[rTMS for a patient with derealisation disorder; an experimental treatment]. / rTMS bij een patiënt met een derealisatie-stoornis; een experimentele behandeling.

We describe a 70 year old patient with a history of epilepsy, who developed a derealisation disorder after discontinuing the use of valproic acid. An experimental treatment with rTMS led to a remarkable decrease of his symptoms. We determined our target, the right ventrolateral prefrontal cortex (VLPFC), with the use of neuronavigation. During treatment no complications occurred, specifically no epileptic seizures.

Poor results after surgery for bronchioloalveolar carcinoma.

BACKGROUND: Bronchioloalveolar carcinoma (BAC) is suggested to be less aggressive than other types of lung cancer. To assess the option of treatment modification, actual outcome data were studied and compared with results for other types of lung cancer. METHOD: Retrospective analysis of all consecutive patients who underwent resection for stage I lung cancer in our hospital. For 18 BAC cases, histological specimens were re-evaluated and in three cases diagnosis was revised. RESULTS: In the period 1989 through 2000, 15 patients with BAC and 260 patients with other tumour types underwent surgery in our hospital. Five-year survival rates were 24 and 53%, respectively, (p = 0.01). CONCLUSIONS: Given the poor results after standard surgery, parenchyma-sparing operations do not seem justified in patients with invasive BAC.

Measuring the wavelength-dependent divergence of transmission through sub-wavelength hole-arrays by spectral imaging.

We present a study on the far-field patterns of light transmitted through sub-wavelength metallic hole-arrays. Spectral imaging measurements are used here on hole arrays for the first time. It provides both spatial and spectral information of the transmission in far-field. The visibility of the images, measured in two illumination modes: Köhler and collimated, is calculated for different planes in and out of focus. The transmission under collimated illumination reveals that 75% of the beam if non-divergent. The results are in agreement with the low divergence measured by Lezec [Science 297, 820 (2002)].

Total variation as a multiplicative constraint for solving inverse problems.

The total variation minimization method for deblurring noise is shown to be effective in increasing the resolution in a contrast source inversion approach to index reconstruction from measured scattered field data. The main drawback is the presence of an artificial weighting parameter in the cost functional, which can only be determined through considerable experimentation Therefore, we introduce the total variation as a multiplicative constraint. Numerical examples demonstrate that the algorithm based on this multiplicative regularization seems to be robust and handling noisy data very well without the necessity of the weighting parameter.

Radio-frequency ring applicator: energy distributions measured in the CDRH phantom.

SAR distributions were measured in the CDRH phantom, a 1 cm fat-equivalent shell filled with an abdomen-equivalent liquid (sigma = 0.4-1.0 S m-1; dimensions 22 x 32 x 57 cm) to demonstrate the feasibility of the ring applicator to obtain deep heating. The ring electrodes were fixed in a PVC tube; diameter 48 cm, ring width 20 cm and gap width between both rings 31.6 cm. Radio-frequency energy was fed to the electrodes at eight points. The medium between the electrodes and the phantom was deionised water. The SAR distribution in the liquid tissue volume was obtained by a scanning E-field probe measuring the E-field in all three directions. With equal amplitude and phase applied to all feeding points, a uniform SAR distribution was measured in the central cross-section at 30 MHz. With RF energy supplied to only four adjacent feeding points (others were connected to a 50 omega load), the feasibility to perform amplitude steering was demonstrated; SAR values above 50% of the maximum SAR were measured in one quadrant only. SAR distributions obtained at 70 MHz showed an improved focusing ability; a maximum at the centre exists for an electric conductivity of the abdomen-equivalent tissue of 0.6 and 0.4 S m-1.

Location of two putative origins of DNA replication of Autographa californica nuclear polyhedrosis virus.

