Semi-Replication-Competent Retroviral Vectors Expressing Gibbon Ape Leukemia Virus Fusogenic Membrane Glycoprotein (GALV FMG) Gene for Cancer Gene Therapy

A semi-replication-competent retroviral (s-RCR) vector system in which the gag-pol and env (GALV FMG, gibbon ape leukemia virus fusogenic membrane glycoprotein) genes were split into two separate packageable vectors was developed. These vectors are more efficient than replication-defective retroviral (RDR) vectors in gene delivery and have a higher transgene capacity than replication-competent retroviral (RCR) vectors. For thegag-pol vector construction, internal ribosomal entry site-enhanced green fluorescent protein (IRES-EGFP) was introduced downstream of the gag-pol sequence of the previously constructed MoMLV-10A1-EGFP vector to generate MoMLV-gag-pol-IRES-EGFP. For env vector construction, GALV FMG was inserted into the pCLXSN vector to generate pCLXSN-GALV FMG-IRES-EGFP.MoMLV-gag-pol-IRES-EGFP and pCLXSN-GALV FMG-IRES-EGFP were co-transfected into 293T cells to generate s-RCR viruses. These viruses propagated EGFP and induced syncytium formation due to the cytotoxicity of GALV FMG. To improve the cytotoxicity of s-RCR vector system, GALV FMG or the fusogenic envelope G glycoprotein of the vesicular stomatitis virus (VSV-G) was inserted into gag-pol vector. Co-transfection of MoMLV-gag-pol-IRES-GALV FMG + MoMLV-EGFP or MoMLV-VSV-G + pCLXSN-GALV FMG-IRES-EGFP in 293T cells induced stronger syncytium formation than s-RCR vectors (MoMLV-gag-pol-IRES-EGFP + pCLXSN-GALV FMG-IRES-EGFP). In addition, s-RCR stocks collected from transfected 293T cells induced syncytium formation in the human cancer cell lines HT1080 and TE671.Hence, the s-RCR vector systems developed in this study are useful tools for cancer gene therapy.

Semi-Replication-Competent Retroviral Vectors Expressing Gibbon Ape Leukemia Virus Fusogenic Membrane Glycoprotein (GALV FMG) Gene for Cancer Gene Therapy

A semi-replication-competent retroviral (s-RCR) vector system in which the gag-pol and env (GALV FMG, gibbon ape leukemia virus fusogenic membrane glycoprotein) genes were split into two separate packageable vectors was developed. These vectors are more efficient than replication-defective retroviral (RDR) vectors in gene delivery and have a higher transgene capacity than replication-competent retroviral (RCR) vectors. For thegag-pol vector construction, internal ribosomal entry site-enhanced green fluorescent protein (IRES-EGFP) was introduced downstream of the gag-pol sequence of the previously constructed MoMLV-10A1-EGFP vector to generate MoMLV-gag-pol-IRES-EGFP. For env vector construction, GALV FMG was inserted into the pCLXSN vector to generate pCLXSN-GALV FMG-IRES-EGFP.MoMLV-gag-pol-IRES-EGFP and pCLXSN-GALV FMG-IRES-EGFP were co-transfected into 293T cells to generate s-RCR viruses. These viruses propagated EGFP and induced syncytium formation due to the cytotoxicity of GALV FMG. To improve the cytotoxicity of s-RCR vector system, GALV FMG or the fusogenic envelope G glycoprotein of the vesicular stomatitis virus (VSV-G) was inserted into gag-pol vector. Co-transfection of MoMLV-gag-pol-IRES-GALV FMG + MoMLV-EGFP or MoMLV-VSV-G + pCLXSN-GALV FMG-IRES-EGFP in 293T cells induced stronger syncytium formation than s-RCR vectors (MoMLV-gag-pol-IRES-EGFP + pCLXSN-GALV FMG-IRES-EGFP). In addition, s-RCR stocks collected from transfected 293T cells induced syncytium formation in the human cancer cell lines HT1080 and TE671.Hence, the s-RCR vector systems developed in this study are useful tools for cancer gene therapy.

