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Dickler A.,Little Company of Mary Hospital | Puthawala M.Y.,Rhode Island Hospital | Thropay J.P.,Beverly Oncology and Imaging Centers | Schreiber G.,Swedish Covenant Hospital
Radiation Oncology | Year: 2010

Background: A modified form of high dose rate (HDR) brachytherapy has been developed called Axxent Electronic Brachytherapy (EBT). EBT uses a kilovolt X-ray source and does not require treatment in a shielded vault or a HDR afterloader unit. A multi-center clinical study was carried out to evaluate the success of treatment delivery, safety and toxicity of EBT in patients with endometrial cancer.Methods: A total of 15 patients with stage I or II endometrial cancer were enrolled at 5 sites. Patients were treated with vaginal EBT alone or in combination with external beam radiation.Results: The prescribed doses of EBT were successfully delivered in all 15 patients. From the first fraction through 3 months follow-up, there were 4 CTC Grade 1 adverse events and 2 CTC Grade II adverse events reported that were EBT related. The mild events reported were dysuria, vaginal dryness, mucosal atrophy, and rectal bleeding. The moderate treatment related adverse events included dysuria, and vaginal pain. No Grade III or IV adverse events were reported. The EBT system performed well and was associated with limited acute toxicities.Conclusions: EBT shows acute results similar to HDR brachytherapy. Additional research is needed to further assess the clinical efficacy and safety of EBT in the treatment of endometrial cancer. © 2010 Dickler et al; licensee BioMed Central Ltd. Source

Ivanov O.,Little Company of Mary Hospital | Dickler A.,Little Company of Mary Hospital | Lum B.Y.F.,Little Company of Mary Hospital | Pellicane J.V.,Virginia Breast Center | Francescatti D.S.,Rush University Medical Center
Annals of Surgical Oncology | Year: 2011

Background: Accelerated partial breast irradiation (APBI) is emerging as a valid alternative to whole-breast radiation therapy (WBRT) in breast-conserving therapy (BCT) for early-stage breast cancer. Axxent electronic brachytherapy (EBX) is a form of portable, balloon-based APBI that utilizes an electronic source of kilovoltage irradiation delivery with minimal shielding requirements. As such, EBX becomes a logical and convenient modality for delivery of intraoperative radiation therapy (IORT). We report 1-year results and clinical outcomes of a trial that utilizes EBX to deliver IORT for patients with early-stage breast cancer. Methods: Eleven patients were enrolled on an institutional review board (IRB)-approved protocol. Inclusion criteria were patient age >45 years, unifocal tumors with infiltrating ductal or ductal carcinoma in situ (DCIS) histology, tumors >3 cm, and uninvolved lymph nodes. Preloaded radiation plans were used to deliver radiation prescription dose of 20 Gy to the balloon surface. Results: The mean time for radiation delivery was 22 min; the total mean procedure time was 1 h 39 min. All margins of excision were negative on final pathology. At mean follow-up of 12 months, overall cosmesis was excellent in 10 of 11 patients. No infection, fat necrosis, desquamation, rib fracture or cancer recurrence has been observed. There was no evidence of fibrosis at last follow-up. Conclusion: IORT utilizing EBX is emerging as a feasible, well-tolerated alternative to postsurgical APBI. Further research and longer follow-up data on EBX and other IORT methods are needed to establish the clinical efficacy and safety of this treatment. © 2010 Society of Surgical Oncology. Source

Prins A.,Little Company of Mary Hospital
South African Journal of Clinical Nutrition | Year: 2015

A central venous incident (CVI) is the second leading cause of death worldwide, and is associated with permanent disabilities.There are many nutrition and lifestyle modifiable risk factors for a CVI. These include diabetes, and hypercholesterolaemia and hypertension, all of which are largely preventable, and involve effective, low-cost treatment. Malnutrition in CVI patients ranges from 6-62%, and often worsens during hospitalisation owing to multiple factors, including dysphagia, the inadequate intake of food, inactivity and metabolic changes in the clinical setting. When malnutrition is present in patients who have an acute CVI, the increased risk of poor functional outcomes relates to complications such as gastrointestinal bleeding, pressure ulcers, and urinary tract and respiratory infections. These are associated with higher mortality and increased length of stay in hospital, and contribute to decreased quality of life and impaired rehabilitative outcomes. Screening and nutritional assessment is vital on admission. The Mini Nutritional Assessment and Patient-Generated Subjective Global Assessment have been validated in this patient population. The energy and protein requirements of stroke patients are poorly defined. There is some evidence for the supplementation of antioxidants, but the efficacy thereof depends on their ability to cross the blood-brain-barrier. Large-scale studies are necessary to assess the effect on neurocognitive recovery. Meeting requirements in this patient population is a challenge because of dysphagia, as well as neurological and cognitive deficiencies, and is best achieved with the support of a multidisciplinary team. Early enteral nutrition improves survival, while oral nutrition supplements improve nutrient intake and quality of life. © SAJCN. Source