Previously, we described a defective Autographa californica nuclear polyhedrosis virus (AcMNPV) which must contain cis-acting elements required for DNA synthesis, such as the origin(s) of replication (ori). Defective genomes of AcMNPV generated after serial undiluted passage were analyzed further. Three small separated regions were retained in DNA of defective AcMNPV and accumulated in extracellular defective interfering viruses as well as in intracellular DNA after 40 passages. Two of these regions have now been identified as containing putative ori. They are located on the HindIII-B fragment between map units (m.u.) 50.1 and 53.2 and on the HindIII-Q fragment between m.u. 87.2 and 88.9 of the physical map of AcMNPV DNA, respectively. Transfection of Spodoptera frugiperda cells with plasmids containing these sequences followed by superinfection with intact helper AcMNPV resulted in amplification of these plasmids, as demonstrated by the Dpnl sensitivity assay. The replicating activity of HindIII-Q is putatively located within the 1000-bp region containing a highly repetitive DNA (hr5), which is also ascribed to enhance delayed-early gene expression. In order to demonstrate replicating activity of test plasmids, it appeared essential to transfect the cells well before superinfection with helper virus.

A three-dimensional iterative scheme for an electromagnetic inductive applicator.

An efficient iterative method for solving quasi-static electromagnetic field problems is presented. The electromagnetic field is generated by an inductive applicator and is represented as a superposition of two constituents, viz. a primary field in absence of the tissue configuration and a secondary field generated by the presence of the tissue. Then, for the secondary field a quasi-static approximation is employed. In the quasi-static field equations a relaxation function is introduced, such that the resulting equations can be solved iteratively. For a realistic three-dimensional model of a human hand numerical results are presented.

A three-dimensional iterative scheme for an electromagnetic capacitive applicator.

An efficient iterative method for solving quasi-static electromagnetic field problems is presented. A relaxation function is introduced in the quasi-static field equations. Then, the resulting equations can be solved by iteration. The method is similar to the one of solving a Laplace equation by computing the stationary state of a diffusion equation. Next, for a radially layered configuration the numerical results are compared with the results from an existing integral equation method. Subsequently, for a realistic three-dimensional model of a human knee numerical results are arrived at.

SAR distribution of the 'coaxial TEM' system with variable aperture width: measurements and model computations.

An extensive comparison between measured and computed heat absorption distributions in several phantoms inside the 'coaxial TEM' applicator is presented. The influence of the width of the aperture and of the presence of a PVC tube is especially considered.

A ring capacitor applicator in hyperthermia: energy distributions in a fat-muscle layered model for different ring electrode configurations.

The energy deposition pattern within a radially layered fat-muscle phantom, diameter 135 mm, heated by a novel ring capacitor applicator has been determined experimentally as well as theoretically. Good to excellent agreement is found between measured and predicted energy distributions. For the specific absorption rate in the muscle tissue the differences are in general smaller than 6%. When the ring electrodes are placed directly on the phantom surface both measured and predicted energy distributions show the presence of superficial hot spots located within the fat layer at the site of the ring electrodes. The theoretical distributions showed that the radial component of the E-field contributes for more than 90% to the energy absorption at the hot spot in the fatty tissue in front of the ring electrodes. Introducing a small air gap (10 mm) between the phantom surface and the ring electrode results in a decrease of the energy absorption within the fatty tissue at the hot spot location by 30%. Further theoretical analysis of the energy distribution within the inhomogeneous model showed that the intensity of the hot spots at the ring electrodes can be controlled by adjustment of the applicator configuration. Independent of the size of the electrode to phantom gap the specific absorption rate values predicted in the fat-muscle model show a more favorable distribution at a frequency of 27.12 MHz than at 13.56 MHz. For a similar electrode to phantom gap the specific absorption rate within the fatty tissue is approximately two times lower at 27.12 than at 13.56 MHz. For the model calculations performed the best ratio of fat to muscle SAR (0.2) is obtained with distilled water as bolus medium in the gap.

A quasi-static model for the ring capacitor applicator.

The electromagnetic heat dissipation in a radially layered biological tissue inside a ring capacitor (RC) applicator has been investigated. A quasi-static model is introduced to compute the relevant electromagnetic field quantities. The method of computation employs the spatial Fourier transform of all field quantities with respect to the axial coordinate. After an iterative solution of a dual boundary value problem for the electric potential and the current density at the electrodes, an inverse Fourier transform is carried out to compute the quantities that are of interest to the deep-body system at hand. Comparison of numerical results with phantom measurements shows excellent agreement.

A computational model for heat generation in a radially layered tissue inside a 'coaxial TEM' applicator.