Carga imediata não funcional associada à RTI-3 / Non-functional immediate loading associated with ITR-3

Os implantes imediatos têm sido utilizados com bastante frequência como uma forma de tratamento para a substituição de dentes condenados. Entretanto, quando a área a ser tratada pertence à zona estética, muito cuidado deve ser tomado. Nessa região, quando o objetivo é alcançar um peri-implante com estética satisfatória, o profissional deve utilizar técnicas que, associadas ao implante imediato, evitem a formação de um defeito decorrente da remodelação pós-exodontia, ou ainda, utilizar procedimentos de melhoria tecidual nos casos em que os dentes condenados já apresentem defeitos de tecido ósseo e/ou mole ao seu redor. O objetivo deste trabalho é, através da apresentação de um caso clínico de reposição do elemento 41 condenado, com perda óssea severa e defeito mucogengival, demonstrar e discutir uma modalidade de tratamento que utiliza o implante imediato de carga imediata não funcional associado ao enxerto de tecido conjuntivo e preenchimento com osso mineral bovino particulado.

Immediate implants have been used frequently as a treatment choice for the replacement of compromised teeth. However, when the area to be treated belongs to the aesthetic zone, great care must be exercised. In this region, when the objective is to reach a peri-implant with a satisfactory esthetics, the professional must use techniques that, associated to the immediate implant, prevent the formation of a defect due to the bone remodeling after tooth loss or to use procedures of tissue improvement for cases where the compromised teeth already have defects of bone and/or soft tissue around them. The objective of this study is to present a clinical case of replacement at tooth 41 with severe bone loss and mucogingival defect to demonstrate and discuss a treatment modality that uses the immediate implant with non-functional immediate loading associated with the connective tissue graft and particulate, deproteinized bovine bone filling.

Carga imediata em área estética utilizando um novo modelo de implante estreito / Immediate loading in the esthetic area using a new narrow dental implant model ­ case report

A utilização de implantes estreitos com carga imediata é um assunto relativamente pouco estudado. Entretanto, nos últimos anos, devido às melhorias tecnológicas, um maior interesse tem sido dado a estes implantes. Neste trabalho são apresentados e discutidos aspectos relativos a este assunto, utilizando como exemplo um caso clínico em que um novo modelo de implante estreito (Slim, Unitite ­ SIN), com 2,9 mm de diâmetro e conexão cônica, foi instalado em uma área com pouco espaço mesiodistal na região do elemento 23. Após o período de um ano de acompanhamento, a área apresentava boa estética peri-implantar e aspectos clínicos compatíveis com saúde e normalidade.

The use of narrow implants with immediate loading is a relatively little studied subject. However, in recent years, due to technological improvements greater interest has been given to these implants. In this work, aspects related to this subject are presented and discussed using as example a clinical case in which a new narrow implant model (Slim, Unitite ­ SIN) with 2.9 mm of diameter and a conical connection was installed in an area with narrow mesiodistal space in the region of element 23. One year later, excellent periimplant esthetic and clinical aspects were achieved compatible with a stable health condition.

Elevação de seio maxilar via crista utilizando a técnica hidrodinâmica / Maxilar transcrestal sinus lift with hidrodynamic technique

A elevação de seio via crista do rebordo maxilar é uma técnica bastante utilizada no aumento ósseo da maxila posterior, e a utilização de osteótomos de Summers com martelo é a modalidade mais conhecida. Esta técnica é denominada "técnica de elevação de seio atraumática", o que se trata de uma designação equivocada, uma vez que as marteladas utilizadas para elevar o assoalho do seio maxilar, dependendo do nível de densidade óssea, são bastante incômodas aos pacientes e não são raras as manifestações de desconforto pelos mesmos. Além do desconforto, devido às marteladas sobre os osteótomos, pode ocorrer a vertigem posicional paroxicística benigna (VPPB). Nos últimos anos, a Implantodontia vem buscando técnicas menos traumáticas para a elevação de seio maxilar, destacando-se aquelas que se utilizam de instrumentos rotatórios. Neste trabalho, foi apresentada uma técnica de elevação de seio via crista, que se caracteriza por ser minimamente invasiva e pouco traumática, utilizando instrumentos rotatórios (kit SCA ­ Neobiotech, Coreia), associada à técnica hidrodinâmica (Aqua Lift System, IM3 ­ Neobiotech, Coreia) para descolamento e elevação da membrana, enxertia com Cerasorb (Curasan, Alemanha) e instalação de implante concomitantemente (SW ­ SIN, Brasil).

