Long-course versus short-course palliative cranial irradiation in brain metastases: a comparative study

Background: Brain metastases are the most common intracranial malignancy in adults and their management poses a significant healthcare problem. Of the various options available, whole brain radiotherapy (WBRT) remains the mainstay of treatment. Nonetheless, there is a need to develop fractionation schedules for best symptom palliation and prolonged survival. This prospective study aims to compare treatment outcome in terms of overall survival in two different WBRT schedules and determine the prognostic factors affecting this outcome.Methods: Sixty previously untreated patients with symptomatic brain metastases were randomized in two arms of 30 patients each to receive WBRT. Arm A patients received 30Gy in 10 fractions (long-course) and arm B received 20Gy in 5 fractions (short-course). All patients were assessed during and after completion of WBRT at 1, 3, 6, 9 and 12 months.Results: At 12 months post WBRT, the objective response rate i.e. complete and partial response (CR+PR) was 6.67% in arm A and 13.34% in arm B (p=0.96). Both WBRT regimens showed similar survival (p=0.65). On multivariate linear regression analysis, age ≤65 years, Karnofsky performance score (KPS) ≥70 and lack of extra-cranial metastases were significantly associated with improved survival at the end of 12 months post WBRT. EORTC QLQ-C30 showed similar improvement in quality of life in both the arms (p=0.86).Conclusions: This study suggests comparable results in the two fractionation schedules. Therefore, short-course WBRT may be used as a more convenient option in favour of shorter hospital stay and lesser burden on RT machines.

Autologous Conditioned Serum as a Novel Alternative Option in the Treatment of Unilateral Lumbar Radiculopathy: A Prospective Study

STUDY DESIGN: The study was conducted on patients who received autologous conditioned serum (ACS) as a line of treatment at the Orthopedics outpatient department of Post Graduate Institute of Medical Education and Research (PGIMER, Chandigarh) from January 2011 to June 2012. Of the 1,224 patients, 20 males or females were included in the study based on the inclusion and exclusion criteria. The institutional board of PGIMER approved the study before it was initiated. PURPOSE: To study the efficacy of ACS in the treatment of unilateral lumbar radiculopathy. OVERVIEW OF LITERATURE: Interleukin (IL)-1 appears to be of special importance among the cytokines identified in orthopedic diseases. ACS contains high concentrations of IL-1 receptor antagonist, antagonist to IL-1 in that is a biochemical 'sensitizer' of nerve roots in radiculopathy. METHODS: We included 20 patients with unilateral lumbar radiculopathy after obtaining informed consent. We prepared ACS as described by Meijer et al. Under bi-planar fluoroscopic imaging in anterior-posterior and lateral views, ACS was administered via epidural perineural technique. Patients in both groups were evaluated by quadruple visual analogue scale, straight leg raising test, revised Oswestry disability index, and 12-Item Short Form of Health Survey before and after epidural injections at 3 weeks, 3 months, and 6 months. RESULTS: There was a statistically significant change in all parameters from pre-injection to first, second, and third follow-up (p<0.001). CONCLUSIONS: ACS can modify the disease course in addition to reducing pain, disability and improving general health.

Spring Cantilever: When and Why – A Clinical Report.

A fi xed partial denture is routinely done for the replacement of the missing natural teeth. In the case of anterior missing teeth, conventional cantilever type of fi xed partial denture is more conservative depending upon the case selection. Replacements of anterior teeth are challenging when there is a generalized spacing between the maxillary anterior teeth. Shape and size of the pontic, which replaces the missing teeth has to be in proportion with natural anterior teeth (golden proportion). In such cases, to achieve acceptable esthetics there may be a need to involve more number of teeth by regular fi xed partial denture. Spring cantilever is an ideal solution in these situations. Th e present article covers the case selection, advantages and disadvantages of spring cantilever type of fi xed partial denture.

Direct immunofluorescent studies of skin biopsies in pemphigus.

Direct immunofluorescent studies of skin biopsies from 16 pemphigus vulgaris patients revealed immunoglobulin deposits in 12 (75%) cases with fluorescence at intercellular areas in epidermis. In 2 patients (12.5%) dermoepidermal junction also showed immunoglobulin deposits. IgG was the commonest type of immunoglobulin demonstrated in 12 out of 16 (75%) cases followed by IgM in 5 (31.25%) and IgA in 1 (6.25%) cases. Seven (43.75%) cases showed presence of IgG alone while IgM with IgG was found in 4 (25%) cases. One (6.25%) case showed deposition of IgG, IgM and IgA. The results indicated that demonstration of immunoglobulin in skin biopsies by direct immunofluorescent technique is quite a useful adjunct in diagnostic confirmation of pemphigus.

Osteoradionecrosis of mandible in patients treated with definitive radiotherapy for carcinomas of oral cavity and oropharynx. A retrospective study.

A retrospective analysis of 1140 cases of cancer of oral cavity and oropharynx treated with definitive radiotherapy was carried out with regard to the incidence and precipitating factors of mandibular osteoradionecrosis. 14 cases developed osteoradionecrosis out of which 10 had spontaneous mandibular necrosis and 4 had dental extractions in the area where osteoradionecrosis developed. Amongst the 10 cases of spontaneous osteoradionecrosis, 8 patients received doses of 6500 cGy in 6 1/2 weeks or 7000 cGy in 7 weeks by megavoltage cobalt 60 teletherapy and the remaining two patients received the doses of 6000 cGy in 6 weeks. The aforesaid 4 patients of osteoradionecrosis in the area of dental extractions had received doses of only 6000 cGy in 6 weeks.