Coon A.B.,Rush University Medical Center | Dickler A.,Little Company of Mary Hospital | Kirk M.C.,Massachusetts General North Shore Cancer Center | Liao Y.,Rush University Medical Center | And 5 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2010

Purpose: For patients with left-sided breast cancers, radiation treatment to the intact breast results in high doses to significant volumes of the heart, increasing the risk of cardiac morbidity, particularly in women with unfavorable cardiac anatomy. We compare helical tomotherapy (TOMO) and inverse planned intensity modulated radiation therapy (IMRT) with three-dimensional conformal radiotherapy using opposed tangents (3D-CRT) for reductions in cardiac volumes receiving high doses. Methods and Materials: Fifteen patients with left-sided breast cancers and unfavorable cardiac anatomy, determined by a maximum heart depth (MHD) of ≥1.0 cm within the tangent fields, were planned for TOMO and IMRT with five to seven beam angles, in addition to 3D-CRT. The volumes of heart and left ventricle receiving ≥35 Gy (V35) were compared for the plans, as were the mean doses to the contralateral breast and the volume receiving ≥20 Gy (V20) for the ipsilateral lung. Results: The mean MHD was 1.7 cm, and a significant correlation was observed between MHD and both heart and left ventricle V35. The V35s for IMRT (0.7%) and TOMO (0.5%) were significantly lower than for 3D-CRT (3.6%). The V20 for IMRT (22%) was significantly higher than for 3D-CRT (15%) or TOMO (18%), but the contralateral breast mean dose for TOMO (2.48 Gy) was significantly higher than for 3D-CRT (0.93 Gy) or IMRT (1.38 Gy). Conclusions: Both TOMO and IMRT can significantly reduce cardiac doses, with modest increases in dose to other tissues in left-sided breast cancer patients with unfavorable cardiac anatomy. © 2010 Elsevier Inc. Source

Manicum A.,University of the Free State | Schutte-Smith M.,University of the Free State | Kemp G.,Little Company of Mary Hospital | Visser H.G.,University of the Free State
Polyhedron | Year: 2014

Beta-diketone type bidentate ligands (acetylacetone - AcacH, trifluoroacetylacetone - TfaaH and hexafluoroacetylacetone - HfaaH) were used in the synthesis of the neutral complexes, fac-[Re(CO)3(Acac)(H2O)] (1), fac-[Re(CO)3(Tfaa)(H2O)] (2) and fac-[Re(CO)3(Hfaa)(H2O)] (3), using the (2 + 1) mixed ligand approach. The complexes were characterised by IR, NMR and X-ray crystallography. A new Re(I) crystal structure, fac-[Re(CO)3(Hfaa)(Py)] (4) (with Py = pyridine) is reported, presenting a distorted octahedral coordination of the ligands around the metal centre. A kinetic study, involving the methanol substitution of fac-[Re(CO)3(Acac)(CH3OH)] (5), fac-[Re(CO)3(Tfaa)(CH3OH)] (6) and fac-[Re(CO)3(Hfaa)(CH3OH)] (7), by pyridine as entering monodentate ligand, is investigated. The following second-order rate constants, were obtained for (5), (6) and (7) respectively at 25.0 °C; forward reaction rate constants: k1(M-1s-1) = (13.7 ± 0.1) × 10-3, (0.35 ± 0.03) × 10-3and (0.17 ± 0.03) × 10-3; reverse rate constants: k-1(s-1) = (0.03 ± 0.02) × 10-3, (0.018 ± 0.004) × 10-3and (0.013 ± 0.004) × 10-3and stability constants: K1(M-1) = 457 ± 305, 19 ± 5 and 13 ± 5. The activation parameters from the Eyring plots for the CH3OH substitution for (5) with Py are: ΔH‡= 64 ± 1 kJ mol-1and ΔS‡= -65 ± 5 J K-1mol-1, indicative of an associative interchange type mechanism. © 2014 Elsevier B.V. All rights reserved. Source

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