Typical values of z-resolution for different Digital Breast Tomosynthesis systems evaluated in a multicenter study.

PURPOSE: The aim of the present study, conducted by a working group of the Italian Association of Medical Physics (AIFM), was to define typical z-resolution values for different digital breast tomosynthesis (DBT) models to be used as a reference for quality control (QC). Currently, there are no typical values published in internationally agreed QC protocols. METHODS: To characterize the z-resolution of the DBT models, the full width at half maximum (FWHM) of the artifact spread function (ASF), a technical parameter that quantifies the signal intensity of a detail along reconstructed planes, was analyzed. Five different commercial phantoms, CIRS Model 011, CIRS Model 015, Modular DBT phantom, Pixmam 3-D, and Tomophan, were evaluated on reconstructed DBT images and 82 DBT systems (6 vendors, 9 models) in use at 39 centers in Italy were involved. RESULTS: The ASF was found to be dependent on the detail size, the DBT angular acquisition range, the reconstruction algorithm and applied image processing. In particular, a progressively greater signal spread was observed as the detail size increased and the acquisition angle decreased. However, a clear correlation between signal spread and angular range width was not observed due to the different signal reconstruction and image processing strategies implemented in the algorithms developed by the vendors studied. CONCLUSIONS: The analysis led to the identification of typical z-resolution values for different DBT model-phantom configurations that could be used as a reference during a QC program.

General and sex profile of women with partner affected by premature ejaculation: results of a large observational, non-interventional, cross-sectional, epidemiological study (IPER-F).

BACKGROUND: Couple distress is a crucial point in premature ejaculation (PE). PE has been associated with significant bother, interpersonal problems, and dissatisfaction with sexual intercourse for both men and their partners. OBJECTIVES: The primary objective of this study was to assess the effect of PE on female sexuality in female partners of men affected from PE. Secondary objectives were to assess the impact of PE on female sexual quality of life, to assess the presence of sexual problems of the male partner, and to evaluate the prevalence and characteristics of comorbidities. MATERIALS AND METHODS: Adult women aged 18 to 80 years old, sexually active, were randomly sampled from the patient lists of General Practitioners in Italy and were included in this observational, non-interventional, cross-sectional epidemiological study. Subjects were asked to fill: a general questionnaire regarding anthropometric data, lifestyle, marital status, education, occupation, economic conditions, general health status, comorbidities, and sexual habits; the Sexual Quality of Life Questionnaire-Female (SQoL-F); the Female Sexual Distress Scale (FSDS-R-PE); the Self-rating Depression Scale (SDS); and Self-rating Anxiety Scale (SAS). In addition, females reported about their partner's ejaculation time and the presence of sexual dysfunctions. RESULTS: A total of 3,104 women were included. Mean age was 45.1 years. Woman with PE partners presented a higher percentage of sexual dysfunction and reported more anxiety compared with female partners of men not affected from PE (42.69% vs. 20.56% and 30.95% vs. 15,34%, respectively). In addition, they referred more sexual dysfunction in their partners. Hypertension, hypercholesterolemia, arthritis, heart diseases, thyroid disease, a history of menopause, or hysterectomy resulted in significantly more prevalence in women with PE partners. DISCUSSION AND CONCLUSIONS: Female partners of PE patients present an increased prevalence of sexual distress, a reduced quality of sexual life, and an increased anxiety score when compared to women whose partners are not affected from PE.

The effect of live feeds bathed with the red seaweed Asparagopsis armata on the survival, growth and physiology status of Sparus aurata larvae.

