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ABSTRACT: The aim was to correlate the color Doppler flow activity pre- and postradiotherapy, using transrectal color Doppler ultrasonography (CDUS) and the 2 year positive biopsy rate after radiotherapy in patients with prostate cancer.
Analysis was carried out in 69 out of 160 patients who had undergone treatment with 3D-conformal radiotherapy (3D-CRT) to prostate and seminal vesicles. Patients were randomized to receive 80 Gy in 40 fractions in 8 weeks (arm A) and 62 Gy in 20 fractions in 5 weeks, 4 fractions per week (arm B). Color Doppler flow activity (CDFA) was evaluated calculating the vascularization index (VI), defined as the ratio between the colored and total pixels in the whole and peripheral prostate, delineated by a radiation oncologist on CDUS images, using EcoVasc a home-made software. The difference between the 2 year post- and pre-3D-CRT maximum VI (VImax), named deltaVImax, was calculated in the whole and peripheral prostate for each patient. Then, deltaVImax and the detected 2 year biopsy outcome were analyzed using the receiver operating characteristics (ROC) technique.
The VImax increased or decreased in patients with positive or negative biopsies, respectively, compared to the value before RT in both arms. The area under the ROC curve for deltaVImax in the whole and peripheral prostate is equal to 0.790 and 0.884, respectively.
The AVImax index, comparing CDFA at 2 years compared to that before RT, allows the 2 year postradiotherapy positive biopsy rate to be predicted.
Medical Physics 12/2008; 35(11):4793-9. · 2.91 Impact Factor
Ejc Supplements - EJC SUPPL. 01/2007; 5(4):283-283.
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ABSTRACT: This report documents a case of asymptomatic esophageal perforation, secondary to a dislocated and then migrated cervical screw after anterior plating, and reviews the relevant Western literature.
To report a rare and potentially dangerous complication and suggest mechanisms of asymptomatic esophageal perforation and healing.
Anterior surgical approaches to the cervical spine have become popular and safer during the past decade. Materials and devices for anterior stabilization have improved in quality and safety. Nevertheless, failure of the devices may occur either because of technical mistakes or rupture. Reoperation is not always necessary, as spontaneous recovery is possible.
Our patient was operated on for severe cervical spondylotic myelopathy. One year after surgery, one of the screws migrated and was found anteriorly to the spine. Six months later, the screw could no longer be identified, and we concluded that an esophageal perforation had occurred and that the screw had been eliminated through the intestinal tract. The results of esophagoscopy were normal.
The neurologic conditions of our patient improved constantly, and his spine alignment was maintained despite the missing screw.
This case demonstrates that a serious complication may not need any treatment. Each case of screw displacement in anterior cervical spine surgery should be evaluated separately in conjunction with the clinical symptoms of the patient, as spontaneous resolution is possible.
Spine 01/2003; 27(23):E499-502. · 2.16 Impact Factor