Population genetic structure of the tropical moss Acanthorrhynchium papillatum as measured with microsatellite markers

Mosses and other bryophytes are vital components of forests, because they sustain a tremendous diversity of invertebrates and influence significant ecological functions. There have been few studies on moss population diversity in Southeast Asia, despite the escalating deforestation in this region of rich biodiversity. The genetic diversity of the tropical moss Acanthorrhynchium papillatum (Harv.) Fleisch., collected from forested areas in Singapore and Peninsular Malaysia, was elucidated using eight microsatellite markers developed for this species. Significant levels of allelic and haplotypic diversity were observed among clumps of the moss. Differences in allelic richness and genotypic diversity among the populations were higher in less disturbed forests compared to the more disturbed areas, suggesting that genetic diversity is affected by habitat quality. Genetic diversity levels within the clumps studied were low, indicating that vegetative reproduction was more important within clumps than sexual reproduction. However, multilocus genotypes of samples within the clumps studied were not all alike, providing evidence of microsatellite mutation or of occasional sexuality. Despite the isolation of populations, A. papillatum can introduce genetic variability by mutation among vegetatively propagated individuals. This study provides baseline information on the genetic diversity of A. papillatum tropical rain forests.

Preparation and characterization of Ni-doped TiO2 materials for photocurrent and photocatalytic applications

Different amounts of Ni-doped TiO(2) (Ni = 0.1 to 10%) powders and thin films were prepared by following a conventional coprecipitation and sol-gel dip coating techniques, respectively, at 400 to 800°C, and were thoroughly characterized by means of XRD, FT-IR, FT-Raman, DRS, UV-visible, BET surface area, zeta potential, flat band potential, and photocurrent measurement techniques. Photocatalytic abilities of Ni-doped TiO(2) powders were evaluated by means of methylene blue (MB) degradation reaction under simulated solar light. Characterization results suggest that as a dopant, Ni stabilizes TiO(2) in the form of anatase phase, reduces its bandgap energy, and adjusts its flat band potentials such that this material can be employed for photoelectrochemical (PEC) oxidation of water reaction. The photocatalytic activity and photocurrent ability of TiO(2) have been enhanced by doping of Ni in TiO(2). The kinetic studies revealed that the MB degradation reaction follows the Langmuir-Hinshelwood first-order reaction relationship.

Stereotactic approach to skull-base lesions

With improved knowledge of the anatomy and increased collaboration between the neurosurgeon and the otolaryngologist, successful surgical resection of skull-based tumors is being achieved with reduced mortality and morbidity. In spite of this, there remains a group of patients in whom an alternate surgical approach of stereotaxis may be indicated. This group of patients includes those in whom only biopsy is required, or those in whom brachytherapy using high-intensity (125)I is planned because the patients' general condition is not good enough to undergo open surgical resection of the tumor or the tumor is unresectable or the patient refuses open surgery. This article presents a preliminary report on stereotactic approach to skull base lesions with special emphasis on the technique.

Heterologous expression of Arabidopsis ERS1 causes delayed senescence in coriander

The phytohormone ethylene is involved in many developmental processes, including leaf and flower senescence. Ethylene is perceived by plants through receptors that trigger the downstream signal transduction pathway. The mutated ethylene receptor ERS1 (ethylene response sensor) from Arabidopsis is of a dominant negative nature and confers ethylene insensitivity in Arabidopsis. To investigate if the altered ERS1 gene can affect the tissue senescence in heterologous plants, we introduced it into coriander by Agrobacterium-mediated transformation. Transgenic plants were regenerated by cocultivating hypocotyl segments with A. tumefaciens harboring binary vector pCGN1547 that carried the ERS1 gene. The presence and expression of the transgene were confirmed by genomic Southern blot and reverse transcriptase-PCR analyses. Leaf and flower senescence were delayed significantly in the transgenic plants. The ability of the mutated ERS1 gene to confer the ethylene-insensitive phenotype can be exploited for extending the shelf-life of leafy vegetables.