The transcrestal maxillary sinus lift is a technique widely used in bone enhancement of the posterior maxilla and the use of Summers osteotomes with hammer is the best known modality. This technique is termed an atraumatic sinus elevation technique, which is probably a misnomer, since hammers used to raise the floor of the maxillary sinus, depending on the level of bone density, are very uncomfortable for patients and manifestations of discomfort are not uncommon. In addition to discomfort, due to the hammering of the osteotomes, benign paroxysmal positional vertigo (BPPV) can occur as a complication. In recent years, Implantology has been seeking less traumatic techniques for maxillary sinus elevation. Among them, stand out those that use rotary instruments. In this work, a technique of sinus elevation via crest is presented, which is characterized by being minimally invasive and not very traumatic, using rotary instruments (kit SCA ­ Neobiotech, Korea), associated to the hydrodynamic technique (Aqua Lift System, IM3 ­ Neobiotech, Korea) for membrane detachment and elevation, grafting with Cerasorb (Curasan, Germany) and concomitant implant installation (SW ­ SIN, Brazil).

Reconstrução tecidual imediata em área estética com substituto ósseo associado à técnica Vista / Immediate tissue reconstruction in the esthetic area with a bone substitute and the Vista technique

Este trabalho teve como objetivo demonstrar um caso clínico no qual foi obtida uma estética peri-implantar adequada, utilizando uma abordagem de reconstrução tecidual imediata (RTI), em um paciente com o dente 21 condenado com comprometimento dos tecidos ósseo e mole. Após a remoção do elemento condenado, um implante do tipo conexão cônica (Unitite, SIN) foi instalado. Para o tratamento do defeito de tecido mole, foi utilizado o enxerto de tecido conjuntivo inserido pela incisão do tipo Vista; para o tratamento do defeito ósseo vestibular, foi utilizado beta-tricálcio fosfato (Cerasorb, Curasan). Uma prótese fixa provisória foi instalada sobre o implante. Após oito meses, esta foi substituída por uma prótese cerâmica com infraestrutura em zircônia. Ao final do tratamento, um tecido peri-implantar harmônico foi obtido. Unitermos:

This case report demonstrates the achievement of adequate peri-implant esthetics using the immediate tissue reconstruction in a patient with compromised tooth (21), bone, and soft tissues. After tooth removal, a conical connection type implant (UniTite, SIN) was installed. After, the connective tissue graft was installed using the Vista technique; for the buccal bone defect, a beta- tricalcium material (Cerasorb, Curasan) was applied along with an immediate fixed provisional prosthesis. Eight months later, the definitive zirconia restoration was delivered. In this way, a harmonic peri-implant environment was obtained.

Analysis of Predictive Factors for Lung Injury after Forward-Planned Intensity-Modulated Radiotherapy in Whole Breast Irradiation / 한국유방암학회지

PURPOSE: This study was performed to assess frequency, timings of occurrence, and predictors of radiologic lung damage (RLD) after forward-planned intensity-modulated radiotherapy (FIMRT) for whole breast irradiation. METHODS: We retrospectively reviewed medical records of 157 breast cancer patients and each of their serial chest computed tomography (CT) taken 4, 10, 16, and 22 months after completion of breast radiotherapy (RT). FIMRT was administered to whole breast only (n=152), or whole breast and supraclavicular regions (n=5). Dosimetric parameters, such as mean lung dose and lung volume receiving more than 10 to 50 Gy (V10-V50), and clinical parameters were analyzed in relation to radiologic lung damage. RESULTS: In total, 104 patients (66.2%) developed RLD after whole breast FIMRT. Among the cases of RLD, 84.7% were detected at 4 months, and 15.3% at 10 months after completion of RT. More patients of 47 or younger were found to have RLD at 10 months after RT than patients older than the age (11.7% vs. 2.9%, p=0.01). In univariate and multivariate analyses, age >47 and V40 >7.2% were significant predictors for higher risk of RLD. CONCLUSION: RLD were not infrequently detected in follow-up CT after whole breast FIMRT. More detected cases of RLD among younger patients are believed to have developed at later points after RT than those of older patients. Age and V40 were significant predictors for RLD after whole breast intensity-modulated radiotherapy.