Larval rearing is affected by a wide range of microorganisms that thrive in larviculture systems. Some seaweed species have metabolites capable of reducing the bacterial load. However, no studies have yet tested whether including seaweed metabolites on larval rearing systems has any effects on the larvae development. This work assessed the development of Sparus aurata larvae fed preys treated with an Asparagopsis armata product. Live prey, Brachionus spp. and Artemia sp., were immersed in a solution containing 0.5% of a commercial extract of A. armata (Ysaline 100, YSA) for 30 min, before being fed to seabream larvae (n = 4 each). In the control, the live feed was immersed in clear water. Larval parameters such as growth, survival, digestive capacity (structural-histology and functional-enzymatic activity), stress level (cortisol content), non-specific immune response (lysozyme activity), anti-bacterial activity (disc-diffusion assay) and microbiota quantification (fish larvae gut and rearing water) were monitored. Fish larvae digestive capacity, stress level and non-specific immune response were not affected by the use of YSA. The number of Vibrionaceae was significantly reduced both in water and larval gut when using YSA. Growth was enhanced for YSA treatment, but higher mortality was also observed, especially until 10 days after hatching (DAH). The mortality peak observed at 8 DAH for both treatments, but higher for YSA, indicates larval higher susceptibility at this development stage, suggesting that lower concentrations of YSA should be used until 10 DAH. The application of YSA after 10 DAH onwards promotes a safer rearing environment.

Experiencia argentina en la etapa final de erradicación de la polio: cambio de vacuna oral trivalente a bivalente / Argentinian experience to finish polio eradication: switch from trivalent to bivalent oral poliovirus vaccine

Entre el 17 de abril y el 1 de mayo de 2016, 155 países en todo el mundo cambiaron el uso de la vacuna oral trivalente, que protege contra los tres tipos de poliovirus (1, 2 y 3), por la vacuna oral bivalente, que protege contra los poliovirus tipo 1 y 3. Este cambio señala el mayor esfuerzocoordinado globalmente en la historia de las vacunas. En Argentina se realizó el pasado 29 de abril, con una intensa planificación previa y una posterior validación.

The impact of computed tomography slice thickness on the assessment of stereotactic, 3D conformal and intensity-modulated radiotherapy of brain tumors

PURPOSE: To evaluate radiotherapy treatment planning accuracy by varying computed tomography (CT) slice thickness and tumor size. METHODS: CT datasets from patients with primary brain disease and metastatic brain disease were selected. Tumor volumes ranging from about 2.5 to 100 cc and CT scan at different slice thicknesses (1, 2, 4, 6 and 10 mm) were used to perform treatment planning (1-, 2-, 4-, 6- and 10-CT, respectively). For any slice thickness, a conformity index (CI) referring to 100, 98, 95 and 90 % isodoses and tumor size was computed. All the CI and volumes obtained were compared to evaluate the impact of CT slice thickness on treatment plans. RESULTS: The smallest volumes reduce significantly if defined on 1-CT with respect to 4- and 6-CT, while the CT slice thickness does not affect target definition for the largest volumes. The mean CI for all the considered isodoses and CT slice thickness shows no statistical differences when 1-CT is compared to 2-CT. Comparing the mean CI of 1- with 4-CT and 1- with 6-CT, statistical differences appear only for the smallest volumes with respect to 100, 98 and 95 % isodoses-the CI for 90 % isodose being not statistically significant for all the considered PTVs. CONCLUSIONS: The accuracy of radiotherapy tumor volume definition depends on CT slice thickness. To achieve a better tumor definition and dose coverage, 1- and 2-CT would be suitable for small targets, while 4- and 6-CT are suitable for the other volumes (AU)

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Clinically relevant quality assurance (QA) for prostate RapidArc plans: gamma maps and DVH-based evaluation.

The aim of this paper is to evaluate clinically relevant quality assurance (QA) tests for RapidArc prostate patients. 26 plans were verified by the COMPASS system that provides an independent angle response and a reconstruction of dose distribution in patient CT model. Plan data were imported from treatment planning system via DICOM. The fluencies, measured by a 2D detector, were used by COMPASS to forward calculate dose in CT patients and reconstruct dose-volume-histogram (DVH). The gamma analysis was performed, using both the criteria 3%-3-mm and 2%-2 mm, for the whole grid patient and the per-structure volume. A DVH-based analysis was accomplished for target and organs-at-risk (OAR). The correlation between gamma passing rates and DVH discrepancies was performed using Pearson's test. Sensitivity, specificity and accuracy of whole and per-structure gamma method were calculated. No significant DVH deviation was observed for target and OAR. Weak correlation between gamma passing rates and dosimetric deviations was observed, all significant r-values were negative. The whole gamma method shows lack of sensitivity to detect dosimetric deviations >5%. Instead, a better balance between sensitivity and specificity was obtained employing per structure gamma both with 3%-3 mm and 2%-2 mm criteria. Because of the poor correlation between DVH goals and gamma passing rates, we encourage the DVH-based gamma passing rates, when it is possible. At least, a gamma method specific for structure was strongly suggested.

