Utilization of a self-administered questionnaire to assess rectal function following prostate brachytherapy.

A sample of 209 consecutive prostate brachytherapy patients completed a self-administered questionnaire to evaluate bowel changes following treatment. With a median followup of 28 months, less than 20% of patients reported deterioration in bowel function.

Rectal function following prostate brachytherapy.

PURPOSE: Quality of life following therapeutic intervention for carcinoma of the prostate gland has not been well documented. In particular, a paucity of data has been published regarding bowel function following prostate brachytherapy. This study evaluated late bowel function in 209 consecutive prostate brachytherapy patients via a one-time questionnaire administered 16-55 months postimplant. MATERIALS AND METHODS: Two hundred nineteen consecutive patients underwent permanent prostate brachytherapy from April 1995 through February 1998 using either (125)I or (103)Pd for clinical T1c-T3a carcinoma of the prostate gland. Of the 219 patients, 7 had expired. Of the remaining 212 patients (median follow-up, 28 months), each patient was mailed a self-administered questionnaire (10 questions) with a prestamped return envelope; 209 (98.6%) surveys were returned. Clinical parameters evaluated for bowel dysfunction included patient age, diabetes, hypertension, history of tobacco consumption, clinical T-stage, elapsed time since implant, and prostate ultrasound volume. Treatment parameters included utilization of neoadjuvant hormonal manipulation, utilization of moderate dose external beam radiation therapy prior to implantation, choice of isotope ((125)I vs. (103)Pd), rectal dose (average, median and maximum doses), total implanted seed strength, values of the minimum dose received by 90% of the prostate gland (D(90)), and the percent prostate volume receiving 100%, 150%, and 200% of the prescribed minimum peripheral dose (V(100), V(150) and V(200), respectively). Because detailed baseline bowel function was not available for these patients, a cross-sectional survey was performed in which 30 newly diagnosed prostate cancer patients of comparable demographics served as controls. RESULTS: The total rectal function scores for the brachytherapy and control patients were 4.3 and 1.6, respectively, out of a total 27 points (p < 0.001). Of the evaluated clinical parameters, only the preimplant number of bowel movements per day were correlated with the total survey score (p < 0.01). None of the treatment parameters were significantly correlated with the total survey score. Despite the fact that implantation with (103)Pd resulted in lower radiation doses to the rectum, the choice of isotope was not predictive of bowel function scores. A trend toward increased rectal scores was noted for older patients, and a nonsignificant improvement in rectal survey scores was noted with elapsed time from implantation. Only 19.2% (40/208) of the treatment group reported a worsening of bowel function following implantation. Patient perception of overall rectal quality of life, however, was inversely related to the utilization of external beam radiation therapy (p = 0.034). CONCLUSION: To date, no severe changes in late bowel function have been noted following prostate brachytherapy. Although the survey scores indicate bowel function is worse after an implant, the minor changes are not significant enough to bother most individuals. Less than 20% of patients reported that their bowel function was worse following prostate brachytherapy.

Radioactive seed embolization to the lung following prostate brachytherapy.

Over the past decade, prostate brachytherapy has been increasingly utilized as definitive management for early stage carcinoma of the prostate gland. One risk of the procedure is pulmonary seed embolization. In this article we report the incidence and timing of seed migration. Pulmonary embolization of radioactive seeds occurs in approximately 20% of patients undergoing prostate brachytherapy. To date, no acute or delayed detrimental effects have been reported which are attributable to the pulmonary embolization of the seeds; nevertheless, it is imperative that patients and health care providers be cognizant of this possible event.

The role of urinary assessment scores in the nursing management of patients receiving prostate brachytherapy.

Nearly all patients experience some degree of urinary irritative or obstructive symptoms following brachytherapy for definitive treatment of early-stage prostate cancer. The American Urological Association (AUA) Symptom Index is a tool developed to measure urinary function and can be incorporated into postoperative nursing management. When this questionnaire is administered at regular intervals following surgery, the patient's urinary status can be assessed quickly and treatment changes made according to symptoms, with resultant improvement in comfort levels. The postoperative use of the AUA index is recommended for all nurses who care for patients undergoing prostate brachytherapy.

Hydration effects on the electrostatic potential around tuftsin.

