27 research outputs found
Traumás gerincvelősérültek rehabilitációja alsó végtagi humán exoskeletonnal
A traumás gerincvelĹ‘sĂ©rĂĽltek rehabilitáciĂłjában az elmĂşlt Ă©vtizedekben számos technolĂłgiai ĂşjĂtás jelent meg, ezek közĂĽl kiemelendĹ‘k az alsĂł vĂ©gtagi, aktĂv robotikus ortĂ©zisek, más nĂ©ven alsĂł vĂ©gtagi humán exoskeletonok. A 2000-es Ă©vek elejĂ©tĹ‘l számos klinikai kutatás indult meg ezen eszközök hatĂ©konyságának vizsgálatára, bemutatva az exoskele- tonok pozitĂv hatásait a gerincvelĹ‘-sĂ©rĂĽlĂ©st követĹ‘ szövĹ‘dmĂ©nybetegsĂ©gek prevenciĂłjában, illetve progressziĂłjuk lassĂtásában. A korábbi munkák kitĂ©rnek a fiziolĂłgiai Ă©s pszichoszociális, valamint társadalmi hatásokra is, továbbá bemutatják az esetleges kockázatokat, rizikĂłfaktorokat is. Dolgozatunkban kitekintĂ©st adunk ezen nemzetközi tanul- mányok fontosabb eredmĂ©nyeire, ismertetjĂĽk Magyarország elsĹ‘ ilyen kĂ©szĂĽlĂ©keinek (ReWalk™ P6.0) felĂ©pĂtĂ©sĂ©t Ă©s működĂ©sĂ©t, bemutatjuk a robotasszisztált rehabilitáciĂłs tevĂ©kenysĂ©g fĹ‘bb, nemzetközi szinten is használt mĂłdozata- it, valamint publikáljuk saját, nemzetközi munkákon alapulĂł vizsgálati protokollunkat, melynek alapján a PĂ©csi Tudo- mányegyetemen Ă©s az Országos Orvosi RehabilitáciĂłs IntĂ©zetben multicentrikus kontrollált klinikai vizsgálatot indĂ- tottunk. HipotĂ©zisĂĽnk, hogy a magas intenzitásĂş, exoskeletonnal kiegĂ©szĂtett komplex rehabilitáciĂłs tevĂ©kenysĂ©g mind a csontsűrűsĂ©get tekintve, mind az urogenitalis Ă©s gastrointestinalis traktusban pozitĂv változásokat idĂ©z elĹ‘, melyeket objektĂv urodinámiás Ă©s defaecatiĂłs paramĂ©terekkel ellenĹ‘rzĂĽnk. A csontok ásványianyag-tartalmának válto- zásait DEXA-val mĂ©rjĂĽk, a mentális statusra gyakorolt hatást kĂ©rdĹ‘Ăvekkel ellenĹ‘rizzĂĽk. KutatĂłmunkánk cĂ©lja, hogy a paraplegia állapotában lĂ©vĹ‘ felhasználĂłk számára validált eredmĂ©nyekkel alátámasztott, kiegĂ©szĂtĹ‘ terápiás eljárást dolgozzunk ki, illetve ajánlást adhassunk az otthoni használatra, valamint eredmĂ©nyeinkkel sikerrel csatlakozhassunk a nemzetközi szintű tudományos műhelyek munkájához
Radiation dose to the nodal regions during prone versus supine breast irradiation
BACKGROUND: Prone positioning for breast radiotherapy is preferable when the aim is a reduction of the dose to the ipsilateral lung or the heart in certain left-sided cases. MATERIALS AND METHODS: In 100 breast cancer cases awaiting postoperative whole-breast radiotherapy, conformal radiotherapy plans were prospectively generated in both prone and supine positions. The axillary nodal region (levels I-III) and internal mammary (IM) lymph-node region in the upper three intercostal spaces were retrospectively contoured. The mean doses to the nodal regions and the volume receiving 25 Gy (V25Gy), V45Gy, and V47.5Gy were compared between the two treatment positions. RESULTS: In most cases, the doses to axillary levels I-III and the IM lymph nodes were inadequate, regardless of the treatment position. The nodal doses were significantly lower in the prone than in the supine position. The radiation doses to levels II-III and IM nodes were especially low. The V45Gy and V47.5Gy of the level I axillary lymph nodes were 54.6% and 40.2%, respectively, in the supine, and 3.0% and 1.7%, respectively, in the prone position. In the supine position, only 17 patients (17%) received a mean dose of 45 Gy to the axillary level I nodes. CONCLUSION: The radiation dose to the axillary and IM lymph nodes during breast radiotherapy is therapeutically insufficient in most cases, and is significantly lower in the prone position than in the supine position
Clinical course of central neurocytoma with malignant transformation: an indication for craniospinal irradiation
Central neurocytoma is generally considered to be a benign tumor and the literature suggests that a cure may be attained by surgery +/- adjuvant focal irradiation. However, there is a need for change in the therapeutic strategy for the subgroup of patients with aggressive central neurocytoma. An example case is presented and the literature on central neurocytoma cases with malignant features and dissemination via the cerebrospinal fluid is reviewed and the radiotherapeutic strategies available for central neurocytoma treatment is discussed. Nineteen cases including the present report with a malignant course and cerebrospinal fluid dissemination have been described to date, most of them involving an elevated MIB-1 labeling index. Our case exhibited atypical central neurocytoma with an initially elevated MIB-1 labeling index (25-30 %). The primary treatment included surgery and focal radiotherapy. Three years later the disease had disseminated throughout the craniospinal axis. A good tumor response and symptom relief were achieved with repeated radiation and temozolomide chemotherapy. Central neurocytoma with an initially high proliferation activity has a high tendency to spread via the cerebrospinal fluid. The chemo- and radiosensitivity of the tumor suggest a more aggressive adjuvant therapy approach. Cases with a potential for malignant transformation should be identified and treated appropriately, including irradiation of the entire neuroaxis and adjuvant chemotherapy may be considered
Individualized positioning for maximum heart protection during breast irradiation
http://www.ncbi.nlm.nih.gov/pubmed/2354435
A prospective study of supine versus prone positioning and whole-body thermoplastic mask fixation for craniospinal radiotherapy in adult patients
PURPOSE: To evaluate neuroaxis irradiation for adults in the supine position using head body thermoplastic mask fixation, from the aspects of dose distribution, patient comfort and set-up accuracy. METHODS AND MATERIALS: Nine of the 12 adult patients were positioned for craniospinal axis irradiation in both prone and supine positions. After mask fixation and planning CTs in both positions, a questionnaire relating to the comfort was completed. The doses to the target and to the organs at risk of the 3D conformal plans in the supine and prone positions were compared. Portal images of all 12 patients irradiated in the supine position were evaluated, the van Herk formulas being used to calculate the systemic and random errors. RESULTS: No significant difference was found between the prone and supine positions target coverage, the dose homogeneity and the dose to the organs at risk. The supine position was considered more comfortable by the patients (scores of 2.8 versus 4.29), with a vector random error of 3.27mm, and a systematic error of 0.32mm. The largest random set-up error was observed in the lateral direction: 4.83mm. CONCLUSIONS: The more comfortable supine position is recommended for craniospinal irradiation in adult patients. Whole-body thermoplastic mask immobilization provides excellent repositioning accuracy