Primary carcinoid tumour of the common bile duct

Background Carcinoid tumours of the extrahepatic biliary tree are exceedingly rare. We report a case of primary carcinoid tumour arising in the distal portion of the common bile duct. Case outline A 30-year-old man was admitted with watery diarrhoea and symptoms of biliary obstruction. Abdominal ultrasound scan showed a normal gallbladder without stones, mild dilatation of the intra- and extrahepatic biliary tree and a 2 cm solid lesion in the head of pancreas compressing the distal common bile duct. Computed tomography confirmed these findings and showed that the tumour was hypervascular. Gastrointestinal hormone screening showed an increase in plasma serotonin. The patient underwent a standard pylorus-preserving proximal pancreatoduodenectomy (PPPD). Results Pathological examination showed a neuroendocrine tumour (carcinoid) of the distal bile duct. The postoperative plasma serotonin decreased to normal levels. One year later the patient is well without evidence of disease. Discussion Primary carcinoid tumours of the extrahepatic biliary tree are rare, accounting for 0.2–2% of all digestive carcinoids. This is the fifth report of a tumour arising from the distal common bile duct. Surgical treatment for neoplasms of the distal common bile duct can be problematic because of the site of the lesion and the difficulty in differentiating them from periampullary neoplasms lesions. Pancreatoduodenectomy (PD) is therefore the treatment of choice

Beam commissioning of the 35 MeV section in an intensity modulated proton linear accelerator for proton therapy

This paper presents the experimental results on the Terapia Oncologica con Protoni-Intensity Modulated Proton Linear Accelerator (TOP-IMPLART) beam that is currently accelerated up to 35 MeV, with a final target of 150 MeV. The TOP-IMPLART project, funded by the Innovation Department of Regione Lazio (Italy), is led by Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA) in collaboration with the Italian Institute of Health and the Oncological Hospital Regina Elena-IFO. The accelerator, under construction and test at ENEA-Frascati laboratories, employs a commercial 425 MHz, 7 MeV injector followed by a sequence of 3 GHz accelerating modules consisting of side coupled drift tube linac (SCDTL) structures up to 71 MeV and coupled cavity linac structures for higher energies. The section from 7 to 35 MeV, consisting on four SCDTL modules, is powered by a single 10 MW klystron and has been successfully commissioned. This result demonstrates the feasibility of a “fully linear” proton therapy accelerator operating at a high frequency and paves the way to a new class of machines in the field of cancer treatment

FULL TEMPORAL RECONSTRUCTION USING AN ADVANCED LONGITUDINAL DIAGNOSTIC AT THE SPARC FEL

FULL TEMPORAL RECONSTRUCTION USING AN ADVANCED LONGITUDINAL DIAGNOSTIC AT THE SPARC FE

The Top-Implart Proton Linear Accelerator: Interim Characteristics of the 35 Mev Beam

In the framework of the Italian TOP-IMPLART project (Regione Lazio), ENEA-Frascati, ISS and IFO are developing and constructing the first proton linear accelerator based on an actively scanned beam for tumor radiotherapy with final energy of 150 MeV. An important feature of this accelerator is modularity: an exploitable beam can be delivered at any stage of its construction, which allows for immediate characterization and virtually continuous improvement of its performance. Currently, a sequence of 3 GHz accelerating modules combined with a commercial injector operating at 425 MHz delivers protons up to 35 MeV. Several dosimetry systems were used to obtain preliminary characteristics of the 35-MeV beam in terms of stability and homogeneity. Short-term stability and homogeneity better than 3% and 2.6%, respectively, were demonstrated; for stability an improvement with respect to the respective value obtained for the previous 27 MeV beam

The management of adult patients with severe chronic small intestinal dysmotility

Adult patients with severe chronic small intestinal dysmotility are not uncommon and can be difficult to manage. This guideline gives an outline of how to make the diagnosis. It discusses factors which contribute to or cause a picture of severe chronic intestinal dysmotility (eg, obstruction, functional gastrointestinal disorders, drugs, psychosocial issues and malnutrition). It gives management guidelines for patients with an enteric myopathy or neuropathy including the use of enteral and parenteral nutritio