Post-transcriptional gene silencing in plants by RNA

RNA silencing, which is termed post-transcriptional gene silencing in plants, is an RNA degradation process through sequence-specific nucleotide interactions induced by double-stranded RNA. In plants, RNA silencing not only serves as a component of the defense mechanism, but also participates in the regulation of endogenous gene expression in a variety of developmental processes. This review elaborates the current progress on the understanding of the molecular basis of RNA silencing including a mechanistic link between the regulation of microRNA and RNA silencing. The practical use of RNA silencing as a reverse genetics approach in plant functional genomics is also discussed.

Lambda exonuclease-based subtractive hybridization approach to isolate differentially expressed genes from leaf cultures of Paulownia kawakamii

Genes that are preferentially expressed in a particular developmental pathway can be isolated by subtractive hybridization (SH). We developed a PCR-based approach coupled with lambda exonuclease digestion that allows for generating single-stranded tester and driver nucleic acids suitable for SH starting from cDNA libraries. An efficient subtraction strategy was developed to overcome some of the problems in the previously described SH protocols, such as the need for large amounts of experimental tissue, RNase contamination during solution hybridization, and postsubtraction recovery of nucleic acids. We used this method to obtain cDNA corresponding to genes expressed during adventitious shoot regeneration from excised leaf cultures of the fast-growing tree Paulownia kawakamii. Over 36 cDNA clones were isolated and 1 of the differentially expressed clones codes for a leucine zipper transcription factor. This clone showed about sixfold higher level of expression in the shoot-forming tissues (tester) compared to that in the callus-forming tissues (driver) of Paulownia, suggesting that differentially expressed genes can be efficiently isolated using this simple lambda exonuclease-based subtractive hybridization method.

Novel method for isolation of major phenolic constituents from cashew (Anacardium occidentale L.) nut shell liquid

Commercially available cashew (Anacardium occidentale L.) nut shell liquid (CNSL) mainly contains the phenolic constituents anacardic acid, cardol, and cardanol. These phenolic constituents are themselves heterogeneous, and each of them contains saturated, monoene, diene, and trienes in the fifteen-carbon side chain. This communication describes the separation of anacardic acid, cardol, and cardanol for industrial application. Anacardic acid was selectively isolated as calcium anacardate. The acid-free CNSL was treated with liquor ammonia and extracted with hexane/ethyl acetate (98:2) to separate the mono phenolic component, cardanol. Subsequently, ammonia solution was extracted with ethyl acetate/hexane (80:20) to obtain cardol.

Interstitial brachytherapy for skull base tumors

1. Irrespective of the histology, all tumors responded to 125I permanent BT. 2. There were no intra- or postprocedural complications, making this modality extremely safe. 3. There were no acute or late complications attributable to continuous LDR radiation with 125I permanent BT. 4. The dose distribution can be tailored to fit the tumor shape by seed placement at the desired location and by selecting the seed strength. 5. Unlike any other radiation therapy procedure, with SBT, the placement of the 125I seed or seeds is verifiable at each step of the procedure on the CT screen, making the treatment more accurate. 6. The procedure is performed under local anesthesia, and the patient is observed overnight at the most, making it safe and cost-effective. 7. Most skull base tumors are located close to the brain, cranial nerves, or blood vessels. Tolerance of these vital structures to high doses of radiation when given continuously at a LDR makes this treatment method safe.

A survey of hospital morbidity, mortality and quality of life following coronary artery bypass surgery in a UK Indo-Asian population

To survey the in-hospital morbidity, mortality, length of stay in the intensive therapy unit (ITU) and hospital and quality of life in patients of Indo-Asian origin following coronary artery bypass (CABG) surgery, 345 consecutive patients (mean age 58 years; SD 8.9; range 32-88 years) undergoing primary, isolated CABG were studied. Non-elective CABG was undertaken in 41% of patients. The left anterior descending artery (LAD) was grafted in 89%, although in 30% of these the internal mammary artery (IMA) was not used. Following CABG, the hospital morbidity and mortality was within the expected range, although there was a trend towards higher in-hospital mortality in the Parsonnet low risk group of patients. The length of ITU and hospital stay was not prolonged. Using the SF-36 questionnaire in postoperative patients, low quality of life scores were obtained for six of the eight modalities tested including physical functioning, bodily pain and general health perception. The low quality of life scores and IMA usage in Indo-Asians needs to be addressed.