Clinically relevant quality assurance for intensity modulated radiotherapy plans: gamma maps and DVH-based evaluation.

PURPOSE: To explore a novel patient-dose DVH-based method for pretreatment dose quality assurance tests. METHODS: 20 IMRT plans for head-and-neck cancer patients were used. A comparison was performed between the planned dose distributions, the computed, and the reconstructed ones using the gamma-index (GI) method. The GI analysis was performed using both the 3%/3 mm and the 2%/2 mm criteria. RESULTS: No significant DVH-deviation was observed. Considering the 3%/3 mm criteria the mean GI% < 1 for the body and structures was significantly higher compared to 2%/2 mm criteria. CONCLUSIONS: Our results underline the importance of QA-methods based on DVH-metrics to predict the impact of delivered dose.

To evaluate the accuracy of dynamic versus static IMRT delivery using portal dosimetry

INTRODUCTION: To evaluate the delivery accuracy of dynamic (DMLC) and static (SMLC) intensity modulated radiation therapy (IMRT) techniques using portal dosimetry (PD) in Varian Eclipse Treatment Planning System. MATERIALS AND METHODS: Seven DMLC IMRT Head and Neck plans were retrospectively generated for the study using SMLC mode at 20, 10 and 5 levels of intensity (SMLC20, SMLC10, SMLC5). Dosimetric verifications performed by PD on a total of 107 fields were evaluated using the gamma index (maximum (γmax), average (γavg), percentage of points with (γ%) ≤ 1). The images were acquired at a source-detector distance of 100 cm at gantry zero degree and also at clinically planned gantry angles. RESULTS: For both modes, measurements are within acceptable criteria. (γ%) ≤ 1 improves by increasing SMLC levels (+3.4 % from SMLC5 to SMLC20, p < 0.001) and using DMLC (+3.9 % and +0.6 % compared to SMLC5 and SMLC20, respectively, p < 0.001). Also (γmax) parameter improves significantly by increasing SMLC levels (+22 % from SMLC5 to SMLC20) and using DMLC (+34 % and +16 % compared to SMLC5 and SMLC20, respectively). The effect of the gantry rotation influences the delivery accuracy by up to -7 % (p < 0.05). The effect of leaves travelling direction was almost negligible (1 %). CONCLUSIONS: A good agreement between calculated and measured fluences was obtained for DMLC and SMLC techniques at higher intensity levels; however, DMLC delivery ensures the best reproduction of computed fluence maps. The gantry rotation influences the delivery accuracy in particular for SMLC modes at lower intensity levels (AU)

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Volumetric and dosimetric assessment by cone-beam computed tomography scans in head and neck radiation therapy: a monitoring in four phases of treatment.

Due to the anatomical changes frequently occurring during the course of head and neck (H&N) cancer radiotherapy, the dose distribution, which was actually delivered to the patient, might significantly differ from that planned. The aim of this paper is to investigate these volumetric changes and the resulting dosimetric implications on organs at risk (OARs) and clinical target volumes (CTVs) by cone beam computed tomography (CBCT) scans throughout the treatment. Ten H&N patients, treated by Intensity Modulated Radiotherapy, were analyzed. CTVs and OARs were delineated on four CBCT, acquired at the 10(th), 15(th), 20(th) and 25(th) treatment session, and then compared with the ones at planning CT. The planned beams were applied to each CBCT to recalculate the dose distribution and the corresponding dose volume histograms were compared with those generated on planning CT. To evaluate the HU discrepancies between the conventional CT and CBCT images we used a Catphan(r) 504, observing a maximum discrepancy of about 30 HU. We evaluated the impact of this HU difference in dose calculation and a not clinically relevant error, within 2.8%, was estimated. No inhomogeneity correction was used. The results showed an increased CTV mean dose (Dmean) of about 3% was found, without significant reduction in volume. Due to the parotids' shrinkage (up to 42%), significant dosimetric increases were observed: ipsilateral gland at 15th CBCT (Dmean by 18%; V30 by 31%); controlateral gland at the 10(th) CBCT (Dmean by 12.2%; V30 by 18.7%). For the larynx, a significant increase of volume was found at the 20th (15.7%) and 25th CBCT (13.3%) but it complied with dose constraint. The differences observed for the spinal cord and mandible maximum doses were not clinically relevant. In conclusion, the dosimetric analysis on CBCT can help clinicians to monitor treatment progress and to evaluate whether and when a new plan is necessary. The main benefit of replanning could be to preserve the parotids and our data support the hypothesis that the 3rd week of radiotherapy should be a check point for parotids.

