Volumetric decrease of pancreas after abdominal irradiation, it is time to consider pancreas as an organ at risk for radiotherapy planning

Abstract Background Volumetric shrinkage of normal tissues such as salivary glands, kidneys, hippocampus are observed after radiotherapy. We aimed to assess the alterations in pancreatic volume of patients who received abdominal radiotherapy and define pancreas as an organ at risk for radiation treatment planning. Material-methods Forty-nine patients operated for gastric adenocarcinoma who received adjuvant abdominal radiotherapy were in the study group, 27 patients with early stage disease who did not need adjuvant treatment after surgery comprised the control group. An experienced radiologist contoured the pancreas of all the patients from computed tomographies imported to the planning system obtained either for radiation planning purpose or for follow-up after surgery. The same procedure was repeated one year later for both groups. Measured volume of the pancreas was expressed in cm3. Results Mean pancreatic volumes were similar in both groups at the onset of the study, 51,34 ± 20,33 cm3, and 50,12 ± 23,75 cm3 in the irradiated and the control groups respectively (p = 0,63). One year later, mean pancreatic volumes were significantly decreased in each group; 22,48 ± 10,53 cm3, 44,18 ± 23,08 cm3 respectively, p < 0,001. However, the decrease in pancreatic volume was significantly more pronounced in the irradiated group in comparison to the control group, p < 0,001. Conclusion Volumetric decrease in normal tissues after radiotherapy is responsible for loss of organ function and radiation related late side effects. Although pancreas is a radiation sensitive organ losing its volume and function after radiation exposure, it is not yet considered as an organ at risk for radiation treatment planning. Pancreas should be contoured as an organ at risk, dose-volume histogram for the organ should be created, and safe organ doses should be determined. This is the first study declaring pancreas as an organ at risk for radiation toxicity and the necessity of defining dose constraints for the organ

Osteoporosis development and vertebral fractures after abdominal irradiation in patients with gastric cancer

Abstract Background Decrease in bone mineral density, osteoporosis development, bone toxicity and resulting insufficiency fractures as late effect of radiotherapy are not well known. Osteoporosis development related to radiotherapy has not been investigated properly and insufficiency fractures are rarely reported for vertebral bones. Methods Ninety-seven patients with gastric adenocarcinoma were evaluated for adjuvant treatment after surgery. While 73 out of 97 patients treated with adjuvant chemoradiotherapy comprised the study group, 24 out of 97 patients with early stage disease without need of adjuvant treatment comprised the control group. Bone mineral densities (BMD) of lumbar spine and femoral neck were measured by dual energy x-ray absorptiometry after surgery, and one year later in both groups. Results There was statistically significant decline in BMDs after one year in each group itself, however the decline in BMDs of the patients in the irradiated group was more pronounced when compared with the patients in the control group; p values were 0.02 for the decline in BMDs of lumbar spine, and 0.01 for femoral neck respectively. Insufficiency fractures were observed only in the irradiated patients (7 out of 73 patients) with a cumulative incidence of 9.6%. Conclusions Abdominal irradiation as in the adjuvant treatment of gastric cancer results in decrease in BMD and osteoporosis. Insufficiency fracture risk in the radiation exposed vertabral bones is increased. Calcium and vitamin D replacement and other measures for prevention of osteoporosis and insufficiency fractures should be considered after abdominal irradiation

Ülkemizdeki paroksismal nokturnal hemoglobinüri hastalarının klinik özelliklerinin ve tedavi sonuçlarının değerlendirilmesi çok merkezli bir çalışma