Influence of petiole and lamina on adventitious shoot initiation from leaf explants of Paulownia fortunei

Adventitious shoot bud differentiation occurred preferentially from the petiolar cut ends of leaf explants of Paulownia fortunei cultured on Murashige and Skoog medium supplemented with 4 μMα-naphthaleneacetic acid and 20 μM benzyladenine. The details of plantlet regeneration and successful transplantation to soil have been reported earlier. We now show that besides medium supplementation with auxin and cytokinin, the presence of lamina and petiole in the explant influence shoot bud induction. Explants with the basal half of the lamina and the entire petiole were much more responsive than those with whole lamina and petiole. A dual-culture-medium technique which permitted incubation of the two ends of excised petioles under two different phytohormone regimes was devised. Our data suggest that some of the diffusible factors from the lamina may be phytohormones, and that the establishment of an endogenous phytohormone gradient in the explants may affect shoot bud differentiation in this culture system.

Inhibition of shoot induction by 5-azacytidine and 5-aza-2'-deoxycytidine in Petunia involves DNA hypomethylation

Shoot bud regeneration from Petunia leaf disks was inhibited when they were cultured with the demethylating agents, 5-azacytidine (AzaC) and 5-aza-2'-deoxycytidine (AzadC), in shoot induction (SI) medium. Explants induced shoot primordia if they were transferred after 1 week from the medium containing the drugs to medium without drugs. The fresh weight of leaf disks cultured on SI medium for 2 weeks in the presence of the drugs was 60-80% lower when compared to control shoot-forming cultures. Internode length was reduced when shoots were transferred to phytohormone-free Murashige and Skoog medium containing the drugs. However, no other morphological abnormalities were seen in these shoots, even at 20 µM AzaC or 5 µM AzadC. Coupled restriction enzyme digestion (with HpaII and MspI) and random amplification of genomic DNA was performed to detect the level of methylation of CCGG sites in the DNA of the explants exposed to AzaC and AzadC. Over 15 amplified bands were detectable in the control. Five of these bands were absent in the amplified products when digested DNA from the drug-treated explants was used as the template, showing that hypomethylation of DNA had occurred. This suggests that inhibition of shoot bud formation in the presence of the drugs AzaC and AzadC may be due to the altered methylation status.

High frequency adventitious shoot regeneration from excised leaves ofPaulownia spp. cultured in vitro

High frequency, direct regeneration of shoots was induced in leaf cultures ofPaulownia tomentosa, P. fortunei x P. tomentosa andP. kawakamii. The optimum culture medium for the leaf explants derived from shoot cultures was Murashige-Skoog (MS) medium supplemented with 10 μM indole-3-acetic acid and 50 μM benzyladenine. Up to 40 shoots were obtained over a 4 month culture period from each leaf explant. Rooting occurred spontaneously in the shoots that were about 1 cm tall when subcultured on phytohormone-free MS medium. The plantlets could be transplanted successfully. Some of the transplantedP. tomentosa plantlets flowered in the greenhouse one year after transplanting. The protocol is suitable not only for rapid multiplication of the various species ofPaulownia, but also for analytical studies associated with adventitious shoot regeneration.

