Respiratory gated simultaneous integrated boost-intensity modulated radiotherapy [SIB-IMRT] after breast conservative surgery for carcinoma of the breast: the Salmaniya medical complex experience

To present our clinical experience using SIB-IMRT Technique for Intact Breast cancer. A retrospective review of 45 cases of Stage I-IV breast cancer patients treated with SIB-IMRT with respiratory gating after conservative treatments from 35th November 2008 to 16th February 2010. The most common fractionation was 1.8 Gy to Ipsilateral Breast tissue and 2.2 Gy to the lumpectomy cavity giving whole breast dose as 50.4 Gy and Lumpectomy cavity dose as 50.4 Gy and Lumpectomy cavity dose as 61.6 Gy over 28 fractions concomitantly. Respiaratory gating was done and CT-images were taken in inspiration breath hold position. A total of 45 patients with breast cancer- stage [17.7%], II [71%], II [8.9%], IV [2.2%] were treated with SIB-IMRT with respiratory gated radiotherapy. Out of 45 patients, 24 are of left sided breast cancer and 21 are of right sided breast cancer patients. The median, Dose maximum [D-max] in SIB-IMRT is 106.2% of prescribed lumpectomy site dose. The median isodose line prescribed to PTV-2 is 100%. The Conformity index [CI] is 0.9688 [median value] and Homogeneity index [HII] 1.06 [median]. The median ipsilateral lung, mean dose is 21.66 Gy and V-20 is 37.4%. For left sided cases the median value of mean heart dose, V-30 and V-40 are 22.98 Gy, 23.45% and 9.45% respectively. Acute skin toxicity was of Grade-I in 2.2%, Grade-II in 64.4%, Grade-III in 31.1%, and Grade-IV in 2.2%. The global Breast cosmoses were seen excellent in majority [93%] of case at median follow up of 8 months duration. Breast SIB-IMRT Technique is feasible and comparable with other treatment techniques with reduced treatment duration by six fractions. At median follow up of 8 months the skin toxicity and cosmoses are excellent in high percentage of cases

Bacterial adherence: the role of serum and wound fluid

Bacteria are known to initiate wound infections and have been found associated with wound infections. The purpose of this study was to investigate the bacterial adherence potential [BAP] of isolates commonly isolated from wounds in the presence of wound agents. The bacteria used were Pseudomonas aeruginosa, Proteus mirabilis, Escherichia coli and Staphylococcus aureus which were isolated from infected wounds and assayed for their adherence ability using wound fluid and serum. The BAP were achieved by exposing the pathogens to freshly excised wounds. The adhered bacteria were then eluded and quantified using log [CFU]/cm[2] on Mueller Hinton Agar per cm[2] of tissue. The results indicated that wound fluid and serum have a remarkable bacterial adherence potential [BAP] when exposed to freshly injured wounds as when compared to distilled water and no agent

Hyperosmolar hyperglycemic non ketotic coma and rhabdomyolysis; an uncommon clinical encounter

Rhabdomyolysis is usually attributed to trauma. However there is an association of rhabdomyolysis with hyperosmolar states. Recognition of this association will enable better management of the patient and reduce the burden on the care taker by preventing the onset of complications that can prove fatal. It is also important to realise that hyperosmolar coma can be the presenting complaint of a diabetic seeking medical attention for the first time

Traumatic false aneurysms in Port Moresby

@# Background: Trauma is responsible for about 30% of surgical admissions in Port Moresby. Vascular injuries are frequently missed due to inadequate assessment by primary health care workers and often present late with large aneurysms which are difficult to manage. The aim of this study was to identify the patterns of morbidity associated with traumatic false aneurysms complicating vascular injuries in Port Moresby General Hospital from January 1995 to July 1999. Methods: A surgical database with 11,004 records was used to identify patients with a diagnosis of false aneurysm. Charts of patients with gunshot wounds, knife wounds and compound fractures were also reviewed to identify further cases with vascular injury. Results: 51 patients were found to have had documented evidence of vascular injury requiring surgical repair within the study period. 21 patients with traumatic false aneurysm presented to Port Moresby General Hospital. 17 of the 21 patients were aged 11 to 40 years. There was only one female patient. Stab wounds (50%) were the commonest mode of injury followed by lacerations (23%) and fish bites (14%). The calf (42%), forearm (13%) and the head (13%) were the commonest sites involved. The time from insult to admission varied from 4 days to 11 years with the modal time being 14 days. Most patients presented with hard signs of false aneurysms (94%) and 81% of the patients were treated within five days. Ligation (67%) was the commonest operation, followed by excision (43%) and vascular repair (19%). There were no deaths or amputations in any of the patients with false aneurysms. Conclusion: False aneurysms are a not infrequent complication of vascular injuries. Greater awareness of the possibility of vascular injury is needed. Patients in Port Moresby often present after considerable delay. However, the diagnosis can be made clinically and the results of surgical exploration are good. Although colour Doppler ultrasound is a useful investigation it sometimes fails to identify the aneurysm because it requires blood flow to be present in the aneurysm.

Comparaisons des effects du chlorhydrate et de l'iodomethylate de naloxone sur le choc endotoxinique chez le rat anesthesie

In the anesthetized rats, both naloxone hydrochloride and methiodide produced transient hypotension and bradycardia. The hydrochloride salt was able to revert [during 1 hr for the dose of 10 mg/kg I.V] the hypotension produced by the endotoxin of Escherichia coli the methiodide salt was ineffective. Further naloxone hydrochloride produced tachycardia and some awaking of the animals which were not observed after the quaternary ammonium salt. These observations strengthen the view that the effects of naloxone observed in the shocked rat are of central origin and that the antihypotensive action results - partly at least - from the antagonism of Beta endorphin released by the toxin