The electrostatic potential and component dielectric constants from molecular dynamics (MD) trajectories of tuftsin, a tetrapeptide with the amino acid sequence Thr-Lys-Pro-Arg in water and in saline solution are presented. The results obtained from the analysis of the MD trajectories for the total electrostatic potential at points on a grid using the Ewald technique are compared with the solution to the Poisson-Boltzmann (PB) equation. The latter was solved using several sets of dielectric constant parameters. The effects of structural averaging on the PB results were also considered. Solute conformational mobility in simulations gives rise to an electrostatic potential map around the solute dominated by the solute monopole (or lowest order multipole). The detailed spatial variation of the electrostatic potential on the molecular surface brought about by the compounded effects of the distribution of water and ions close to the peptide, solvent mobility, and solute conformational mobility are not qualitatively reproducible from a reparametrization of the input solute and solvent dielectric constants to the PB equation for a single structure or for structurally averaged PB calculations. Nevertheless, by fitting the PB to the MD electrostatic potential surfaces with the dielectric constants as fitting parameters, we found that the values that give the best fit are the values calculated from the MD trajectories. Implications of using such field calculations on the design of tuftsin peptide analogues are discussed.

Comparison of the potentials of mean force for alanine tetrapeptide between integral equation theory and simulation.

The dielectrically consistent reference interaction site model (DRISM) integral equation theory is applied to determine the potential of mean force (PMF) for an alanine tetramer. A stochastic dynamics simulation of the alanine tetramer using this PMF is then compared with an explicit water molecular dynamics simulation. In addition, comparison is also done with simulations using other solvent models like the extended reference interaction site model (XRISM) theory, constant dielectric and linear distance-dependent dielectric models. The results show that the DRISM method offers a fairly accurate and computationally inexpensive alternative to explicit water simulations for studies on small peptides.

Nursing management of patients receiving brachytherapy for early stage prostate cancer.

New technologies used in the area of prostate brachytherapy have resulted in a resurgence of interest in this modality of therapy for early stage prostate cancer. Results of prostate brachytherapy have been reported to be as favorable as radical prostatectomy. Nursing care is multifaceted and necessitates a thorough understanding of brachytherapy techniques, sequelae, and radiation safety.

Rectal dosimetric analysis following prostate brachytherapy.

PURPOSE: To retrospectively assess the rectal tolerance dose in transperineal ultrasound-guided prostate brachytherapy using easily measured point doses. METHODS AND MATERIALS: Forty-five consecutive patients who underwent prostate seed implantation from January 1996 to October 1996, using either 125I or 103Pd as monotherapy or as a boost following 45 Gy of external beam radiotherapy (XRT), were evaluated. For monotherapy using 125I, the minimal peripheral dose (mPD) was 160 Gy, utilizing dosimetry parameters which are equivalent to 144 Gy under the American Association of Physicists in Medicine Task Group 43 (AAPM TG43) recommendations. Computed tomography (CT)-based dosimetry was performed within 9 days of the implant, with a urinary catheter in place for identification of the urethra, and a rectal obturator positioned prior to the CT scan for identification of the anterior rectal mucosa. Dosimetric parameters relevant to this study were the average, maximal and minimal anterior rectal mucosal dose, and the surface area and length of the anterior rectal mucosa irradiated to 50%, 75%, 90%, 100%, and 120% of the prescribed dose. Rectal complications were determined by patient reporting during office visits and telephone follow-up. Follow-up ranged from 19 to 28 months (median 23). RESULTS: Among the four cohorts, the average anterior rectal mucosal dose as a percent of the prescribed mPD was 82.5% +/- 14.1% (standard deviation, SD), and the average maximum was 120% +/- 35%. The length of the rectum receiving a given dose was found to be correlated with the rectal surface area receiving that dose (r2 = 0.82 - 0.93 over the dose range 0.5-1.2 mPD). Rectal complications occurred in only four patients, and consisted of mild, self-limited proctitis. Three of the four were in the top quartile of average and maximal rectal dose and length of rectum receiving > or = 100% of mPD, while the fourth was in the bottom quartile of these parameters. In terms of surface area, all four patients were in the upper half of the study group, with > or = 90 mm2 at dose levels > or = 100% of mPD. CONCLUSION: Our results indicate that in an implant program which maintains the anterior rectal mucosa point dose averages to about 85% of the prescribed dose (regardless of the choice of isotope or the treatment approach), the average maximum to 120% of mPD, and the length of the anterior rectal mucosa receiving 100% and 120% of the prescribed dose at approximately 10 mm and 5 mm, respectively, the incidence of mild self-limited proctitis will be in the range of approximately 9%, without incidence of rectal ulceration and/or fistula formation.

A simple two-dimensional representation for the common secondary structural elements of polypeptides and proteins.

