Adjuvant radiation therapy after immediate implant-based breast reconstruction

The role of radiotherapy in the postmastectomy setting with substantial lymph node burden or locally advanced disease has been well described. In the last decade, the indications for postmastectomy radiotherapy (PMRT) have expanded in light of a measurable disease-free survival benefit, even in T1–2N1-patient subgroup. Concurrently, immediate breast reconstruction (IBR) rates after mastectomy are rapidly increasing. Optimal integration of IBR and PMRT is challenging, as PMRT has a known deleterious effect on reconstruction outcomes and IBR has been reported to pose challenges to PMRT delivery. Implant-based reconstruction is the most common type of IBR performed nowadays. This article reviews the current problems regarding integration of the implant-based IBR with optimum radiation delivery and discusses the advantages and disadvantages of each reconstruction method with PMRT

Outcome after PET-CT based radiotherapy for non-small cell lung cancer

Introduction. The value of PET-CT in radiotherapy for non-small cell lung cancer (NSCLC) with regard to determination of target volumes is established. It is less clear whether its use can improve clinical outcomes of irradiated NSCLC patients compared to conventional staging. The outcome of NSCLC patients included in a previously published prospective study of the value of PET-CT in curative radiotherapy candidates was assessed. Materials and methods. Patients were treated according to the PET-CT findings. The survival data were compared between 67 patients treated curatively and 22 patients with palliative treatment given after upstaging based on the PET-CT findings. Survival of curatively treated stage III patients was compared with a previously published outcome of 173 stage III patients treated in the same institution with the same radiation schedule but without PET-CT. Results. The 3-year overall survival was 42% and 0% (median: 21 months and 7 months), for curatively and palliatively managed patients, respectively (p < 0.0001). However, the median overall survival of 17 months for 50 stage III patients was the same as that in a previously published series of stage III patients treated with the same radiation schedule but without PET-CT. Three-year overall survival rates were 33% for the PET-CT group and 19% for historical group, p = 0.1. Twenty-one local recurrences and 21 distant metastases were reported. Three of 50 patients (6%) treated without elective nodal irradiation developed isolated nodal failure (without local recurrence). Conclusions. The high early mortality rate in the patients disqualified from curative radiotherapy after PET-CT suggests the potential value of PET-CT for improving the radiotherapy outcome. However, this benefit seems to be limited in stage III patients.Wstęp: Wartość badania PET-CT w planowaniu radioterapii chorych na niedrobnokomórkowego raka płuca (NSCLC) w wyznaczaniu objętości tarczowych jest uznana. Wpływ tego badania na wyniki leczenia napromienianych chorych jest mniej poznany. Oceniono wyniki napromieniania chorych włączonych do opublikowanego uprzednio badania klinicznego nad zmianami obszaru napromieniania po zastosowaniu badania PET-CT do planowania radioterapii. Materiał i metody: Radioterapia planowana była na podstawie informacji z PET-CT. Porównano przeżycia dla grupy 67 chorych leczonych radykalnie i grupy 22 chorych, którzy w związku z migracją do wyższego stopnia zaawansowania po badaniu PET-CT byli leczeni paliatywnie. Wyniki leczenia radykalnego chorych na NSCLC w III° zaawansowania porównano z wynikami grupy historycznej 173 chorych na NSCLC w III° zaawansowania leczonych wcześniej w tej samej instytucji według tego samego schematu napromieniania, jednak bez wykorzystania badania PET-CT.Wyniki: Trzyletnie przeżycia całkowite dla chorych leczonych radykalnie i paliatywnie wyniosły odpowiednio 42% i 0% (mediana przeżycia: 21 i 7 mies.), p < 0,0001. Mediany przeżycia 50 chorych na NSCLC w III° zaawansowania oraz porównywanej grupy historycznej wyniosły 17 miesięcy. Odsetki 3-letniego przeżycia wyniosły w grupie współczesnej i historycznej odpowiednio 33% i 19%, p = 0,1. Stwierdzono 21 przypadków nawrotów miejscowych oraz 21 przypadków przerzutów odległych. W grupie 50 chorych leczonych z ominięciem napromieniania elektywnego śródpiersia, wystąpiły 3 (6%) przypadki izolowanej wznowy regionalnej (bez współistniejącego nawrotu miejscowego). Wnioski: Wysoki odsetek wczesnych zgonów wśród chorych zdyskwalifikowanych od napromieniania po badaniu PET-CT sugeruje potencjalną rolę PET-CT w poprawie wyników radioterapii. Korzyść ta wydaje się być ograniczona w grupie chorych na NSCLC w III° zaawansowania