Treatment of Traumatic Posterior Dislocation of the Sternoclavicular Joint: A Case Report

Compared with acromioclavicular dislocation, dislocation of the clavicle at its sternal end is uncommon and accounts for 3% of all injuries to the shoulder girdle. Furthermore, the posterior dislocation of the sternoclavicular joint is relatively a rare injury compared to the other types of sternoclavicular dislocation. We report this case since we have experience with similar cases of traumatic posterior dislocation at the sternoclavicular joint, which were successfully treated with x-ray guided reduction.

Feasibility of Superficial Femoral Artery Intervention Using Mobile C-arms Compared to Fixed C-arms / 대한혈관외과학회지

PURPOSE: Endovascular therapy (ET) for peripheral arterial occlusive disease has increased dramatically in the past decade. ET is currently being performed by different specialists with available resources, with some of these resources being far superior to others, yet there have been no studies comparing the interventional outcomes according to the varying resources. The aim of this study was to analyze the outcomes of ET for superficial femoral artery (SFA) atherosclerosis using a mobile C-arm, in comparison to a historical control group. METHODS: Between March 2009 and December 2010, ET for SFA atherosclerosis was performed in 54 limbs from 47 patients using a mobile C-arm in the operation theater (mobile group). In contrast, a historical group for comparison consisted of 60 patients, for whom ET for SFA atherosclerosis was performed in 76 limbs using a fixed C-arm in the angiographic suite, between July 2003 and May 2008 (fixed group). The outcomes of ET for both groups were retrospectively analyzed by a medical chart review. RESULTS: There was no statistically significant difference in gender, age, risk factors, Trans-Atlantic Inter-Society Consensus (TASC) classification, intervention type, and postoperative blood creatinine levels between the two groups. However, procedural time was statistically higher in the mobile group. Patency rates at 1 year were 68.3% and 68.1% in the fixed and mobile group, respectively, which was not statistically significant. Subgroup analysis of 1 year patency rates for TASC A, B lesions and TASC C, D lesions were also similar. CONCLUSION: ET using the mobile C-arm in the operating theater is as effective as using the fixed C-arm, in the treatment of SFA atherosclerosis in terms of the technical success, patency, and early postoperative outcomes.

Insufficiency Fracture of Ipsilateral Femur Neck in Patient Treated with Long Term Bisphosphonate Treatment: A Case Report

Bisphosphonate is notable for the treatment of osteoporosis in the world. But recently if Bisphosphonate is taken for a long time, it causes an insufficiency fracture by suppression of bone turn-over and it is reported rarely on femur neck. Here we report a case of insufficiency fracture on ipsilateral femur neck in woman treated with long term Bisphosphonate therapy.

Drug-eluting Stent Implantation for a Below-the-knee Chronic Total Occlusion Lesion: A Case Report / 대한혈관외과학회지

For many years, surgical bypass has been considered mainstream therapy of below-the-knee peripheral arterial occlusive disease. The introduction of endovascular techniques and devices has made percutaneous transluminal angioplasty (PTA) and stenting feasible and safe in these patients. However, PTA has a significant risk of restenosis by elastic recoil and stenting is associated with restenosis by neointinal hyperplasia and vessel wall remodeling. With the advent of coronary artery drug eluting stent (DES), these limitations of PTA and stenting have been circumvented. Herein, we report a successful case of DES implantation for below-the-knee chronic total occlusion lesion. A 65-year-old male patient presented with severe claudication on his left leg. Computed tomography angiography showed long segment total occlusion involving the left distal superficial femoral, popliteal and proximal anterior tibial arteries. We tried to treat the lesion using endovascular surgery. During balloon angioplasty, flow limiting dissection developed in the proximal anterior tibial artery and we deployed a DES (Cypher, Cordis, Johnson & Johnson, USA) in that lesion. To our knowledge, this is the first report of DES for the treatment of below-the-knee chronic total occlusion lesion in Korea.