A simple method is presented for projecting the conformation of extended secondary structure elements of peptides and proteins that extend over four C alpha atoms onto a simple two-dimensional surface. A new set of two degrees of freedom is defined, a pseudodihedral involving four sequential C alpha atoms, as well as the triple scalar product for the vectors describing the orientation of the three intervening peptide groups. The method provides a reduction in dimensionality, from the usual combination of multiple phi,psi pairs to a single pair, yielding valuable information concerning the structure and dynamics of these important elements. The new two-dimensional surface is explored by reference to 63 selected protein crystal structures together with a comparison of model built peptides representing the common secondary structural elements. Dynamical aspects on this new surface are examined using a molecular dynamics trajectory of Basic Pancreatic Trypsin Inhibitor.

Salt effects on peptide conformers: a dielectric study of tuftsin.

Four 1-ns molecular dynamics computer simulations of tuftsin, Thr-Lys-Pro-Arg, are analyzed: (1) cis tuftsin in water, (2) trans tuftsin in water, (3) cis tuftsin in 1 M NaCl, and (4) trans tuftsin in 1 M NaCl. Independently of the salt concentration, the trans conformer has a higher dielectric constant than the cis conformer because the former exhibits a more widely distributed charge distribution in space. Independently of the peptide conformation, the presence of salt reduces the dielectric constants of both the peptide and the solvating water molecules because ions, on binding, restrict the motion of other atoms. In contrast to the dielectric constants, neither the peptide conformation nor the salt concentration shows a significant influence on the dielectric relaxation time of water molecules.

Simulations of conformers of tuftsin and a cyclic tuftsin analog.

The conformational properties of the configurational isomers of tuftsin, a linear tetrapeptide with the sequence Thr-Lys-Pro-Arg, were investigated with six 1 ns molecular dynamics simulations in explicit water and in a 1.0 m NaCl solution. The average conformation of the cis isomer is a type VI beta-turn. Our results indicate that water-peptide hydrogen bonding, in addition to intramolecular hydrogen bonds, stabilizes the cis conformer. The trans isomer is neither a beta- nor a gamma-turn. Results are compared with parallel studies on a cyclic analog of tuftsin, cyclo(Thr-Lys-Pro-Arg-Gly). The addition of salt does, not influence the backbone conformation of the peptide. Differences between the structures are confined to the side-chain orientations of the Lys and Arg residues.

Half-life and vitreous clearance of trifluorothymidine after intravitreal injection in the rabbit eye.

To determine the half-life and vitreous clearance of trifluorothymidine, a drug that demonstrates good toxicity against cytomegalovirus (CMV), we injected 200 micrograms of the drug intravitreally in the eyes of nine New Zealand white rabbits. None of the rabbits showed any adverse reactions to the injection or the drug. The rabbits were killed at 3, 6, 12, 24 or 72 hours. High-performance liquid chromatography was used to measure the vitreous trifluorothymidine concentration. The half-life of the drug was found to be 3.15 hours, and the vitreous concentration remained above the ID50 (concentration required to inhibit cytopathic effects by 50% compared with control cultures) for CMV for about 30 hours. We conclude that trifluorothymidine may be of future benefit in the management of CMV retinitis.

Identification of the metabolites of di-(2-ethylhexyl) phthalate in urine from the African green monkey.

The metabolites of di-(2-ethylhexyl) phthalate (DEHP) found in urine from African Green monkeys after intravenous administration of the 14C-labeled parent compound were isolated and identified. Criteria of identification included cochromatography with rat-derived standards on direct-phase HPLC and a variety of gas-chromatographic columns, as well as correspondence of mass spectra (70-eV electron impact and methane positive chemical ionization) with those of known standards. Approximately 80% of the urinary metabolites were excreted in the form of glucuronide conjugates. This is analogous to what has been reported for the urinary metabolites of DEHP from humans, but in clear contrast to the metabolites found in rat urine. Rat urinary metabolites of DEHP are excreted unconjugated, and consist primarily of derivatives more highly oxidized than the major metabolites produced by monkey or human. It is suggested that the African Green monkey may be a better model for human metabolism of DEHP than is the rat.

Results of keratoprosthesis.

The technique of keratoprosthesis was used in 21 cases of severe and intractable forms of keratopathy during the past 3 1/2 years. The results in terms of visual acuity were satisfactory in more than half the cases. Significant problems that occurred after this procedure included the diagnosis and management of glaucoma, vitreitis, and retroprosthetic membrane. There were no instances of extrusion of the keratoprosthesis nor were there any cases of endophthalmitis. However, one case developed necrosis of the tissue around the optical cylinder on the eyelid after surgery. Although its use is limited to only some forms of keratopathy, keratoprosthesis seems to offer a solution in cases where no other treatment is available.

Endothelial cell density in relation to morphology.

Corneal endothelium of 121 normal corneas was studied with the clinical specular microscope, and the relationship between cell density, cell morphology, and age was examined. Our observations indicate a decrease in cell density with age in homomegethous endothelium but no such correlation in a polymegethous endothelium.