To evaluate the accuracy of dynamic versus static IMRT delivery using portal dosimetry.

INTRODUCTION: To evaluate the delivery accuracy of dynamic (DMLC) and static (SMLC) intensity modulated radiation therapy (IMRT) techniques using portal dosimetry (PD) in Varian Eclipse Treatment Planning System. MATERIALS AND METHODS: Seven DMLC IMRT Head and Neck plans were retrospectively generated for the study using SMLC mode at 20, 10 and 5 levels of intensity (SMLC20, SMLC10, SMLC5). Dosimetric verifications performed by PD on a total of 107 fields were evaluated using the gamma index (maximum (γmax), average (γavg), percentage of points with (γ%) ≤ 1). The images were acquired at a source-detector distance of 100 cm at gantry zero degree and also at clinically planned gantry angles. RESULTS: For both modes, measurements are within acceptable criteria. (γ%) ≤ 1 improves by increasing SMLC levels (+3.4 % from SMLC5 to SMLC20, p < 0.001) and using DMLC (+3.9 % and +0.6 % compared to SMLC5 and SMLC20, respectively, p < 0.001). Also (γmax) parameter improves significantly by increasing SMLC levels (+22 % from SMLC5 to SMLC20) and using DMLC (+34 % and +16 % compared to SMLC5 and SMLC20, respectively). The effect of the gantry rotation influences the delivery accuracy by up to -7 % (p < 0.05). The effect of leaves travelling direction was almost negligible (1 %). CONCLUSIONS: A good agreement between calculated and measured fluences was obtained for DMLC and SMLC techniques at higher intensity levels; however, DMLC delivery ensures the best reproduction of computed fluence maps. The gantry rotation influences the delivery accuracy in particular for SMLC modes at lower intensity levels.

The impact of computed tomography slice thickness on the assessment of stereotactic, 3D conformal and intensity-modulated radiotherapy of brain tumors.

PURPOSE: To evaluate radiotherapy treatment planning accuracy by varying computed tomography (CT) slice thickness and tumor size. METHODS: CT datasets from patients with primary brain disease and metastatic brain disease were selected. Tumor volumes ranging from about 2.5 to 100 cc and CT scan at different slice thicknesses (1, 2, 4, 6 and 10 mm) were used to perform treatment planning (1-, 2-, 4-, 6- and 10-CT, respectively). For any slice thickness, a conformity index (CI) referring to 100, 98, 95 and 90 % isodoses and tumor size was computed. All the CI and volumes obtained were compared to evaluate the impact of CT slice thickness on treatment plans. RESULTS: The smallest volumes reduce significantly if defined on 1-CT with respect to 4- and 6-CT, while the CT slice thickness does not affect target definition for the largest volumes. The mean CI for all the considered isodoses and CT slice thickness shows no statistical differences when 1-CT is compared to 2-CT. Comparing the mean CI of 1- with 4-CT and 1- with 6-CT, statistical differences appear only for the smallest volumes with respect to 100, 98 and 95 % isodoses-the CI for 90 % isodose being not statistically significant for all the considered PTVs. CONCLUSIONS: The accuracy of radiotherapy tumor volume definition depends on CT slice thickness. To achieve a better tumor definition and dose coverage, 1- and 2-CT would be suitable for small targets, while 4- and 6-CT are suitable for the other volumes.

