Effectiveness of abdominal compression in reducing internal target motion during conformal radiotherapy for carcinoma stomach – A pilot study

AIM: To assess the effectiveness of abdominal compression in reducing internal target motion during conformal radiotherapy for stomach cancer. MATERIALS AND METHODS: A pilot study was conducted on five patients who received adjuvant radiotherapy for stomach cancer. All the patients had surgical clips and were offered radiotherapy and concurrent chemotherapy as per the institutional protocol. An abdominal compression device was developed consisting of a triangular Styrofoam's plate and an inflatable air bladder that was positioned over the patients' abdomen. The pneumatic pressure was set according to the patients' comfort. On the simulation day, patients had two computed tomography (CT)-scanning sessions, with and without abdominal compression. Target volumes and organs at risk (OAR) were delineated on the CT images without compression. On the treatment day, fluoroscopy was acquired with onboard imager (OBI) and movements of surgical clips with and without compression analyzed with the help of a tracker software. Observed values with and without abdominal compression were compared. RESULTS: Abdominal compression usage has reduced the mean breathing excursion (MBE) in medio lateral(ML) direction from 5.92mm to 4.15 mm and in cranio caudal direction (CC) from 11.3mm to 7.2mm. The range of reduction by 29.85% in the ML and 36.86% in CC direction. The average residual breathing excursion was 1.766 mm (SD = 1.33 mm) in the ML and 4.02 mm (SD = 2.18 mm) in the CC direction, respectively. CONCLUSION: Abdominal compression was useful in reducing internal target motion during stomach cancer conformal radiotherapy. The device we developed is patient friendly and cost-effective.

Effect of fluidics on corneal endothelial cell density, central corneal thickness, and central macular thickness after phacoemulsification with torsional ultrasound.

Aim: To study the relative effects of high and low fluidic parameters on endothelial cell density (ECD), central corneal thickness (CCT), and central macular thickness (CMT) after phacoemulsification with torsional ultrasound. Settings and Design: Prospective, randomized clinical trial based on a tertiary eye hospital. Subjects and Methods: The study included 65 patients in each group. Patients were randomized to either the high or the low flow group using a computerized random number table. The study was patient and examiner masked. All patients underwent phacoemulsification with torsional ultrasound. Visual acuity, ECD, CCT, and CMT were measured for all patients preoperatively at 2 weeks and 6 weeks postoperatively. Statistical Analysis Used: The Shapiro–Wilks test was used to assess the normality of the data. Mann–Whitney U‑test with the P value set at 0.05 was used to compare the two groups. Results: Cumulative dissipated energy was significantly higher in the low flow group (16.44 ± 9.07 vs. 11.74 ± 6.68; P = 0.002). No statistically significant difference was noted between the two groups in the ECD, CCT, CMT, or corrected distance visual acuity at the end of 6 weeks. Conclusions: No significant difference was noted in the postoperative outcome between high and low flow groups. Parameters can be modified to suit the surgeon’s preference, as both high and low flow parameters were found to have comparable postoperative outcomes.

The effect of thermocycling on fracture toughness and hardness of different core build up materials.

Introduction: Core build up materials are routinely used to restore grossly decayed teeth and in the oral environment they are subjected to changes in the temperature due to consumption of hot and cold food. Aims: The purpose of this study was to determine the effect of thermocycling on the fracture toughness and hardness of 5 core build up materials. Materials and Methods: Fifteen specimens were prepared for each of the following materials: DPI alloy, Miracle‑mix, Vitremer, Fuji II LC and Photocore. American Standard for Testing Materials guidelines were used for the preparation of single‑edge notch, bar‑shaped specimens. Ten specimens of each material were thermocycled for 2000 cycles and the other 5 specimens were not thermocycled (non‑thermocycled group). All specimens were subjected to 3-point bending in a universal testing machine. The load at fracture was recorded and the fracture toughness (KIC) was calculated. Vickers hardness test was conducted on the thermocycled and non‑thermocycled group specimens. Results: Photocore had the highest mean KIC in both thermocycled and non‑thermocycled groups. Miracle‑mix demonstrated the lowest mean fracture toughness (KIC) for both thermocycled and non‑thermocycled groups. By applying Mann Whitney ‘U’ test the Vickers hardness value in all materials used in the study is highly superior in non‑thermocycled group as compared to thermocycled group (P < 0.01). Non‑thermocycled Photocore showed highest hardness values of 87.93. Vitremer had lowest hardness of 40.48 in thermocycled group. Conclusion: Thermocycling process negatively affected the fracture toughness and hardness of the core build‑up materials.

