Conclusion: This study provides further evidence that using gold markers in the prostate improves dose delivery to the prostate. Also, it has been demonstrated that the EPID can be a powerful tool in the reduction of treatment setup errors and the quality assurance and verification of complex treatments

Refractory status epilepticus in children; risk factors, management and early outcome

Refractory status epilepticus is a life-threatening disease in children wherein seizure movements don't response to first line anti convulsion drugs. This study reviewed risk factors, management and early outcome of children with refractory status epilepticus. Patients with refractory status epilepticus admitted in Tabriz children's hospital between 2003 and 2006 were reviewed prospectively for risk factors, management and outcome at time of discharge from hospital. Of the total of 121 patients with status epilepticus, 47 patients [38.8%] were afflicted with refractory status epilepticus. The most common form of refractory status epilepticus was acute symptomatic [38.3%]. Seizure caused by acute symptomatic [RR= 2.36, [CI 95%= 1.25 - 4.44], P=0.006] was a risk factor for refractory status epilepticus development. 87.2% of patients with refractory status epilepticus were treated by midazolam infusion. There was no significant relation between non-response to midazolam, etiology [P=0.798] and type of seizure [P=0.273]. Early outcome of children with refractory status epilepticus was significantly worse than those with status epilepticus [P=0.0001]. About 38% of patients with status epilepticus develop refractory status epilepticus with an increased mortality and morbidity. Seizure caused by acute symptomatic is an important risk factor for developing refractory status epilepticus. In most cases, midazolam infusion results in end of seizure

[ comparison of phenobarbital and phenytoin serum levels between children with status epilepsy and refractory status epilepsy]

Due to high kinetic variation of antiepileptic medications in children, judgment on the efficacy of intravenous phenytoin and phenobarbital in treatment of refractory status epilepsy, requires measurement of serum levels of the drugs. The aim of this study was determine and compare serum levels of phenytoin and phenobarbital, as the two major and common first- line drugs in treatment of children with status epilepsy and refractory status epilepsy. Serum levels of phenytoin and phenobarbital in 20 children [1 month - 12 years] with refractory status epilepsy [candidates for midazolam infusion] was compared with 20 children with status epilepsy. Age, gender, etiology, type of seizure and previous use of antiepileptic drugs were matched. In patients with status epilepsy and refractory status epilepsy mean serum levels of phenobarbital were 28.03 +/- 12.7 microg/ml, 37.22 +/- 20.78 microg/ml respectively while serum levels of phenytoin were 30.38 +/- 16.80 micro g/ml, 31.42 +/- 14.81 microg/ml respectively. There was no significant difference between phenobarbital [P=0.1] and phenytoin [P=0.8] serum levels in these two groups. There was no significant correlation between phenobarbital serum level with age in the group of status epilepsy [P=0.1] and refractory status epilepsy [P=0.8]. In contrast, increased phenytoin serum level was associated with increased age in status epilepsy group [P=0.004] and refractory status epilepsy group [P=0.01]. In both groups, blood level of the drugs were within the therapeutic range. High pharmacokinetic variation of antiepileptic medications in children does not cause any changes in the serum level of intravenous phenytoin and phenobarbital in the groups of status epilepsy and refractory status epilepsy. Development of refractory status epilepsy is probably due to the nature of disease or other unknown factors which need further studies

Childhood status epilepticus: a study on its etiology, management and early outcome

Status epliepticus is a true medical urgency with high mortality. This study was surveyed etiology, management and early outcome of children with status epilepticus. Patients with status epilpeticus who admitted to emergency ward of Tabriz Children's Hospital between 1381 and 1384 were reviewed cross-sectional and analytical study on seizure type and etiology, its management and outcome at discharge from hospital. Among 123 patients with status epilepticus, 50 patients [40.7%] were afflicted with refractory status epilepticus and 73 patients [59.3%] had non - refractory status epilepticus. The most common etiologies in patients with status epilepticus in order of decreasing frequency were related to be prolonged febrile seizure [40.7%], remote symptomatic [28.4%], acute symptomatic [16.2%] and idiopathic [14.6%]. There was significant correlation between age and etiology [P=0.007]. The most common type of seizure was generalized seizure in 70.7% of patients. The median of duration of status epilepticus was 60 [37-146.25] minutes. In 28 patients [22.7%], diazepam with phenytoin or phenobarbital was used. In 40 patients [32.5%], diazepam with phenytoin and phenobarbital and in 50 patients [40.7%], midazolam were used. In 4 patients [3.25%], thiopental was used. Using midazolam, in 82% of patients with refractory status epilepticus lead to control of seizure. 85.9% of patients returned to their condition before status epilepticus. 8.26% of patients died, and in 5.7% of patients a new neurological sequel was established after status epilepticus. There was statistically significant correlation between patient's outcome and etiology of seizure [p=0.001]. The lowest rate of the mortality and morbidity was seen in prolonged febrile seizure [4%] and the most was in acute symptomatic [45%]. Prolonged febrile seizure was the most common etiology in status epilepticus. The highest mortality rate was seen in patients with acute symptomatic etiology. In most cases, intravenous midazolam infusion terminated the refractory status epilepticus

Liver abnormality in celiac disease: report of a case

Many extra-intestinal manifestations are associated with celiac disease. One of the most important of them is hepatobiliary abnormalities. This association is recently under consideration. We report a 34-year-old man with elevated liver enzymes and primary diagnosis of nonalcoholic fatty liver disease. Further follow up revealed celiac disease as the proper diagnosis in this patient

[Comparison of serum zinc and copper levels between term and preterm neonates cord blood and their mothers' blood]

Zinc and copper belong to the essential trace metals needed for optimal growth and development. Measurement of serum zinc and copper in maternal blood and cord blood of neonates was carried out to study and compare the level of trace metals in term and preterm neonates and their mothers. 152 healthy neonates, both term and preterm and their mothers were selected. Measurement of serum zinc and copper was carried out by atomic absorption spectrophotometer. The mean serum zinc level in the term neonates and their mothers was 0.83 microg/ml and 0.62 microg/ml respectively. The mean serum zinc level in the preterm neonates and their mothers was 0.78 microg/ml and 0.47 microg/ml respectively. The mean serum copper level in the term neonates and their mothers was 0.55 microg/ml and 2.29 microg/ml respectively. The mean serum copper level in the preterm neonates and their mothers was 0.63 microg/ml and 2.17 microg/ml respectively. Cord blood zinc level was significantly higher and cord blood copper level was significantly lower than the corresponding maternal blood levels [p<0.05]. There was no significant difference between cord blood zinc and copper levels in term and preterm neonates. The serum levels of zinc in both maternal and cord blood seem to be lower in our sample population compared to the levels found by other authors