Phase I/II study of resection and intraoperative cesium-131 radioisotope brachytherapy in patients with newly diagnosed brain metastases.

OBJECT: Resected brain metastases have a high rate of local recurrence without adjuvant therapy. Adjuvant whole-brain radiotherapy (WBRT) remains the standard of care with a local control rate \u3e 90%. However, WBRT is delivered over 10-15 days, which can delay other therapy and is associated with acute and long-term toxicities. Permanent cesium-131 ((131)Cs) implants can be used at the time of metastatic resection, thereby avoiding the need for any additional therapy. The authors evaluated the safety, feasibility, and efficacy of a novel therapeutic approach with permanent (131)Cs brachytherapy at the resection for brain metastases. METHODS: After institutional review board approval was obtained, 24 patients with a newly diagnosed metastasis to the brain were accrued to a prospective protocol between 2010 and 2012. There were 10 frontal, 7 parietal, 4 cerebellar, 2 occipital, and 1 temporal metastases. Histology included lung cancer (16), breast cancer (2), kidney cancer (2), melanoma (2), colon cancer (1), and cervical cancer (1). Stranded (131)Cs seeds were placed as permanent volume implants. The prescription dose was 80 Gy at a 5-mm depth from the resection cavity surface. Distant metastases were treated with stereotactic radiosurgery (SRS) or WBRT, depending on the number of lesions. The primary end point was local (resection cavity) freedom from progression (FFP). Secondary end points included regional FFP, distant FFP, median survival, overall survival (OS), and toxicity. RESULTS: The median follow-up was 19.3 months (range 12.89-29.57 months). The median age was 65 years (range 45-84 years). The median size of resected tumor was 2.7 cm (range 1.5-5.5 cm), and the median volume of resected tumor was 10.31 cm(3) (range 1.77-87.11 cm(3)). The median number of seeds used was 12 (range 4-35), with a median activity of 3.82 mCi per seed (range 3.31-4.83 mCi) and total activity of 46.91 mCi (range 15.31-130.70 mCi). Local FFP was 100%. There was 1 adjacent leptomeningeal recurrence, resulting in a 1-year regional FFP of 93.8% (95% CI 63.2%-99.1%). One-year distant FFP was 48.4% (95% CI 26.3%-67.4%). Median OS was 9.9 months (95% CI 4.8 months, upper limit not estimated) and 1-year OS was 50.0% (95% CI 29.1%-67.8%). Complications included CSF leak (1), seizure (1), and infection (1). There was no radiation necrosis. CONCLUSIONS: The use of postresection permanent (131)Cs brachytherapy implants resulted in no local recurrences and no radiation necrosis. This treatment was safe, well tolerated, and convenient for patients, resulting in a short radiation treatment course, high response rate, and minimal toxicity. These findings merit further study with a multicenter trial

OXANDROLONE THERAPY IN SKELETAL DYSPLASIA

Three patients with short stature and different forms of skeletal dysplasia were treated with oxandrolone, 1.25 mg/day. All patients had a normal growth hormone response (10 ng/ml) to the insulin-induced hypoglycemia test (ITT). After one year of follow-up, it was noted that the pretreatment growth rate which was 2 5 cm/yr in the patient with spondyloepiphyseal dysplasia congenita (chronological age, 13 4/12 yr) had increased to 6.7 cm/yr after one year of treatment, while the pretreatment growth rate of the patient with hypochrondroplasia (chronological age, 12 7/12 yr) which was recorded at 2 cm/yr had risen to 5.3 cm/yr. The patient with multiple epiphyseal dysplasia (chronological age, 9 5/12 yr) had a pretreatment growth rate of 1.5 cm/yr which had risen to 8 cm/yr after the same period of treatment. An increase was noted in the height standard deviation score for chronological age and in the height standard deviation score for bone age in all patients. After one year of therapy, all patients were observed to still be in the prepubertal stage

Herpes encephalitis in children - MRI assessment

The magnetic resonance imaging (MRI) findings in 14 patients with biopsy or polymerase chain reaction proven herpes simplex encephalitis were retrospectively reviewed to evaluate the diagnostic value of MRI in the early diagnosis of herpes simplex encephalitis in children. In addition to the early findings, follow-up MRI scans were obtained in four patients, Typical limbic system involvement was seen in 78 percent of the cases. Contrast-enhanced MRI was found to be superior to routine MRI sequences and computerized tomography (CT) in the early detection of inflammation. Follow-up MR images in four patients demonstrated the volume loss and late petechial hemorrhage in the involved regions. Magnetic resonance imaging is the method of choice in the diagnosis and follow-up of herpes simplex encephalitis

MR findings of a duplex kidney with replacement lipomatosis

Replacement lipomatosis of the kidney is a severe form of renal sinus lipomatosis which is a rare but recognized distinct entity. Replacement lipomatosis may be severe enough to have a mass effect causing lateral displacement of the kidney and ureter. The most important feature of this case is that this is a duplex kidney with the nonfunctioning lower segment terminating ectopically at the bladder neck contrary to the Weigert-Meyer rule. To our knowledge, this is the only case of replacement lipomatosis of a duplex kidney with a mass effect in which the MR appearance is described

Evaluation of bone height and bone density by computed tomography and panoramic radiography for implant recipient sites.

PubMed ID: 11831327The objective was to compare the bone height and bone density measurements of implant recipient sites by panoramic radiography and computed tomography. Thirty-seven sites of 21 patients were evaluated using both panoramic radiography and computed tomography. The bone height was measured as the vertical distance from the alveolar crest to the closest anatomical landmark. Density was compared by means of densitometric measurements. Data was evaluated using paired t-test and Pearson's correlation coefficient analysis. Although bone heights measured with the two imaging modalities differed significantly (p < 0.05), there was a significant correlation between bone density measurements (r = 0.93, p = 0.0). Measurements of bone height as well as bone density was found to be comparable using either radiographic method

Diagnostic value of MR arthrography in detection of intrinsic carpal ligament lesions: use of cine-MR arthrography as a new approach

Twenty-five patients with chronic wrist pain and a preliminary diagnosis of carpal instability were examined with conventional MR imaging and MR arthrography with single compartment intra-articular injection. A new cine-MR arthrography technique, with image acquisition at every 5 s during intra-articular injection, was performed in 17 subjects. The purpose of this study was to determine the diagnostic value of MR arthrography in ligamentous lesions of the wrist and to assess the value of cine-MR arthrography in comparison with arthroscopy and/or surgery Magnetic resonance arthrography, a semi-invasive technique, increased the diagnostic accuracy of intrinsic carpal ligament injuries. Cine-MR arthrography can be considered as a promising technique especially for the evaluation of lunatotriquetral and scapholunate ligament injuries of the wrist

The Hajdu-Cheney syndrome: A case report and review of the literature

Hajdu-Cheney syndrome which is also known as type VI idiopathic osteolysis is a rare disease transmitted autosomal dominantly. In this syndrome, oestolysis involves primarily the terminal phalanges. We describe here a 18-year-old boy with typical clinical and radiological signs of Hajdu-Cheney syndrome. © 1990 Springer-Verlag