Effects of Water Extracts of Red Pepper Seeds Powder on Antioxidative Enzyme Activities and Oxidative Damage in Rats Fed High-Fat and High-Cholesterol Diets

The purpose of the present study was to examine the effects of water extracts from red pepper seeds powder on antioxidative enzyme activities and oxidative damage in groups of rrats fed high-fat and high-cholesterol diets group (HFC). The Rrats were divided into the following five experimental groups which are : composed ofa normal diet group, a high fat.high cholesterol diet group, and a high fat.high cholesterol diet group supplemented with different amounts contents (1%, 2% and 4%) of red pepper seeds powder water extracts supplemented groups (HFCW1, HFCW2 and HFCW4, respectively). Body weight gains and food intake were lower ofin the red pepper seed water extracts groups were lower than those inof the HFC group. Hepartic xanthine oxidase (XOD) activity was decreased in the HFCW2 and HFCW4 groups compared to the HFC group. Hepartic glutathione peroxidase (GSH-px) activitiyactivity was increased in the HFCW4 group compared to the HFC group. Hepatic superoxide radicals within the mitochondria and microsomes of cells were significantly reduced in the HFCW2 and HFCW4 groups compared to the HFC group. Hepartic hydrogen peroxide in the cytosol was significantly reduced in the HFCW3 and HFCW4 groups compared to the HFC group. Hepatic carbonyl values in the microsomes and mitochondria were significantly reduced in the HFCW4 group compared to the HFC group. Hepartic thiobarbituric acid reaction substance (TBARS) activity was decreased in the HFCW2 group compared to the HFC group. These results suggest that water extracts of red pepper seeds powder may reduce oxidative damage by activation of antioxidative defense systems in rats fed high fat.high cholesterol diets.

Internal Fixation of Humeral Shaft Fractures Using Anterior Plating Technique

PURPOSE: To evaluate clinical results after anterior plate fixation for humeral shaft fractures. MATERIALS AND METHODS: We evaluated 20 patients with a humeral shaft fracture. Anterior plate fixation with anterolateral approach to the humeral shaft was performed in all cases. Time to fracture healing, presence of complications such as radial nerve injury, and range of motion of the affected shoulder and elbow joint were assessed. RESULTS: All fractures were united and the mean healing time was 16 weeks (range, 12 week to 1 year). There were one nonunion and one postoperative radial nerve palsy. The nonuion was treated with a longer plate and bone grafting, resulting in union. The radial nerve palsy recovered at 4 months after operation. Two preoperative radial nerve injury recovered spontaneously at 6 to 8 months. The mean flexion of elbow was 125degrees and mean extension was 0degrees. The mean flexion of shoulder was 170degrees and mean extension was 170degrees. CONCLUSION: Internal fixation of humeral fractures using anterior plating technique is recommended as a reliable method to regain satisfactory range of motion of the elbow and shoulder.

Dose Verification Study of Brachytherapy Plans Using Monte Carlo Methods and CT Images / 의학물리

Most brachytherapy treatment planning systems employ a dosimetry formalism based on the AAPM TG-43 report which does not appropriately consider tissue heterogeneity. In this study we aimed to set up a simple Monte Carlo-based intracavitary high-dose-rate brachytherapy (IC-HDRB) plan verification platform, focusing particularly on the robustness of the direct Monte Carlo dose calculation using material and density information derived from CT images. CT images of slab phantoms and a uterine cervical cancer patient were used for brachytherapy plans based on the Plato (Nucletron, Netherlands) brachytherapy planning system. Monte Carlo simulations were implemented using the parameters from the Plato system and compared with the EBT film dosimetry and conventional dose computations. EGSnrc based DOSXYZnrc code was used for Monte Carlo simulations. Each (192)Ir source of the afterloader was approximately modeled as a parallel-piped shape inside the converted CT data set whose voxel size was 2x2x2 mm3. Bracytherapy dose calculations based on the TG-43 showed good agreement with the Monte Carlo results in a homogeneous media whose density was close to water, but there were significant errors in high-density materials. For a patient case, A and B point dose differences were less than 3%, while the mean dose discrepancy was as much as 5%. Conventional dose computation methods might underdose the targets by not accounting for the effects of high-density materials. The proposed platform was shown to be feasible and to have good dose calculation accuracy. One should be careful when confirming the plan using a conventional brachytherapy dose computation method, and moreover, an independent dose verification system as developed in this study might be helpful.