Planning target volume assessment in lung tumors dring 3D conformal radiotherapy by means of an aSi electronic portal imaging device in cine mode

PURPOSE: The major uncertainties in treating lung cancer are the repositioning errors and respiratory lung tumor motion. Typically, margins are added to the clinical target volume (CTV) to obtain a planning target volume (PTV) allowing the accommodation of such uncertainties. We want to test a new technique to assess the adequacy of the chosen PTV using an aSi electronic portal imaging device (EPID). METHODS: Four patients affected by lung cancer and treated by radical 3D conformal radiotherapy (3DRT) were studied. During treatment the EPID was used in cine mode acquisition: acquired images were used to the aim. RESULTS AND CONCLUSIONS: Treatment monitoring with an EPID in cine mode is shown to be a clinically feasible and useful tool (AU)

Planning target volume assessment in lung tumors during 3D conformal radiotherapy by means of an aSi electronic portal imaging device in cine mode.

PURPOSE: The major uncertainties in treating lung cancer are the repositioning errors and respiratory lung tumor motion. Typically, margins are added to the clinical target volume (CTV) to obtain a planning target volume (PTV) allowing the accommodation of such uncertainties. We want to test a new technique to assess the adequacy of the chosen PTV using an aSi electronic portal imaging device (EPID). METHODS: Four patients affected by lung cancer and treated by radical 3D conformal radiotherapy (3DRT) were studied. During treatment the EPID was used in cine mode acquisition: acquired images were used to the aim. RESULTS AND CONCLUSIONS: Treatment monitoring with an EPID in cine mode is shown to be a clinically feasible and useful tool.

Parotid gland volumetric changes during intensity-modulated radiotherapy in head and neck cancer.

OBJECTIVE: To evaluate volumetric changes of parotid glands (PGs) during intensity-modulated radiotherapy (IMRT) in head and neck cancer patients. METHODS: During IMRT all patients underwent kilovolt cone-beam CT (CBCT) scans to verify the set-up positioning in a protocol study. On each CBCT scan, the PGs were retrospectively contoured and evaluated with a dose-volume histogram. RESULTS: From February to June 2011, 10 patients were enrolled. 140 CBCT scans were registered (280 PGs): for each patient, a median of 14 CBCT scans were performed (range 14-16). At the start of radiation, the average volume for ipsilateral PGs (iPGs) was 18.77 ml (range 12.9-31.2 ml), whereas for contralateral PGs (cPGs) it was 16.63 ml (range 8.3-28.7 ml). At the last CBCT scan, the average volume loss was 43.5% and 44.0% for the iPG and cPG, respectively. When we analysed the percentage of volume loss, we observed that the volume decreased by linear regression (r(2)=0.92 for iPG; r(2)=0.91 for cPG), with an average volume loss rate of 1.5% per day for both PGs. During the third week of treatment the volume of both PGs reduced by 24-30%. CONCLUSION: Our data show that, during IMRT, the shrinkage of PGs should be taken into account. A replan could be indicated in the third week of radiotherapy.

Temporal trend of diagnostic medical exposure to the Emilia-Romagna region population.

PURPOSE: This paper illustrates the annual trends in medical radiation exposure due to conventional radiography (CR), computed tomography (CT) and nuclear medicine (NM) procedures of the Emilia-Romagna population from 2001 to 2006. MATERIALS AND METHODS: We gathered information about the type, number and mean doses of CR, CT, and NM examinations performed in 17 hospitals of the Emilia-Romagna region. In particular, numerical values of the following dosimetric parameters were requested: entrance skin dose for CR, CT dose index and dose-length product for CT and activity administered for NM. Lastly, the annual collective dose S and annual average per-caput dose were calculated. RESULTS: The 13 diagnostic imaging procedures that were the greatest contributors to the Emilia-Romagna population dose between 2001 and 2006 were identified and, for the year 2006, their percentage contribution to total procedures and population dose are indicated. CR, CT and NM accounted for 12%, 78% and 10% of the dose, and 83%, 15% and 2% of total procedures, respectively. The annual trends of S and average per capita dose are shown, and the theory underlying the use of these parameters is briefly discussed. CONCLUSIONS: This type of study relies heavily on the analysis of field data and as such, the growing attention paid in recent years to procedure optimisation should continue, and expand even for the justification of the procedures themselves as justification has a significant impact on the reduction of S and per-caput doses.

