Efficacy and toxicity of Stereotactic Radiotherapy for brain Metastases

Objective: Stereotactic radiotherapy [SRT] has been increasingly used for treatment of brain metastases in recent years. The goal of this study was to evaluate the clinical outcomes in patients with brain metastases treated with LINAC-based SRT

Methods: Patients who underwent SRT at our institution between 2013 and 2017 were retrospectively analyzed. Treatment plans were generated using either iPlan stereotactic treatment planning system [Brainlab Ag, Feldkirchen, Germany] or Eclipse V11.0.47 [Varian Medical Systems, Palo Alto, CA, USA] and patients were treated on a TrueBeam machine equipped with a robotic couch. The treatment response was assessed using RANOBM criteria. The primary endpoint was local control. Secondary endpoints were distant brain control, overall survival and treatment toxicity

Results: Fifty-six patients [28 males and 28 females] with 100 lesions were identified for this study from July 2013 to November 2017. The median age at the time of SRT was 65 years [range 16-86]. The most common histologies were lung [66percent] and breast [26percent]. Seventeen lesions [17percent] were treated postoperatively. Median GPA score [graded prognostic assessment] was 2.5.Treatment regimens consisted of: 1 fraction [median dose = 20 Gy], 3 fractions [median dose = 27 Gy], 5 fractions [median dose = 30 Gy] and 6 fractions [median dose = 30 Gy] in 27percent, 18percent, 41percent and 14percent of the lesions respectively. The median GTV size was 2.44cc [range 0.1-119.67cc] and the median PTV size was 5.03cc [range 0.32-197.22cc]. At a median follow-up of 9.4 months, 7 patients recurred locally. The 1-year local control rate was 88percent and the mean local control was 33 months. The 1-year and mean distant brain control were 45percent and 16.8 months respectively and the 1-year and mean overall survival were 70percent and 29.5 months respectively. A GPA score > 2 was significantly associated with better overall survival than a GPA score

Conclusion: Our institution experience showed that LINAC-based SRT is an effective local ablative treatment for brain metastases with an excellent toxicity profile

Cardiovascular effects of meloxicam

Non steroidal anti-inflammatory drugs are among the most commonly used drugs all over the world in treatment of a variety of rheumatic disorders and are commonly used in patients with cardio-vascular disorders. The present work, aimed to study the cardiovascular modulatory effects of meloxicam [selective COX-2 inhibitor] through in vitro experiments [isolated rabbits heart and aortic strip] and in vivo study that was done on albino rats, through which we investigated the effect of meloxicam on the blood pressure, by blood pressure transducer, and blood flow to different vascular beds and hence different organs as gastrointestinal tract and kidney, using doppler flowmetry. This work was also accompanied by biochemical studies [Liver and kidney functions]. The results revealed a cardio-stimulatory effect of meloxicam in a dose ranging from 0.03-0.3 micro mol/ml on the heart in vitro, but no change in aortic basal tone. Also, interaction of meloxicam, in dose ranging from 0.03-0.3 micro mol/ml, with different vasopressor agonists [noradrenaline, angiotensin and serotonin] showed no change in aortic basal tone. There was a statistically significant dose dependant increase in the blood pressure upon acute intravenous injection of meloxicam in a dose ranging from 0.03-0.3 micro gram/kg, while chronic intra-peritoneal administration produced no significant changes. Acute intravenous injection of meloxicam in a dose ranging from 0.03 - 0.3 micro g/kg produced an increase in both renal blood flow to the values of 14 +/- 1.3, 17 +/- 3.0 and 21 +/- 2.0 cm/sec and mesenteric blood flow giving values of 21 +/- 2.0, 25 +/- 1.5 and 30.0 +/- 3.0 cm/sec. while chronic administration produced no significant changes. There was no effect of meloxicam on the hindquarter or carotid blood flow in neither acute nor chronic administration. The results of the biochemical studies showed no alteration of the biochemical parameters within therapeutic doses. In conclusion, meloxicam was found to have a positive inotropic effect on the heart and safe towards the kidney and gastrointestinal system, increasing the blood flow to these beds

Current concepts in cardiopulmonary resuscitation in adults.

Cardiopulmonary resuscitation (CPR) provides artificial circulation and ventilation during cardiopulmonary arrest. CPR is further categorised as basic life support (BLS), advanced cardiac life support (ACLS) and postresuscitation support. BLS consists of provision of a patent upper airway, ventilation and circulation of blood by closed chest cardiac compressions. ACLS includes use of specialised equipment to maintain the airway, early defibrillation and pharmacologic therapy. Successful outcome from an arrest depends on the total duration of an arrest and early defibrillation, as ventricular fibrillation is the most common cardiac rhythm found in adult cardiac arrest. Initial drug therapy during CPR aims at correction of arterial hypoxaemia and restoring coronary and cerebral perfusion. Oxygen and epinephrine constitute the mainstay of drug therapy during CPR. In patients with ventricular tachycardia, lidocaine is the drug of choice, followed by bretylium. Magnesium has proved to be useful in both refractory pulseless ventricular tachycardia and fibrillation. Atropine has not been demonstrated to improve outcome from arrest but can be administered in bradyasystolic cardiac arrest. The routine administration of bicarbonate and calcium is no longer recommended but situations exist where they can be used appropriately. Administration of drugs during CPR should preferably be via a central route, but epinephrine, lidocaine and atropine can be administered via the endotracheal tube if intravenous access has not been established. Postresuscitation care includes mechanical ventilation if necessary to optimise oxygenation and ventilation and steps to maintain vital organ and optimal brain protection, which includes avoidance of hypertension, hypotension and hyperglycaemia.

Immune alterations of morphine on phagocytic power and serum interleukin [IL] in rats

In spite of the evidence suggesting that many morphine addicts are victims ofdiseases and infections, yet there is little information about the extend ofimmune alterations and whether it is uniform on all immunologic parameters ornot. In order to clarify these issues, morphine [10 mg/kg] was administeredto Sprague Dawley rats in acute and chronic manners to have models foraddictive