IAA-induced apogamy in Platycerium coronarium (Koenig) Desv. gametophytes cultured in vitro

Apogamous sporophytes were produced on Platycerium coronarium gametophytes cultured in the presence of indole-3-acetic acid (IAA). The percentage of apogamy as well as the total number of apogamous sporophytes produced per gametophyte clump were highest in the presence of 40 μM IAA. When ethylene was allowed to accumulate in the culture vessel in the presence of an optimum level of IAA, the percentage and total number of apogamous sporophyte production decreased significantly. Using light microscope and confocal laser scanning microscope we have shown that nuclear size can be used as a quick parameter to estimate the ploidy level of P. coronarium.

Role of brachytherapy in the management of the skull base meningioma. Treatment of skull base meningiomas

BACKGROUND

The treatment of primary and recurrent skull base meningiomas presents a formidable surgical problem.

METHODS

Fifteen patients with primary and recurrent skull base meningiomas were treated by means of interstitial irradiation with iodine 125 (125I) seed implantation. The physical characteristics of 125I enabled the authors to administer a minimum tumor dose ranging from 100 to 500 Gy at a low dose rate of 0.05-0.25 Gy per hour.

RESULTS

All 15 patients are alive at a median follow-up of 29 months. Of the 15 patients, 2 with calcification and 2 without calcification achieved only partial responses. The remaining 11 patients achieved a complete response. No early or late complications were observed.

CONCLUSIONS

From these data, the authors conclude that interstitial irradiation with 125I seeds is an effective, safe, and simple method in the treatment of both recurrent and primary skull base meningiomas.

Intracranial skip metastasis from parotid and facial skin tumors: mechanism, diagnosis, and treatment

Perineural and endoneural tumor spread is a form of metastatic disease in which the primary tumors spread along neural pathways and gain access to noncontiguous regions. Although rare, this type of skip metastasis into the cranial cavity occurs from tumors of the parotid gland and facial skin. Recognition of this process, evaluation of the patient with proper diagnostic procedures, and its treatment are presented.

Continuous low dose rate brachytherapy with high activity iodine-125 seeds in the management of meningiomas

The purpose of this study was to evaluate if meningiomas can be effectively treated with brachytherapy using permanent implantation of high activity I-125 seeds. Thirteen patients with intracranial meningiomas were treated by means of permanent stereotactic implantation of one or more high-activity I-125 seeds. The physical characteristics of I-125 enabled us to deliver a minimum tumor dose ranging from 100 Gy to 500 Gy at a low dose rate of 5 cGy to 25 cGy per hr. Indications for this procedure included recurrence after initial surgery or as primary modality of treatment in patients who were not candidates for surgery. All 13 patients are alive at a median follow-up of 25 months. Nine of 13 patients achieved complete resolution of the tumor and in the remaining four, more than 50% reduction in tumor volume was noted at the last follow-up. No late complications were observed. We conclude from this initial data that localized high dose irradiation delivered at a low dose rate using I-125 permanent implantation is an effective, safe, and simple method in the treatment of both recurrent and primary intracranial meningiomas.

Stereotactic external beam irradiation system

Stereotactic localization is of vital importance in treating small intracranial lesions either with interstitial or external beam irradiation. This article describes a simple, fast, accurate, and verifiable system that can be used with a standard computerized axial tomography (CAT) scanner and linear accelerator for stereotactic external beam irradiation.

Estimation of the mean effective organ doses for total body irradiation from Rando phantom measurements

For the total body irradiation (TBI) procedure, it is necessary to compare the mean dose obtained from the tissue or organs and the estimated dose equivalent value from the computer program. Due to the easy-access of the Rando phantom and repeatability of TLDs and its output, the results from the experiment are quite encouraging for the verification of the dose distributions from total body irradiation at the given prescribed monitor units. The estimation of effective dose equivalent particularly across the lung sections was studied by combinations of using arms as the scatter volume to compensate for the inhomogeneity across the breast portion, as well as using the spoiler for skin-sparing purposes. The results were based upon various beam quality such as 4 MV, 6 MV, and 10 MV X rays. One series of experiments performed for this survey to ascertain the dose equivalent of the tissues was conducted. This paper describes the method and procedure for comparison between the measured data and computed data as a reference in the dosimetry of total body irradiation. Comparison of the measured and computed data for the largest collimated field shows that the calculated dose rates do not differ by more than 2% from the measured data. Because uncertainty is inherent in non-patient-like phantoms, the calculated data may be served as a reference for the dosimetry. For the total body irradiation setup, considering the radiation field size and treatment distances commonly employed, we conclude that the best combination of the patient setup will be (1) laying both arms down as compensation for lung inhomogeneity, and (2) the spoiler, which is made of acrylic about 8 mm thick and functions like a bolus, is needed to reduce the skin sparing effects and contribute the uniform dose distribution. The beam spoiler with the frame stands near the patient during the treatment.