Increased expression of selected very late antigen integrin subunits on CD4 and CD8 blood T lymphocytes in patients with clinically stable asymptomatic atopic asthma

Recruitment of the inflammatory cells from blood to the airways in asthma is mediated by adhesive molecules, e.g. selectins and integrins. The most important integrins in cells trafficking are molecules containing $\alpha_{4}$ and $\beta_{2}$ subunits. We hypothesized that also $\alpha_{1}\beta_{1}$ and $\alpha_{2}\beta_{1}$ integrins (both found by us on blood eosinophils. To assess the expression of selected very late antigen (VLA) subunits ($\alpha_{1}$, $\alpha_{2}$, $\alpha_{4}$ and $\beta_{1}$) on blood CD4 and CD8 T lymphocytes from stable atopic asthmatic patients. of asthmatic subjects) are important in asthma pathogenesis. The study was conducted on 25 adult atopic asthmatics (mild to moderate persistent asthma in a stable clinical condition) and 17 matched healthy controls using flow cytometry. Expression of $\alpha_{4}$ and $\beta_{1}$ on CD4 T cells was significantly higher in asthma than in controls. The $\alpha_{1}$ subunit was absent from blood lymphocytes. The $\alpha_{2}$ chain hardly detected on lymphocytes from healthy subjects was distinctively present in asthmatics. Surprisingly, in subjects suffering from asthma for longer than 4 years (n = 15), the overexpression of $\alpha_{2}$, $\alpha_{4}$ and $\beta_{1}$ was observed on both: CD4 and CD8 T cells. Expression of selected VLA subunits on blood T cells may depend on asthma duration. The biological role of $\alpha_{2}\beta_{1}$ integrin in asthma is unknown, but as it was described as a stimulator of collagen accumulation in the airways, $\alpha_{2}\beta_{1}$ integrin could be, at least in part, responsible for asthma airway remodelling

Udział wojsk litewskich w misji stabilizacyjnej w Iraku

Lithuania officially declared their support for international mission in Iraq 21st March 2003. Four days later, 25th March, Parliament of the Republic of Lithuania adopted the resolution, in which resolved “to dispatch for a six-month period to the international operation led by United States of America in the Persian Gulf Region, a humanitarian type mission of Lithuanian soldiers.” Assignment of that mission was a support of international operation and assistance to victims of the conflict. In the beginning of the mission Lithuanian soldiers served in two areas of responsibility: Polish and British. This country delegated officers to the headquaters of the divisions in Basra and Babylon, and to the NATO Training Mission. In each unit, a total of 100 Lithuanian military personnel served in the UK- and Polishcontrolled sectors in Iraq. Lithuania took part in the European Union’s training program called EU Integrated Rule of Law Mission for Iraq. On this initiative, the Iraqi officers familiarized themselves with the implementation of Lithuanian penitentiary system reform and the respect for human rights in the area of criminal justice. 25th January 2006 was the last day of Lithuanian military contingent duty within Multinational Division Central South.Lithuania officially declared their support for international mission in Iraq 21st March 2003. Four days later, 25th March, Parliament of the Republic of Lithuania adopted the resolution, in which resolved “to dispatch for a six-month period to the international operation led by United States of America in the Persian Gulf Region, a humanitarian type mission of Lithuanian soldiers.” Assignment of that mission was a support of international operation and assistance to victims of the conflict. In the beginning of the mission Lithuanian soldiers served in two areas of responsibility: Polish and British. This country delegated officers to the headquaters of the divisions in Basra and Babylon, and to the NATO Training Mission. In each unit, a total of 100 Lithuanian military personnel served in the UK- and Polishcontrolled sectors in Iraq. Lithuania took part in the European Union’s training program called EU Integrated Rule of Law Mission for Iraq. On this initiative, the Iraqi officers familiarized themselves with the implementation of Lithuanian penitentiary system reform and the respect for human rights in the area of criminal justice. 25th January 2006 was the last day of Lithuanian military contingent duty within Multinational Division Central South

Corpus, base de données, cartes mentales pour l'enseignement

International audienceAs part of an ANR project aimed at the linguistic description of the lexicon of emotions in five European languages, we developed an interface for querying a database (EmoProf) and proposed a sequence for teaching collocations of emotions in an FFL classroom. In this chapter, we will describe the tools and justify our use of "mind maps" to teach FFL.Dans le cadre d'une ANR visant la description linguistique du lexique des émotions dans cinq langues européennes, nous avons développé une interface (EmoProf) pour interroger une base de données et proposer des séquences didactiques pour l'enseignement des collocations d'affect auprès d'un public FLE. Nous décrirons ici les outils et les possibilités d'interrogations ainsi que le choix didactique d'insertion de cartes mentales dans une classe de langue