[Endemic corridors: a useful tool for the epidemiological surveillance of influenza]. / Corredores endémicos: una herramienta útil para la vigilancia epidemiológica de la influenza.

Epidemiological surveillance provides updated information about health problems which allows for the establishment of health policy guidelines. The methods for detecting the epidemic frequency of disease require the systematic collection of data on the occurrence of specific diseases. Influenza has cyclic seasonal peaks and its endemic baseline rates are useful for identifying outbreaks: the comparison between baseline and current data supplies epidemiological evidence related to an ongoing outbreak. The upper and lower incidence curves were traced for the data referring to IA detection in the nasopharyngeal aspirates from children hospitalized for acute lower respiratory tract infection from 1996 to 2002. The arithmetic mean and the 95% confidence interval for upper and lower limits of weekly incidence were calculated. The highest incidence was observed between weeks 25 and 32. When analyzing the prepared endemic corridor, it was observed that the highest detection in 2003 occurred between weeks 19 and 25, whereas two peaks occurred in 2004, the first starting at week 20, at a lower level than the normal epidemic peak, and the second at week 26.

Corredores endémicos: Una herramienta útil para la vigilancia epidemiológica de la influenza / Endemic corridors: a useful tool for the epidemiological surveillance of influenza

La vigilancia epidemiológica provee información actualizada y oportuna sobre los problemas de salud y sus condicionantes, lo que permite definir acciones de prevención y control. Para la detección de epidemias es útil disponer de corredores endémicos, que indican el número de casos esperados para un cuadro infeccioso en un momento determinado. Con datos de la sección Microbiología del Hospital de Niños "Dr. Pedro de Elizalde" acerca de pacientes internados con diagnóstico de infección respiratoria aguda baja (IRAB) entre el 1/1/96 y el 31/12/2002 se confeccionaron los corredores para influenza A (IA) por semanas epidemiológicas, correspondientes a un período de siete años. En ese período se internaron 10.473 niños con diagnóstico de IRAB y se identificó IA en 411 aspirados nasofaríngeos. Se calcularon la media y el intervalo de confianza de 95% para los límites superior e inferior de incidencia en períodos semanales, y se encontró que el pico estacional ocurre entre las semanas 25 y 32. Al analizar los datos del año 2003, se observó que el pico se produjo antes, entre las semanas 19 y 25, y con valores muy por encima de los esperados para esas semanas. En 2004 aparecen 2 picos, el primero en la semana 20 y sin superar los valores de fluctuación de la parte central de la curva, y el segundo en la semana 26.

Epidemiological surveillance provides updated information about health problems which allows for the establishment of health policy guidelines. The methods for detecting the epidemic frequency of disease require the systematic collection of data on the occurrence of specific diseases. Influenza has cyclic seasonal peaks and its endemic baseline rates are useful for identifying outbreaks: the comparison between baseline and current data supplies epidemiological evidence related to an ongoing outbreak. The upper and lower incidence curves were traced for the data referring to IA detection in the nasopharyngeal aspirates from children hospitalized for acute lower respiratory tract infection from 1996 to 2002. The arithmetic mean and the 95% confidence interval for upper and lower limits of weekly incidence were calculated. The highest incidence was observed between weeks 25 and 32. When analyzing the prepared endemic corridor, it was observed that the highest detection in 2003 occurred between weeks 19 and 25, whereas two peaks occurred in 2004 , the first starting at week 20, at a lower level than the normal epidemic peak, and the second at week 26.

Influence of the surgical treatment on local recurrence of rectal cancer: a prospective study (1980-1992).

