Ocular prostheses in the last century: a retrospective analysis of 8018 patients.

PURPOSE: To analyze the clinical characteristics of patients with ocular prosthesis to assess the causes of eye loss in the different genders and age groups, and their incidence over the years. METHODS: We retrospectively examined the rates of ocular prosthesis application and related causes in the period from 1927 to 2011 in a referral center in Rome, Italy, and compared them over time. We also compared the results within the population in terms of age and gender. RESULTS: Of 8018 ocular prosthesis wearers, 63% were males and 37% were females, with a mean age of 29 years. The most frequent cause of ocular prosthesis application was a traumatic event (54%), with work-related eye injuries being the most frequent single cause of ocular trauma reported. Other frequent causes were end-stage ocular diseases, tumors, and malformations, without significant differences in gender. Tumors and malformations showed a slight increasing trend over time, while end-stage ocular diseases and work-related injuries remained unchanged, and other traumatic events decreased. CONCLUSION: The constantly high frequency of ocular prosthesis application for work-related injuries and end-stage ocular diseases suggests that preventive measures for these events have not been addressed accordingly, and might represent a neglected public-health issue.

Quality control by portal film analysis in radiotherapy for prostate cancer: a comparison between two different institutions and treatment techniques.

AIMS AND BACKGROUND: Accuracy and reproducibility of patient setup during radiotherapy for prostate cancer were investigated in two different Institutions (A and B), within their Quality Assurance programs. The purpose of the study was to evaluate and compare setup accuracy and reproducibility in Institutions A and B, which adopt different patient positioning and treatment techniques for prostate irradiation. MATERIALS AND METHODS: A retrospective analysis of portal localization films taken during the treatment course was performed: 30 and 21 patients in Institutes A and B, respectively, entered the study. In Institute A, patients were treated in a prone position, utilizing an individualized immobilization cast (either an alpha cradle or a heat and vacuum-formed cellulose acetate cast) with an open table top and individual abdominal wall compressor to minimize small bowel irradiation; a 5-field conformal technique was used. In Institute B, patients were treated in a supine position without any immobilization device; a 6-field BEV-based technique (conformal only for patients treated with a radical aim) was adopted. A total of 598 portal films (420 from Institute A and 178 from Institute B) were analyzed. The mean number of films per patient was 12 (range, 4-29). Systematic and random setup errors were estimated utilizing the statistical method suggested by Bijhold et al. (1992). RESULTS: When patients with a mean (systematic) error larger than 5, 8 and 10 mm in craniocaudal, lateral and posterior-anterior directions, respectively, were compared, no statistically significant difference between the two groups was observed. Similarly, when comparing portal films, a significant difference (P <0.01) appeared only in the craniocaudal direction (errors > 5 mm: Institute A = 24%; Institute B = 11%). In both Institutes, the SD of random and systematic error distribution ranged from 1.8 to 4.2 mm, with a small prevalence of systematic errors. Only for craniocaudal shifts in Institute A was the random error larger than the systematic error, and it was significantly worse than in Institute B (1 SD, 4.2 mm in Institute A vs 1.8 mm in Institute B). CONCLUSIONS: Setup errors observed in Institutes A and B were similar and in accord with data reported in the literature. In Institute B, satisfactory geometrical treatment quality was achieved without patient immobilization. In Institute A, the goal of minimizing small bowel irradiation and prostate motion through the aforementioned technique, which makes patient position less comfortable, did not seem to considerably increase daily setup uncertainty.

[Clinical and methodological aspects of quality assurance in external radiotherapy: optimization of radiotherapy in early cancer of the breast]. / Aspetti clinico-metodologici di assicurazione della qualità nella radioterapia esterna: ottimizzazione del trattamento radiante nel cancro precoce della mammella.