Granulomatosis with polyangiitis (Wegener’s granulomatosis) with hard palate and bronchial perforations treated with rituximab — a case report

We present a case of a 57-year-old woman suffering from granulomatosis with polyangiitis (GPA), who in the seventh months of immunosuppressive treatment (cyclophosphamide) progressed with new pulmonary changes and perforations of the hard palate and bronchi. Rituximab was introduced resulting in B-cell depletion and disappearance of anti-PR3 antibody. Palatal holes have substantially diminished and all bronchial perforations disappeared, covered by fibrous tissue. In the fourth month after rituximab administration, large scarring obstruction of the right main bronchus with upper and middle lobes atelectasis emerged. Because of increasing dyspnoea, stenotic bronchus was re-opened by bronchoscopy. Intervention was complicated by bilateral pneumothorax and later, on the seventh day, by fatal pulmonary bleeding. To our knowledge, this is the first report of GPA refractory to cyclophosphamide complicated by palatal and bronchial perforations.Przedstawiamy przypadek 57-letniej pacjentki z ziarniniakowatością z zapaleniem naczyń (GPA), u której pomimo trwającej siedem miesięcy terapii immunosupresyjnej (cyklofosfamidem) doszło do progresji choroby podstawowej. Z uwagi na to, że u chorej stwierdzono nowe zmiany w płucach oraz perforacje oskrzeli i podniebienia twardego, włączono rituximab, co doprowadziło do zmniejszenia ilości limfocytów B we krwi obwodowej oraz do zaniknięcia przeciwciał anty-PR3. Perforacje podniebienia uległy znacznemu zmniejszeniu, natomiast perforacje oskrzeli zanikły i zostały pokryte przez tkankę włóknistą. Po czterech miesiącach od rozpoczęcia leczenia rituximabem uwidoczniono niedodmę płatów górnego i środkowego prawego wynikającą z niedrożności oskrzela głównego prawego (wtórnie do procesu bliznowacenia). Z uwagi na narastającą niewydolność oddechową wykonano zabieg poszerzenia oskrzela, powikłany obustronną odmą, a następnie, siódmego dnia po zabiegu, doszło do krwawienia dooskrzelowego zakończonego zgonem chorej. Według naszej wiedzy przedstawiony przypadek jest pierwszym opublikowanym opisem pacjenta z ziarniniakowatością z zapaleniem naczyń oporną na cyklofosfamid, która została powikłana perforacjami oskrzeli i podniebienia.

Recurrent cervical cancer – therapeutic options

Cervical cancer is a malignancy associated with high morbidity and mortality in Poland. In a high number of cases the disease is diagnosed at an advanced stage, namely FIGO IB2-IVA. The standard method for radical treatment in these patients is external beam irradiation, together with concurrent chemotherapy, based on cisplatin in the first stage, and brachytherapy in the next step. Despite such radical treatment, nearly half of women have relapses within the genital tract and regional lymph nodes. The procedure in these patients is a difficult therapeutic problem in gynecologic oncology. There is a small percentage of relapses, which are located exclusively in the genital tract. In these cases appropriate treatment offers a chance for permanent cure, but also a high risk of lower quality of life, which is the consequence of surgery or radiotherapy. Therapeutic options available in this strictly selected group of patients are the subject of the present analysis

Hypofractionated conformal radiotherapy in combination with chemotherapy in limited disease small cell lung cancer patients