BACKGROUND AND OBJECTIVES: The incidence of locoregional recurrences (LR) following radical surgery of rectal cancer varies from 5% to 30% according to the literature. The purpose of this prospective study was to compare the outcome of the Abdomino-Perineal Excision (APE) vs. the Anterior Resection (AR) in a consecutive series of 188 patients who underwent surgery for cure from 1980 to the end of 1992 (81 APE and 107 AR), followed for 5 years, evaluating their influence on the incidence of the recurrences. METHODS: The patients were enrolled at random in the two surgical groups, provided that a radical excision of the tumour, with only two limits: the level of the lesion from the anal verge and the presence of a severe incontinence instrumentally proven. TNM, Dukes staging, grading, and tumour location were statistically evaluated. Further primary suture vs. packing of the perineal wound in APE and handsewn vs. stapled anastomosis in AR were compared in relation with the incidence of LR. RESULTS: The overall local recurrence rate was 19.2% (32/167), in details 19.7% for APE and 18.5% for AR. Similar recurrence rates were observed following both procedures, matching the patients according to the Dukes stage and different details of techniques. A slight statistically significant difference was found as far as the tumour location is concerned in the group treated with anterior resection (p = <0.05) because of the higher recurrence observed in AR performed for tumours of the lower third of the rectum in comparison with the more proximal level. CONCLUSIONS: The AA conclude that the choice of the right surgical procedure in the rectal carcinoma depends on the characteristics of the tumour and the conditions of the patients, provided that the oncologic indications were respected, because recurrence and survival rate are independent from the surgical approaches.

Surgical laparoscopy with intraoperative manometry in the treatment of esophageal achalasia.

The aim of this study was to describe and evaluate the laparoscopic treatment of esophageal achalasia in nine patients over a 35-month period. Five trocars were used to perform a Heller's myotomy to completely eliminate the cardial high-pressure zone, under manometric control. Intraoperative manometry also was used to calibrate a pick degrees 360 Rossetti's antireflux wrap. A complete regression of symptoms was observed postoperatively in seven of nine patients (77.8%); in two patients (22.2%) a moderate dysphagia persisted, but it disappeared 3 and 6 months, respectively. Only one intraoperative complication (esophageal perforation, recognized and laparoscopically repaired) occurred. At the present follow-up of 18 +/- 5.34 months (range 6-35), no dysphagia or symptoms related to reflux have been observed. Laparoscopic treatment of esophageal achalasia is considered a safe and effective procedure, and the results of this procedure are comparable with those of the open technique. Advantages common to other laparoscopic techniques are emphasized.

[Meningococcal meningitis:descriptive study of 76 cases in a pediatric hospital]. / Meningitis meningocócica: estudio descriptivo de 76 casos en un hospital pediátrico.

BACKGROUND: One of the principal causes of bacterial meningitis (BM) in children older than one month is Neisseria meningitidis (Nm). A quick diagnosis and an immediate treatment are considered essential for a good outcome. We propose this study with the purpose of evaluating the clinical and epidemiological characteristics of the patients with BM caused by Nm and analyzing the effect on the presentation and incidence of sequelae and/or complications of the time elapsed since the starting of symptoms and the beginning of the treatment. METHODS: We performed a retrospective analysis of the clinical registers of 76 patients diagnosed as BM caused by Nm entered in the Hospital de Pediatria Pedro de Elizalde, Buenos Aires, Argentina, during the years 1992 and 1993. We investigated age, sex, date of entrance, first symptoms, biochemistry of cerebrospinal fluid (CSF), nutritional status, convulsions and/or complications, length of internation and conditions at discharge. Processing was done with Epi-info 5.0. Differences between qualitative variables were analyzed with chi 2 and differences between means with z-test. RESULTS: Boys were majority; fever was the most frequent initial symptom; petechiae were less frequently found, specially among infants. 79% of the patients had CSF of purulent characteristics; 32.9% of the patients had complications during their evolution; its incidence raised up to 48% in infants. Lethality was 1.3%, 6.5% of the children had sequelae at the moment of discharge. The average time of internment was 13 days. There were no significant differences when different groups were compared according to their prior evolution time. CONCLUSIONS: 1) Petechiae and vomits were significantly less frequent in infants; 2) the incidence of complications was significantly higher in this last group; 3) no greater incidence of complications or sequelae was observed in patients whose previous period of evolution was longer than 48 hours; 4) in all groups of age we found insidious forms of starting, and 5) there were patients with CSF of normal biochemical characteristics in all groups considered independently of the time of evolution elapsed.