Implementation and Evaluation of the Electron Arc Plan on a Commercial Treatment Planning System with a Pencil Beam Algorithm / 의학물리

Less execution of the electron arc treatment could in large part be attributed to the lack of an adequate planning system. Unlike most linear accelerators providing the electron arc mode, no commercial planning systems for the electron arc plan are available at this time. In this work, with the expectation that an easily accessible planning system could promote electron arc therapy, a commercial planning system was commissioned and evaluated for the electron arc plan. For the electron arc plan with use of a Varian 21-EX, Pinnacle3 (ver. 7.4f), with an electron pencil beam algorithm, was commissioned in which the arc consisted of multiple static fields with a fixed beam opening. Film dosimetry and point measurements were executed for the evaluation of the computation. Beam modeling was not satisfactory with the calculation of lateral profiles. Contrary to good agreement within 1% of the calculated and measured depth profiles, the calculated lateral profiles showed underestimation compared with measurements, such that the distance-to-agreement (DTA) was 5.1 mm at a 50% dose level for 6 MeV and 6.7 mm for 12 MeV with similar results for the measured depths. Point and film measurements for the humanoid phantom revealed that the delivered dose was more than the calculation by approximately 10%. The electron arc plan, based on the pencil beam algorithm, provides qualitative information for the dose distribution. Dose verification before the treatment should be mandatory.

Error Analysis of Delivered Dose Reconstruction Using Cone-beam CT and MLC Log Data / 의학물리

We aimed to setup an adaptive radiation therapy platform using cone-beam CT (CBCT) and multileaf collimator (MLC) log data and also intended to analyze a trend of dose calculation errors during the procedure based on a phantom study. We took CT and CBCT images of Catphan-600 (The Phantom Laboratory, USA) phantom, and made a simple step-and-shoot intensity-modulated radiation therapy (IMRT) plan based on the CT. Original plan doses were recalculated based on the CT (CTplan) and the CBCT (CBCTplan). Delivered monitor unit weights and leaves-positions during beam delivery for each MLC segment were extracted from the MLC log data then we reconstructed delivered doses based on the CT (CTrecon) and CBCT (CBCTrecon) respectively using the extracted information. Dose calculation errors were evaluated by two-dimensional dose discrepancies (CTplan was the benchmark), gamma index and dose-volume histograms (DVHs). From the dose differences and DVHs, it was estimated that the delivered dose was slightly greater than the planned dose; however, it was insignificant. Gamma index result showed that dose calculation error on CBCT using planned or reconstructed data were relatively greater than CT based calculation. In addition, there were significant discrepancies on the edge of each beam while those were less than errors due to inconsistency of CT and CBCT. CBCTrecon showed coupled effects of above two kinds of errors; however, total error was decreased even though overall uncertainty for the evaluation of delivered dose on the CBCT was increased. Therefore, it is necessary to evaluate dose calculation errors separately as a setup error, dose calculation error due to CBCT image quality and reconstructed dose error which is actually what we want to know.

Outcomes of Endovascular Intervention and Bypass Surgery for Femoral Artery Atherosclerosis

PURPOSE: The main treatment modality of peripheral arterial occlusive disease (PAOD) of the lower extremities has shifted from traditional bypass surgery (BS) to a less invasive endovascular intervention (EI), but there is still conflicting data about the differences in long-term patency between the two modalities The purpose of this study was to analyze restenosis rates of femoral EI and to compare both anatomical and functional results between EI and femorodistal BS. METHODS: Between July 2003 and June 2009, 88 limbs (61 patients) and 47 limbs (43 patients) with femoral artery PAOD were treated with EI and BS, respectively. A retrospective analysis of prospectively collected data was performed by reviewing medical records, radiologic images and noninvasive vascular studies. Patient demographics and risk factors were analyzed. Technical outcomes such as restenosis rates, patency rates and functional outcomes using modified questionnaires were evaluated. RESULTS: The restenosis rates for EI at 6 months, 1 year, 2 years and 3 years were 10.4%, 20.1%, 41.1% and 52.7%, respectively, and the mean restenosis duration was 36.5+/-3.24 months. Comparison of patency rates between EI and BS showed no significant difference (P=0.204) in TASC C and D lesions. Functional outcome analysis showed that both EI and BS improved functional status after treatment, and comparison between the two groups showed that BS had a better functional improvement than EI (P=0.010). CONCLUSION: EI could provide equivalent patency rates compared with BS, but for TASC C and D lesions, BS is still a preferred treatment modality based on better functional outcomes.