Since 1988, a specific physical and clinical quality assurance program for external whole breast irradiation has been activated in our department. Three areas of clinical investigation and related audit loops are analyzed to show our policy to improve the quality of patient care. Quality control procedures deal with (a) the evaluation of the adequacy of conventional methods of clinical target volume (CTV) localization, (b) the evaluation of the adequacy of the conventional method of determining the planning target volume (PTV) and (c) the systematic and objective assessment of acute and late side-effects. Corrective actions to maintain or meet the standards are also reported. The localization of residual mammary gland using conventional methods (anatomy and/or palpation) was compared in 100 patients with US localization: conventional methods were often inadequate and thus the use of US in PTV determination is necessary. Portal film analysis helped reduce ideal margins from 20 mm to 11 mm. The amount of irradiated ispilateral lung, retrospectively calculated in 88 consecutive patients, appeared adequate to the chosen reference standard. The systematic study of late skin reactions had shown in some patients telangectasia regions outside the boost area: since 1991, a corrective action, decreasing the thickness of the customized immobilization cast inside the treatment area, from 2 mm to 0.2 mm, has been adopted. These examples show that the routine application of quality assurance procedures can help optimize radiation treatment.

Occurrence of hepatitis delta virus infection in hepatitis B virus-infected patients with different serum patterns of preS gene-encoded proteins.

The occurrence of delta superinfection among viremic and nonviremic HbsAg-positive carriers with different serum patterns and levels of preS1 and preS2 antigens was investigated. PreS1 and preS2 antigens in serum, as well as their levels, were found to be independent of hepatitis B virus (HBV) replicative activity. Serological evidence of hepatitis delta virus (HDV) superinfection was found in 34 out of 233 (14.6%) HBsAg-positive carriers; all these 34 patients resulted positive for antibody to hepatitis B 'e' antigen, and 33 of them were negative for circulating HBV-DNA. Delta superinfection occurred only among HBsAg-positive carriers whose sera were reactive for both preS1 and preS2 antigens (30 out of 142; 21.1%) or at least for preS1 alone (4 out of 63; 6.3%), but not among the patients with undetectable levels of both these antigens. Serum levels of both preS1 (p < 0.005) and preS2 (p < 0.001) antigens were found to be significantly higher in delta-positive HBsAg-positive carriers than in patients with HBV infection uncomplicated by HDV. In addition to confirm previous observations that the detection of both preS antigens in HBsAg-positive sera is independent of HBV replication, these findings clearly show that HDV infection requires not only the presence of HBsAg, but also the presence of preS peptides, and seem to suggest a low susceptibility of HBsAg-positive carriers with low or undetectable synthesis and secretion of HBV surface proteins to delta superinfection.

Beam modifying devices in the treatment of early breast cancer: 3-D stepped compensating technique.

A 3-D compensating technique utilizing stepped brass filters to ensure an adequate dose distribution in the breast after conservative surgery is described. No compensation for lung inhomogeneity is applied. These compensators are part of a procedure which also involves the use of a rotatable half-beam block (HBB) and of an individualized immobilization cast. Results of patient dosimetry show a good agreement with dose prescription in the target volume (measured dose/prescribed dose = 100.9% +/- 1.8% at the reference point). Phantom dosimetry is discussed.

Prolonged viral hepatitis type A with cholestasis: case report.

We describe a clinical case of an eleven year old boy with a protracted cholestatic form of viral hepatitis type A. The role of a macrolide antibiotic in the determinism of this form of hepatitis is discussed.

Expression of preS antigens in serum during the chronic phase of hepatitis B virus infection.

Serum patterns of preS gene encoded proteins during the chronic phase of hepatitis B virus infection and their relationship with hepatitis B virus deoxyribonucleic acid and hepatitis B 'e' antigen were investigated. The results indicate that the presence of preS1 and/or preS2 antigens in serum does not correlate with circulating hepatitis B virus deoxyribonucleic acid and hepatitis B 'e' antigen. It is, therefore, suggested that preS antigens cannot be regarded as specific markers of active viral replication in chronically hepatitis B virus infected patients.