Improved results of allogeneic bone marrow transplantation for advanced hematologic malignancy using busulfan, cyclophosphamide and etoposide as cytoreductive and immunosuppressive therapy

Twenty-four patients between the ages of 8 and 48 years (median 27.5) with high-risk for relapse hematologic malignancy received a marrow transplant from an HLA and MLC compatible sibling donor after chemotherapy with busulfan, 4 mg/kg/day for 4 days by mouth, cyclophosphamide 60 mg/kg/day i.v. for 2 days, and etoposide 60 mg/kg i.v. over 4 h on the first day of cyclophosphamide treatment (BU/CY/VP). Toxicity consisted of mucositis, skin rash, and nausea and vomiting in all patients, transient fever thought to be due to etoposide administration in 16/24 (67%) patients, and clinical veno-occlusive disease (VOD) of the liver in 4/24 (17%). There were nine deaths from causes other than recurrent disease in the first 100 days after transplant and two deaths after day 100, a total transplant mortality of 11/24 (46%). Three patients relapsed, but 10/24 (40%) remain alive and disease free 26-182 weeks (median 60 weeks) from transplant. These results compare favorably with results in a group of 12 similar risk patients treated with total body irradiation (TBI) containing regimens during an overlapping time period. Six of the TBI patients have had persistent or recurrent disease and only two (17%) are currently alive and disease free. The probability of disease persistence or relapse is 67% in the TBI group and 20% in the BU/CY/VP group (p less than 0.02).

Brachytherapy: a viable alternative in the management of basal meningiomas

Thirteen patients with intracranial meningiomas of the skull base were treated with one or more high-activity iodine-125 seeds. In 11 patients, the seeds were implanted stereotactically under local anesthesia. A minimum dose of 100 to 500 Gy was delivered to the tumor at a dose rate of 5 to 25 cGy/h. Indications for this procedure included recurrence after initial surgery or as the primary modality of treatment in patients who were not candidates for surgery. All 13 patients are alive at a median follow-up of 15 months. Nine of 11 patients (82%) without calcification in their meningiomas achieved complete response. The remaining 4 patients-2 with calcification and 2 without--achieved partial response. No early or late complications were observed. We conclude from our experience that both recurrent and primary meningiomas of the skull base can be treated effectively with permanent iodine-125 brachytherapy.

Retreatment of advanced esthesioneuroblastoma with high-activity I-125 endocurietherapy: a case report

A 67-year-old woman presented with an advanced esthesioneuroblastoma that recurred 2 years following external irradiation. She was successfully retreated with continuous low-dose rate interstitial irradiation from high-activity I-125 seeds implanted permanently into the tumor.

Applicator for use of cesium-137 miniaturized tube sources in the treatment of uterine cervix cancer

A modified afterloading Kumar Cervical Applicator with a 3 mm diameter central tandem permits insertion of the afterloading tandem into the uterus without need of manual cervical dilatation. While general anesthesia is required for insertion of standard cervical applicators, this is eliminated because the central tandem is no larger than a uterine sound, and the tandem may be painlessly inserted into the uterus while the patient is awake.