Late solitary skeletal metastasis to the patella from retinoblastoma.

Isolate metastasis to the patella is rare. A young girl treated with bilateral enucleation for retinoblastoma, reported 9 years later with solitary patellar metastasis. Treatment options for distant metastasis from retinoblastoma are not well defined but include combinations of chemotherapy, radiotherapy and surgery. Late skeletal metastasis from retinoblastoma should be differentiated from second primary bone malignancies, with immunohistochemistry, cytogenetic and electron microscopic features, as the prognosis and management are different.

Imipramine in persistent vomiting.

A 21-year-old female presented with persistent vomiting for last 3 years. She had all the investigations done including gastroscopy but there was no abnormality detected. She was tried earlier with medicines prescribed in a medical college or a private nursing home. The cause of vomiting was thought of psychogenic. She was advised imipramine 25 mg thrice daily and responded to the treatment favourably.

Drug-eluting stents: a pharmacoclinical perspective.

In the 26 years since Gruntzig introduced a simple balloon angioplasty technique, percutaneous coronary intervention has made extraordinary progress and has now surpassed bypass surgery in frequency. The area of coronary stenting has been the focus of intense research. One of the major problems encountered after stenting is an exaggerated vascular neointimal proliferation called in-stent stenosis. The evolution of drug-eluting stents has helped in reducing the incidence of in-stent stenosis by almost half. A number of pharmacological agents have been tried in coronary stents with varying degrees of success; many more are being developed and tested. Serious doubts have been expressed about the pharmacoeconomics of drug-eluting stents compared with bare metal stents, because of the huge disparity in costs. Drug-eluting stents, which can be grouped under both device and instrument, have thrown up interesting challenges for clinical trials. The future could see the development of more compact devices with the help of diverse fields such as nanotechnology, microelectronics and advanced materials technology.

Primary esophageal T-cell non-Hodgkin's lymphoma.

Primary non-Hodgkin's lymphoma of the esophagus is a rare disease. We report a 52-year-old man who had a polypoid mass in the esophagus at endoscopy. Histology was suggestive of non-Hodgkin's lymphoma; immunohistochemistry was positive for CD3, CD45 RO, LCA. He was treated with 6 cycles of CHOP and is disease-free 14 months later.

Essential thrombocythaemia.

A case of essential thrombocythaemia which responded to aspirin and hydroxyurea is presented.

Natural regulation of white grub (Holotrichia sp: Scarabidae) by birds in agroecosystem.

The white grub (Holotrichia sp: Scarabidae) is an important subterranean pest damaging root systems of several crops. Experiments conducted during I985 and I986 showed that at least I4 species of birds picked up the grubs exposed during ploughing operation. The important bird predators were mynas Acridotheres tristis (Linnaeus) and Acridotheres ginginianus (Latham), crows Corvus splendens (Vieillot), Corvus macrorhynchos (Sykes), drongo Dicrurus adsimilis (Hodgson) and cattle egret Bubulcus ibis. The birds were found to reduce 45 to 65% grub population during 3 subsequent ploughings. The plant stand of second crop raised in bird exposed field was higher in experimental plot compared to the control. The number of birds attracted to the plough was not consistent with the density of grubs exposed but oh many extraneous factors. Factors affecting the extent of bird predation were presence of insectivorous birds in the surroundings, proximity to their breeding sites and timing of ploughing. White grub control by birds is economically cheaper and environmentally safe compared to the chemical control.