Multisegmented tangential breast fields: A rational way to treat breast cancer

Purpose: Using three-dimensional conformal radiation therapy (3D-CRT) and multisegmented conformal radiation therapy (MS-CRT) for breast cancer treatment, the dose coverage of the planning target volume (PTV) and the radiation burden on the organs at risk (OARs) were evaluated. Material and Methods: 3D-CRT and MS-CRT were planned for 436 unilateral breasts (217 left). All patients were treated with MS-CRT between 2005 and 2007. For PTV delineation and beam orientation, supportive structures were applied. The mean PTV was 1,130 cm 3 (in ten patients > 2,200 cm3). Three-dimensional planning with weight-optimized medial and lateral open fields at a total dose of 50.4/1.8 Gy was followed by multisegmented planning with a reasonably high-dose-level dose cloud to define the medial subfield, and renewed optimization. This was repeated for the lateral subfield with a final optimization. For PTV coverage evaluation, the ICRU 50 was considered: the PTV portions receiving 95-107%, 107% of the prescribed dose (PTVD95- 107%, PTVD107%), and the PTV maximal dose (PTVDmax). To compare the OAR radiation burdens, the mean doses to the ipsi-/contralateral lung, contralateral breast, and whole heart were documented. Results: The multisegmented plans furnished significantly (p D107% 5.9% vs. 0.3% and PTVDmax 56.6 vs. 54.3 Gy). The mean OAR doses remained almost unchanged: ipsilateral lung 10.5 versus 10.4 Gy, contralateral lung 0.4 versus 0.4 Gy, contralateral breast 0.8 versus 0.8 Gy, and whole heart (for left-sided cancers) 4.8 versus 4.8 Gy. The subfields required a mean of 9.8 MU (monitor units), i.e., a mean total 7.6 MU increment. The planning took 10-20 min, and the delivery 5-10 min. Conclusion: MS-CRT is a good alternative to breast intensity-modulated radiation therapy (IMRT) and seems adequate for right-sided cancers, whereas left-sided cancers necessitate a longer follow-up of heart-related side effects before a final assessment. © 2008 Urban & Vogel

Contemporary Use of Laser During Percutaneous Coronary Interventions: Insights from the Laser Veterans Affairs (LAVA) Multicenter Registry

Background. The contemporary use and outcomes of excimer laser coronary atherectomy (ELCA) in percutaneous coronary intervention (PCI) are not well described. Methods. We examined the baseline clinical and angiographic characteristics and procedural outcomes of 130 target lesions in 121 consecutive PCIs (n = 116 patients) in which ELCA was performed at three United States Department of Veterans Affairs (VA) medical centers between 2008 and 2016. Results. Mean age was 68.5 +/- 9 years and 97% of the patients were men. Patients had high prevalence of diabetes mellitus (63%), prior coronary artery bypass graft surgery (41%), and prior myocardial infarction (60%). The most common target vessel was the left anterior descending (32%), followed by the right coronary artery (30%), circumflex artery (20%), and saphenous vein graft (12%). The target lesions were highly complex, with moderate/severe calcification in 62% and in-stent restenosis in 37%. The most common indication for ELCA was balloon-uncrossable lesions (43.8%), followed by balloon-undilatable lesions (40.8%) and thrombotic lesions (12.3%). Use of ELCA was associated with high technical success rate (90.0%) and procedural success rate (88.8%), and low major adverse cardiac event (MACE) rate (3.45%). Mean procedure time was 120 min (interquartile range [IQR], 81-191 min), air kerma radiation dose was 2.76 Gy (IQR, 1.32-5.01 Gy), and contrast volume was 273 mL (IQR, 201-362 mL). Conclusion. In a contemporary multicenter United States registry, ELCA was commonly used in highly complex lesions and was associated with high technical and procedural success rates and low incidence of MACE

Medicinal Properties of Mediterranean Oyster Mushrooms: Species of Genus Pleurotus (Higher Basidiomycetes)

The term \u201cMediterranean area,\u201d applied in this chapter, refers to the definition reported in Med-Checklist and particularly to all countries bordering the Mediterranean Sea plus Portugal, Bulgaria, the Crimea (Ukraine), and Jordan. The \u201cMediterranean oyster mushrooms\u201d is a geographically and ecologically well-defined group of Basidiomycetes. The medicinal properties of some widely investigated species such as Pleurotus ostreatus and P. eryngii are recognized worldwide, while in the case of some other Mediterranean Pleurotus taxa, there is still a lack of knowledge. A substantial increase in knowledge about the anticancer and antibacterial properties of the group of Pleurotus species growing as saprophytes on dead roots of plants of family Apiaceae (P. nebrodensis, P. eryngii var. elaeoselini, P. eryngii var. ferulae in particular) has been recorded in recent years, thanks to research carried out at the University of Palermo (Italy). This chapter summarizes the latest research on medicinal oyster mushrooms growing in the Mediterranean environment