Iodine 125 interstitial irradiation for localized prostate cancer

We present the technique, complications, and 5-year results of transperineal percutaneous template permanent interstitial iodine 125 endocurietherapy of localized prostate cancer in 85 treated patients. The 5-year outcome appears similar to that of external beam radiation therapy or radical surgery, but the iatrogenic mortality, morbidity, treatment time, and hospitalization are significantly reduced.

Radiation therapy alone versus radiation therapy and chemotherapy in the management of Hodgkin's disease

Forty-four patients with histologically proven Hodgkin's disease underwent initial treatment with extended-field radiation therapy. Nineteen of these patients also received combination chemotherapy. For analysis, patients were assigned to three treatment groups: group 1 received radiation therapy only (25 patients); group 2 received combination chemotherapy followed by consolidative (low-dose extended-field) radiation therapy; and group 3 was treated with alternate chemotherapy and radiation therapy using the sandwich technique. The actuarial 5-year disease-free survival rates were 83% (group 1), 83% (group 2), and 100% (group 3). The overall actuarial survival rates were 96% (group 1), 92% (group 2), and 100% (group 3). No factor was identified as being of prognostic value in predicting relapse. We conclude that extended-field radiation therapy delivered in this manner is a safe and effective approach to the initial management of Hodgkin's disease.

Survival of patients with glioblastoma multiforme treated by intraoperative high-activity cobalt 60 endocurietherapy

The authors report their initial treatment results in 49 patients with glioblastoma multiforme (GM) who received intraoperative endocurietherapy (ECT) with high-activity cobalt 60 (60Co) probe. Thirty poor prognosis (unresectable tumor) patients (Group I) with newly diagnosed GM were treated by either biopsy or subtotal excision, followed by 20.00-Gy single-fraction 60Co probe ECT, and 60.00-Gy external-beam radiation therapy (EXRT) (80.00 Gy total tumor dose). Nineteen patients (Group II) with recurrent, previously resected and externally irradiated GM were retreated with 20.00-Gy single-fraction 60Co probe ECT alone. The authors' initial experience with intraoperative ECT of GM is discussed.

Permanent high-activity iodine-125 in the management of petroclival meningiomas: case reports

Two cases of petroclival meningiomas are reported wherein the tumors were completely destroyed without surgical resection or external-beam irradiation by means of permanent stereotactic implantation of one or two high-activity iodine-125 seeds.

Retreatment of recurrent pelvic tumors with iodine-125

We describe our experience with successful retreatment of common pelvic tumors including recurrent cervical and endometrial cancer, colorectal cancer, and soft tissue sarcomas. Two different permanent interstitial 125iodine (125I) endocurietherapy (ECT) techniques were employed. The first technique, percutaneous transperineal template 125I ECT, was used in the retreatment of recurrent tumors located within the true pelvis. The second technique, implantation of 125I in Vicryl carrier following celiotomy, was used for retreatment of recurrent tumors located outside the true pelvis within the false pelvis.

Breast carcinoma en cuirasse: pathophysiology and rotational subtotal skin electron beam therapy (SSEBT), a new technique

Carcinoma en cuirasse of the breast, which invades the skin via lymphatics and may encase the entire thorax and abdomen, is poorly controlled by surgery, chemotherapy, or conventional irradiation. Palliation of patients with breast carcinoma en cuirasse is a difficult clinical problem which must be effectively managed over extended periods due to the indolent nature of this disease. The management of three cases is reported, and the new technique of rotational subtotal skin electron-beam therapy (SSEBT) is presented.

High-activity iodine-125 endocurietherapy for head and neck tumors

Inoperable solid tumor recurrence within a surgical bed or within a previously irradiated field usually responds poorly to re-treatment with conventional external beam irradiation (EXRT) and/or chemotherapy. We present a new, alternative method of re-treatment used in two patients with recurrent head and neck cancer involving the parotid (adenocarcinoma) and neck nodes (squamous cell carcinoma). These patients were successfully re-treated with high-activity 125iodine (I-125) permanent implantation.