Cel: Ocena wyników hipofrakcjonowanej konformalnej radioterapii (RT) u chorych na drobnokomórkowego raka płuca w postaci ograniczonej (DRP-LD), z uwzględnieniem wartości „wczesnej” RT, tzn. rozpoczętej przed podaniem trzeciego kursu chemioterapii (CHT).Materiał i metody: Przeprowadzono retrospektywną ocenę wyników leczenia 100 kolejnych chorych na DRP-LD, leczonych według schematu hipofrakcjonowanej RT skojarzonej z CHT: dawka — 42 Gy po 2,8 Gy, w tym 39 Gy po 2,6 Gy na obszar elektywny (technika concomitant boost — obszar elektywny i zmiany chorobowe leczone w czasie jednej frakcji), 19–21 dni leczenia. Wyniki leczenia porównano z wynikami grupy historycznej 117 chorych napromienianych w tym samym ośrodku według schematu konwencjonalnej lub hiperfrakcjonowanej RT.Wyniki: „Wczesną” RT otrzymało 42% chorych. Popromienne zapalenie przełyku w stopniu 3 według NCI CTC stwierdzono u 5% chorych. Odnotowano trzy zgony związane z leczeniem. Aktualizowany odsetek 3-letnich przeżyć całkowitych (OS) wyniósł 39,4%, mediana 24 miesiące w grupie badanej v. 26,0% i 18 miesięcy w grupie historycznej, P = 0,02. Trzyletnie OS dla chorych, którzy otrzymali ≤ 3 kursy CHT (22 chorych), wyniosło 30,0%, mediana 14 miesięcy v. 42,2% i 28 miesięcy dla 78 chorych, którzy otrzymali &gt; 3 kursy CHT, P = 0,03. Aktualizowane 3-letnie ryzyko wznowy miejscowo-regionalnej (LRF) wyniosło 34,0% v. 51,0% w grupie historycznej, P = 0,04. Analiza wielowariantowa wykazała trend w kierunku zmniejszenia ryzyka LRF przy zastosowaniu „wczesnej” RT: RR = 0,43 (95%CI: 0,17–1,04), P = 0,06. Czas zastosowania RT nie wpływał znamiennie na OS.Wnioski: Skrócenie leczenia przez zastosowanie hipofrakcjonacji pozwala na uzyskanie dobrych wyników leczenia przy niewielkiej toksyczności. Decydujący wpływ na przeżycie chorych ma realizacja całej zaplanowanej CHT.Aim: To evaluate the results of hypofractionated conformal radiotherapy (RT) in limited disease small cell lung cancer (LD-SCLC) patients, with particular interest in the value of “early” RT, i.e. given before the 3rd chemotherapy (CHT) cycle.Material and methods: Outcome of hypofractionated RT (42 Gy, 2.8 Gy/fraction, given over 19–21 days, using “concomitant boost” technique — elective volume [39 Gy, 2.6 Gy/fraction] and tumour volumes treated during the same fraction) combined with CHT in 100 consecutive LD-SCLC patients, was retrospectively assessed. The outcomes were compared with a previously published series of 117 LD-SCLC patients treated in the same institution with hyperfractionated or conventionally fractionated RT.Results: Forty-two patients (42%) received “early” RT. Grade 3 NCI CTC acute oesophageal toxicity appeared in 5% of patients. There were three treatment-related deaths. Three-year overall survival (OS) rate was 39.4%, median — 24 months in the examined group vs. 26.0%, and 18 months in historical control, P = 0.02. Three-year OS for 78 patients with completed CHT was 42.2%, median — 28 months vs. 30%, and 14 months for 22 patients who received ≤ 3 CHT cycles, (P = 0.03). The actuarial 3-year locoregional failure risk (LRFR) was 34.0% in the examined group vs. 51.0% in the historical control, P = 0.04. Multivariate analysis showed a marginally significant correlation between the “early” use of RT and LRFR: RR = 0.43 (95% CI: 0.17–1.04), P = 0.06, with no significant impact on OS.Conclusions: Shorter duration of RT using hypofractionation results in encouraging outcomes and acceptable toxicity. Completion of all planned CHT cycles is the most important factor for OS

Granulomatosis with polyangiitis (Wegener's granulomatosis) with hard palate and bronchial perforations treated with rituximab : a case report

We present a case of a 57-year-old woman suffering from granulomatosis with polyangiitis (GPA), who in the seventh months of immunosuppressive treatment (cyclophosphamide) progressed with new pulmonary changes and perforations of the hard palate and bronchi. Rituximab was introduced resulting in B-cell depletion and disappearance of anti-PR3 antibody. Palatal holes have substantially diminished and all bronchial perforations disappeared, covered by fibrous tissue. In the fourth month after rituximab administration, large scarring obstruction of the right main bronchus with upper and middle lobes atelectasis emerged. Because of increasing dyspnoea, stenotic bronchus was re-opened by bronchoscopy. Intervention was complicated by bilateral pneumothorax and later, on the seventh day, by fatal pulmonary bleeding. To our knowledge, this is the first report of GPA refractory to cyclophosphamide complicated by palatal and bronchial perforations

Bromidotetra­kis­(2-isopropyl-1H-imidazole-κN 3)copper(II) bromide

The CuII atom in the title salt, [CuBr(C6H10N2)4]Br, is coordinated in a square-pyramidal geometry by four imidazole N atoms and one bromide anion that is located at the apex of the pyramid. The cations and the anions form a two-dimensional network parallel to (001) through N—H⋯Br hydrogen bonds