Repair of double-chambered right ventricle using right ventricular outflow chamber ventriculotomy via left intercostal thoracotomy under beating heart in two dogs

Double-chambered right ventricle was diagnosed in two dogs, one of them a pup and the other full grown. Both dogs underwent surgery using the novel approach of right ventricular outflow chamber ventriculotomy via left intercostal thoracotomy with moderate hypothermia and moderate pump flow cardiopulmonary bypass under beating heart. No major complication occurred during and after the operation. On continuous wave Doppler echocardiography, the pressure gradient across the stenosis in the right ventricle decreased from 130 mmHg pre-operatively to 40 mmHg post-operatively at 1 year 5 months in the adult dog, and from 209 mmHg pre-operatively to 47 mmHg post-operatively at 1 year in the pup. Both dogs are active without clinical signs

WIDGET: System Performance and GRB Prompt Optical Observations

The WIDeField telescope for Gamma-ray burst Early Timing (WIDGET) is used for a fully automated, ultra-wide-field survey aimed at detecting the prompt optical emission associated with Gamma-ray Bursts (GRBs). WIDGET surveys the HETE-2 and Swift/BAT pointing directions covering a total field of view of 62 degree x 62 degree every 10 secounds using an unfiltered system. This monitoring survey allows exploration of the optical emission before the gamma-ray trigger. The unfiltered magnitude is well converted to the SDSS r' system at a 0.1 mag level. Since 2004, WIDGET has made a total of ten simultaneous and one pre-trigger GRB observations. The efficiency of synchronized observation with HETE-2 is four times better than that of Swift. There has been no bright optical emission similar to that from GRB 080319B. The statistical analysis implies that GRB080319B is a rare event. This paper summarizes the design and operation of the WIDGET system and the simultaneous GRB observations obtained with this instrument.Comment: 19 pages, 11 figures, Accepted to appear in PAS

Acceptable fetal dose using flattening filter-free volumetric arc therapy (FFF VMAT) in postoperative chemoradiotherapy of tongue cancer during pregnancy

Optimizing irradiation protocols for pregnant women is challenging, because there are few cases and a dearth of fetal dosimetry data. We cared for a 36-year-old pregnant woman with tongue cancer. Prior to treatment, we compared three intensity-modulated radiation therapy (IMRT) techniques, including helical tomotherapy, volumetric arc therapy (VMAT), and flattening-filter free VMAT (FFF-VMAT) using treatment planning software. FFF-VMAT achieved the minimum fetal exposure and was selected as the optimal modality. We prescribed 66 Gy to the involved nodes, 60 Gy to the tumor bed and ipsilateral neck, and 54 Gy to the contralateral neck over 33 fractions. To confirm the out-of-field exposure per fraction, surface doses and the rectal dose were measured during FFF-VMAT delivery. Postoperative chemoradiotherapy was delivered using IMRT and a cisplatin regimen. Without any shielding, the total fetal dose was 0.03 Gy, within the limits established by the ICRP. A healthy girl was born vaginally at 37 weeks’ gestation

SBRT FOR CENTRAL LUNG TUMORS WITH 56 Gy/7 fr

Stereotactic body radiotherapy (SBRT) for centrally‑located lung tumors remains a challenge because of the increased risk of treatment‑related adverse events (AEs), and uncertainty around prescribing the optimal dose. The present study reported the results of central tumor SBRT with 56 Gy in 7 fractions (fr) at the University of Tokyo Hospital. A total of 35 cases that underwent SBRT with or without volumetric‑modulated arc therapy consisting of 56 Gy/7 fr for central lung lesions between 2010 and 2016 at the University of Tokyo Hospital were reveiwed. A central lesion was defined as a tumor within 2 cm of the proximal bronchial tree (RTOG 0236 definition) or within 2 cm in all directions of any critical mediastinal structure. Local control (LC), overall survival (OS), and AEs were investigated. The Kaplan‑Meier method was used to estimate LC and OS. AEs were scored per the Common Terminology Criteria for Adverse Events Version 4.0. Thirty‑five patients with 36 central lung lesions were included. Fifteen lesions were primary non‑small cell lung cancer (NSCLC), 13 were recurrences of NSCLC, and 8 had oligo‑recurrences from other primaries. Median tumor diameter was 29 mm. Eighteen patients had had prior surgery. At a median follow‑up of 13.1 months for all patients and 18.3 months in surviving patients, 22 patients had died, ten due to primary disease (4 NSCLC), while three were treatment‑related. The 1‑ and 2‑year OS were 57.3 and 40.4%, respectively, and median OS was 15.7 months. Local recurrence occurred in only two lesions. 1‑ and 2‑year LC rates were both 96%. Nine patients experienced grade ≥3 toxicity, representing 26% of the cohort. Two of these were grade 5, one pneumonitis and one hemoptysis. Considering the background of the subject, tumor control of our central SBRT is promising, especially in primary NSCLC. However, the safety of SBRT to central lung cancer remains controversial

Limb salvage and vascular augmentation by microsurgical free flap transfer for treatment of neuropathic diabetic foot ulcers

Background : Neuropathic diabetic foot ulcers are generally deep and infectious wounds extending to the bone or joint. We performed microsurgical free flap transfer for limb salvage and vascular augmentation of feet with diabetic neuropathy. Methods : Angiography was performed to identify any significant arterial disease. The free flaps were transplanted after resection of the damaged skin and infected bone. Flow-through or end-to-side anastomosis to the dorsalis pedis artery was performed to preserve the arterial blood flow to the residual foot. Results : An anterolateral thigh flap and free flaps based on the subscapular artery system were transplanted in 1 and 10 patients, respectively. All flaps survived. Arterial flow on the distal side of the anastomosis was postoperatively confirmed in all patients. During a mean follow-up period of 52 months, the long-term complications observed were recurrent ulcers in 4 patients. The limb salvage rate was 100%, and 82% of patients achieved functional ambulation. Conclusions : Microsurgical flap transplantation is a safe and useful technique for minimal amputation of a diabetic neuropathic foot. Postoperative protection of the feet is important in order to avoid recurrence of foot ulceration. The use of protective footwear custom-tailored for each patient is strongly recommended