The electromagnetic heat dissipation in a radially layered biological tissue inside a circular cylinder has been investigated theoretically. The theory is based on a three-dimensional model and the electromagnetic field is assumed to be generated by a prescribed electric field along a ring-shaped aperture. The method of computation employs the spatial Fourier transform of all field quantities with respect to the axial coordinate, after which the field equations are solved in the spectral domain. Subsequently, an inverse Fourier transform is carried out to compute the quantities that are of interest to the clinical deep-body hyperthermia system at hand. For a number of representative configurations numerical results at 70 MHz are given.

Evaluation of ring capacitor plates for regional deep heating.

Based upon a capacitive system a quasi-microwave cavity operating at a frequency of 13.56 or 27.12 MHz has been developed. The prototype consisted of two capacitive plates with a circular aperture at the centre of each plate in which a cylindrically shaped tissue volume can be placed. Phantom measurements showed that a second-generation applicator, consisting of two narrow rings with equal inner and outer diameter, gave identical results. Due to the positioning of the rings along the enclosed tissue cylinder, the electrical field is mainly parallel to the body axis. SAR distributions were measured by infrared thermography in cylindrical, muscle equivalent phantoms enclosed in PVC-tubes using the 'split phantom' technique. For phantom diameters up to 13.5 cm a homogeneous heating, SAR 70-100 per cent of the maximum SAR, has been obtained over the tissue volume between the inner edges of the two rings. For these measurements the non-isolated ring electrodes are placed directly onto the PVC cover. When the phantom diameter, excluding PVC cover, is increased to 22.5 cm the SAR values at the centre vary from 30 to 40 per cent of the maximum SAR value which is located near the inner edge of the rings. In this case a 1 cm gap between the rings and the PVC cover was used in order to reduce the intensity of the hot spots. In all experiments no cooling of the phantom surface or ring electrodes has been used. The results from this initiating study indicate the feasibility of this type of applicator for regional deep heating, although more experimental work is needed when the applicator is used to heat tissue bodies with a diameter larger than 13.5 cm. Already, the applicator in its most simple design may be of clinical value for hyperthermic treatment of tumors in arms or legs.

Evaluation of calculated temperature distributions for a 27 MHz ridged waveguide used in localized deep hyperthermia.

The computational model developed by van den Berg has been used to perform two-dimensional simulations of tissue-equivalent phantoms heated by a 27 MHz ridged waveguide. The program is able to calculate temperature distributions for realistic inhomogenous tissue configurations (as derived from CT scans) in about 20 min on a PDP 11-44. Results for tissue-equivalent phantoms are evaluated with respect to their accuracy in predicting actual temperature distributions by comparing them with measured temperature distributions. In general the computer simulation tends to overestimate the depth of penetration; this can be ascribed to the two dimensional approach followed which does not take into account the divergence of the electric field in the third dimension. This effect can to a certain degree be compensated by assigning a higher value for the electrical conductivity of the medium. For homogenous phantoms this results in a satisfactory agreement between measured and calculated temperature distributions. Furthermore, a correct approximation for the electric field distribution over the aperture appears to be of importance, since it significantly influences the calculation results, especially for waveguide loads whose size exceeds the width of the ridge area. For inhomogeneous media the simulation results, using realistic (literature) values for the electrical conductivity, can be used with these limitations in mind, as a best-case estimate of the absorbed power distribution at depth. For more accurate simulations a three-dimensional computer model is ultimately needed.

A three-dimensional model for the 'coaxial TEM' deep-body hyperthermia applicator.

A rigorous three-dimensional electromagnetic model predicting the complete field distribution in the space interior to the 'coaxial TEM' applicator is presented. The applicator consists of a radiating ring aperture, with a given electric-field distribution in the wall of a hollow circular cylinder. The method of calculation employs the spatial Fourier transform of all field quantities with respect to the axial co-ordinate, after which the field equations are solved in the spectral domain. Subsequently, an inverse Fourier transform is carried out to compute the quantities that are of interest to the optimum clinical deep-body hyperthermia system. Numerical results for a number of representative applicator configurations are given. The present results are compared with the ones that are obtained by a model based on the far-field approximation of a distribution of dipole sources located in the ring aperture.