Tardy Ulnar Nerve Palsy due to Recurrent Dislocation of the Ulnar Nerve after Medial Epicondylar Fracture of the Humerus: A Case Report

Tardy ulnar nerve palsy might develop secondary to nonunion, malunion, or elbow deformity after medial epicondylar fracture of the humerus. We report a case of tardy ulnar nerve palsy following medial epicondylar fracture, treated with excision of bony fragment, neurolysis and relocation of the ulnar nerve.

Estimation of Jaw and MLC Transmission Factor Obtained by the Auto-modeling Process in the Pinnacle3 Treatment Planning System / 의학물리

Radiation treatment techniques using photon beam such as three-dimensional conformal radiation therapy (3D-CRT) as well as intensity modulated radiotherapy treatment (IMRT) demand accurate dose calculation in order to increase target coverage and spare healthy tissue. Both jaw collimator and multi-leaf collimators (MLCs) for photon beams have been used to achieve such goals. In the Pinnacle3 treatment planning system (TPS), which we are using in our clinics, a set of model parameters like jaw collimator transmission factor (JTF) and MLC transmission factor (MLCTF) are determined from the measured data because it is using a model-based photon dose algorithm. However, model parameters obtained by this auto-modeling process can be different from those by direct measurement, which can have a dosimetric effect on the dose distribution. In this paper we estimated JTF and MLCTF obtained by the auto-modeling process in the Pinnacle3 TPS. At first, we obtained JTF and MLCTF by direct measurement, which were the ratio of the output at the reference depth under the closed jaw collimator (MLCs for MLCTF) to that at the same depth with the field size 10x10 cm2 in the water phantom. And then JTF and MLCTF were also obtained by auto-modeling process. And we evaluated the dose difference through phantom and patient study in the 3D-CRT plan. For direct measurement, JTF was 0.001966 for 6 MV and 0.002971 for 10 MV, and MLCTF was 0.01657 for 6 MV and 0.01925 for 10 MV. On the other hand, for auto-modeling process, JTF was 0.001983 for 6 MV and 0.010431 for 10 MV, and MLCTF was 0.00188 for 6 MV and 0.00453 for 10 MV. JTF and MLCTF by direct measurement were very different from those by auto-modeling process and even more reasonable considering each beam quality of 6 MV and 10 MV. These different parameters affect the dose in the low-dose region. Since the wrong estimation of JTF and MLCTF can lead some dosimetric error, comparison of direct measurement and auto-modeling of JTF and MLCTF would be helpful during the beam commissioning.

Delayed Open Repair for Persistent Type I Endoleak after EVAR: A Case Report

Endovascular aneurysm repair (EVAR) is used with increasing frequency in the management of high-risk abdominal aortic aneurysm (AAA) patients. We report a delayed open repair for a persistent type I endoleak after EVAR in a patient with co-morbidities. An infrarenal AAA with a transverse diameter of 9.86 cm was detected on CT angiography; it extended from 8 mm below the renal artery to both common iliac arteries. The infrarenal angle was 90 degrees. After insertion of a Zenith stent graft (COOK, USA), a type I endoleak was detected on aortography, and several balloon dilatations were performed. The procedure was finished with a sustained type I endoleak. The endoleak persisted after 5 days on Doppler ultrasound, so open repair was performed. Total operative time was 240 minutes, and the duration of supra-celiac aorta clamping was approximately 35 minutes. The patient suffered an acute myocardial infarction on postoperative day 7 and recovered with conservative management. The patient was discharged on postoperative day 29.