Amaç: Paroksismal nokturnal hemoglobinüri (PNH), kronik intravasküler hemoliz bulguları,kemik iliği yetersizliği ve trombozla kendini gösterebilen edinsel, klonal bir hematopoietikkök hücre hastalığıdır. Klinik bulguların çok değişken olması, tanıda gecikmelere vehastalığın morbi-mortalitesinde artışa yol açabilmektedir. Tanıda altın standart yöntem, temelmoleküler defektin, yani glukozilfosfotidilinozitol (GPİ) çıpası yardımıyla hücre membranınabağlanan proteinlerdeki eksikliğin akım sitometrik yöntemle ortaya konulmasıdır.Tedavisinde ise tek küratif yöntem allojeneik kök hücre naklidir. Ancak günümüzde PNHtedavisinde, hemoliz, transfüzyon bağımlılığı, organ hasarı ve semptomları azalttığı gösterilenve bir terminal kompleman inhibitörü olarak görev yapan eculizumab da yaygın olarakkullanılmaktadır. Bu çok merkezli çalışmada amacımız, ülkemizdeki PNH hastaların kliniközelliklerinin ve tedavi yönetimlerinin değerlendirilmesidir.Gereç ve yöntem: Çalışmamıza yirmi farklı merkezin hematoloji kliniğinde PNH tanısı alantoplam 60 olgu dahil edilmiştir. Tüm olguların retrospektif olarak dosyaları taranmış,hastaların demografik özellikleri, laboratuvar bulguları, gelişen komplikasyonlar, akımsitometri bilgileri, aldıkları tedaviler ve ölüm sebepleri kaydedilmiştir.Bulgular: Çalışmamıza alınan 60 hastanın ortanca yaşları 33 (17-77) idi. Kırkaltı hasta klasikPNH ve 14 hasta sekonder PNH (13 hasta aplastik anemi+PNH, 1 hasta myelodisplastiksendrom+PNH) idi. Hastaların temel demografik özellikleri, hematolojik parametreleri,semptom ve bulguları Tablo1’de özetlenmiştir. Halsizlik ve karın ağrısı en sık başvuruyakınmaları olup, organomegali sadece 7 hastada saptanmıştı. Akım sitometrik analizdeortanca granülosit ve monosit klonları klasik PNH olgularında sırasıyla %75 (23.1-99.5) ve%77 (14.2-99) ve sekonder PNH olgularında %70.5 (13.8-95) ve %61 (14-95.5) olarak izlendi. Tromboembolik olaylar 60 hastanın 18 inde (%30) gözlenmişti. Klasik ve sekonderPNH olguları arasında tromboembolik olay gelişimi açısından istatistiksel bir farkgözlenmemişti (sırasıyla %17.3 ve %14.2, p:0.57). Hastaların, 2009 yılında eculizumabülkemizde ulaşılabilir olana dek immünsupresif ilaçlarla tedavi gördükleri, bu tarihten sonraise olguların %67.4’ünde (31/46) eculizumab tedavisine geçildiği izlendi. Ortalama yaşamsüresi 42 ay (7-183) olarak belirlendi. 60 hastadan 4’ü (%6.6) infeksiyon, 2’si fungalpnömoni, 1’i sepsis ve diğer 1 hasta ise CMV enfeksiyonu nedenli kaybedildi.Tartışma: Çalışmamızda, nadir bir hematopoietik kök hücre hastalığı olan PNH’nin görülmeyaşının literatürle benzerlik gösterdiğini görülmüştür. Trombotik komplikasyon sıklığı %30olarak belirlenmiş olup, sıklıkla ve beklendiği üzere venöz tromboz şeklinde geliştiğigörülmüştür. Literatürden farklı olarak tromboz nedenli ölen hasta görülmemiş, en sık ölümsebebi enfeksiyon olarak belirlenmiştir.Çalışmamız, PNH hastalarının değerlendirildiği ve ülkemizde bugüne kadar yapılmışen kapsamlı çalışmadır. Bu ve benzer çalışmaların, nadir görülen PNH gibi hastalıklarda,ileriye yönelik olarak hastalık yönetimini de etkileyebilecek çok değerli bilgiler verebileceğinidüşünüyoruz.Anahtar kelimeler: Eculizumab, Paroksismal nokturnal hemoglobinüri, Tromboz&nbsp;</p

Bilateral Native Kidney Papillary Renal Cell Carcinomas in a 11-Year-Old Renal Transplant Patient

Renal cell carcinomas (RCCs) are the most common renal tumors in adults and are usually sporadic and unilateral. Renal transplant recipients have an increased risk of developing RCC. RCC development after kidney transplantation is very rarely reported in children. We present a 11-year-old boy who had cadaveric kidney transplantation for kidney failure 2 years ago. He was under immunosuppressive therapy and presented with microscopic hematuria. An ultrasound (US) revealed bilateral solid renal masses. Further cross-sectional imaging showed a 60 × 70 × 60-mm right renal mass with claw sign and a 5 × 6 × 6-mm mass in the left renal lower pole. A bilateral radical nephroureterectomy of native kidneys was performed. The pathology revealed bilateral papillary RCC without TFE3 upregulation. The patient was kept on low-dose immunosuppressive therapy in the perioperative period. He received no chemotherapy but a close radiological surveillance was undertaken. He is tumor-free 2 years after the operation. RCC is a rare tumor for children and bilateralism is even rarer. The child had a history of chronic kidney disease, peritoneal dialysis, and immunosuppressive therapy. As there are no standardized protocols regarding imaging in transplanted kidneys routine surveillance, US follow-up should also focus on detecting malignancy

VISKON-RS : Rapid Damage Assessment Software with Remote Sensing

23nd Signal Processing and Communications Applications Conference (SIU) -- MAY 16-19, 2015 -- Inonu Univ, Malatya, TURKEYWOS: 000380500900422After a disaster, a rapid damage assessment is required for coordinating emergency response teams and planning emergency aid. In this study, in line with AFAD requirements, ViSKON-RS software was developed for the aim of using disaster damage assessment by analysing images obtained via remote(space/air) imaging technologies. The developed software includes specialized applications for damage assessment of disaster types such as earthquake, flood and forest fires. In addition, applications for general image analysis were integrated to the software like change detection analysis, supervised/unsupervised classification, object based image analysis and texture analysis. The main purpose of ViSKON-RS software is to be integrated software solution by opening, processing, analysing, showing and exporting results to desicion support system of post-disaster remote sensing data.Dept Comp Engn & Elect & Elect Engn, Elect & Elect Engn, Bilkent Uni

VISKON-RS: Rapid damage assessment software with remote sensing

Afet sonrası, acil müdahale ekiplerinin yönlendirilmesi ve iyileştirme çalışmalarının planlanması amacıyla hızlı hasar değerlendirmesine ihtiyaç duyulmaktadır. Bu çalışmada, AFAD ihtiyaçları doğrultusunda uzaktan (uzay/hava) algılama teknolojileri ile elde edilen görüntülerin afet hasar analizinde kullanılmasına yönelik VİSKON-RS yazılımı geliştirilmiştir. Geliştirilen yazılım; deprem, sel ve orman yangını gibi afet türlerinin hasar analizlerine özelleşmiş uygulamalar içermektedir. Ayrıca genel görüntü analizinde kullanılabilecek değişiklik analizi, eğitimli/eğitimsiz sınıflandırma, nesne tabanlı görüntü analizi ve doku analizi gibi uygulamalar yazılıma entegre edilmiştir. VİSKON-RS yazılımın temel amacı, afet sonrası uzaktan algılama verilerinin, açılması, işlenmesi, analiz edilmesi, sonuçların sergilenmesi ve karar destek sistemlerine aktarılması adımlarını içeren bütünleşik bir yazılım çözümü sunmaktır.After a disaster, a rapid damage assessment is required for coordinating emergency response teams and planning emergency aid. In this study, in line with AFAD requirements, ViSKON-RS software was developed for the aim of using disaster damage assessment by analysing images obtained via remote(space/air) imaging technologies. The developed software includes specialized applications for damage assessment of disaster types such as earthquake, flood and forest fires. In addition, applications for general image analysis were integrated to the software like change detection analysis, supervised/unsupervised classification, object based image analysis and texture analysis. The main purpose of ViSKON-RS software is to be integrated software solution by opening, processing, analysing, showing and exporting results to desicion support system of post-disaster remote sensing data.Publisher's Versio