Need for invasive diagnostic procedures in the management of superior vena cava syndrome

Radiation therapy is considered the first treatment of choice for thoracic malignant diseases causing superior vena cava syndrome (SVCS). However, its use is poorly documented in cases in which intravascular tumor thrombosis is the major cause of obstructive symptoms. We report two cases of SVCS caused by thoracic malignancy. The first case failed to respond to the initial course of mediastinal radiation therapy. Contrast and radionuclide venography revealed two sites of tumor thrombosis located outside the radiation portal. Irradiation of these areas resulted in prompt relief of symptoms and complete relief of obstruction. In the second case, superior venacavogram and transluminal biopsy established the diagnosis and location of superior vena cava obstruction.

Decreased morbidity and increased survival in cervical cancer treatment

Thirty-seven patients with previously untreated invasive carcinoma of the uterine cervix, International Federation of Gynecology and Obstetrics (FIGO) stages IB to IVA, were treated with 4,000 rad external beam radiotherapy (EXRT) to midplane, followed by two intracavitary endocurietherapy (ECT) applications of 2,500 rad each to point "A" using a Kumar applicator, for a total dose of 9,000 rad. The major complication rate was 2.7 percent, and the local control rate was 85 percent (22/26 patients) for stages IB and II, and 91 percent (10/11 patients) for stages III and IVA. The three-year uncorrected observed actuarial survival was 80.3 percent for stages IB and II, and 81.8 percent for stages III and IVA. The three-year adjusted actuarial survival rate was 95.2 percent for stages IB and II, and 90.5 percent for stages III and IVA.

TAH and BSO with adjuvant pelvic EXRT and vaginal Cs-137 boost in the management of carcinoma of the endometrium

Combined surgery and radiation has become standard therapy for operable endometrial cancer patients with stage IA (grade 2-3 or deep muscle invasion), stage IB, stage II, and selected stage III disease. We discuss the rationale for whole pelvic external-beam radiation therapy (EXRT) followed by vaginal endocurietherapy (ECT) boost, and present the outcome of 43 patients with endometrial cancer treated by combined surgery and radiation.

Intraoperative cobalt-60 treatment of glioblastoma multiforme

An intraoperative remote afterloading endocurietherapy (ECT) technique with high-activity 60cobalt (60Co) for the treatment of glioblastoma multiforme (GM) is described. The technique can be used for initial management of the unresectable tumor or for retreatment of patients with recurrent tumor who have been treated previously with surgery and postoperative radiotherapy. We present the technique, tumor response, radiographic findings, and survival of 38 glioblastoma patients treated with intraoperative 60Co.

Transperineal 125iodine endocurietherapy of prostate cancer

We present the improved implant technique, intraoperative and postoperative complications, local control, and survival of 67 patients with cancer of the prostate treated by means of percutaneous transperineal template permanent 125iodine interstitial endocurietherapy (ECT). This ECT technique is a simple, easily learned, accurate and rapid procedure that can be performed without subjecting the patient to celiotomy. The use of vicryl carriers for permanent 125iodine implantation of the prostate with the percutaneous transperineal template technique prevents seed loss and permits implantation of patients after transurethral resection of the prostate (TURP).

Techniques to deliver high dose localized irradiation for tissue-sparing management of sarcomas

Soft tissue sarcomas may be effectively treated conservatively with limited surgery combined with high dose tumor-bed irradiation instead of more radical surgery or amputation alone. High dose local irradiation is safely accomplished with intraoperative electron beam therapy (EBT) or perioperative interstitial 192iridium endocurietherapy (ECT), following external beam radiation therapy (EXRT), to deliver a minimum tumor bed dose of 8,000 rad to 10,000 rad. We describe our techniques for EBT and ECT in the management of soft tissue sarcomas. Two case reports of sarcoma of the pterygoid region treated with EXRT, surgery, and perioperative ECT, and sarcoma of the thigh treated with EXRT, surgery, and intraoperative EBT are used to illustrate the techniques.

Activities of Ribulose Bisphosphate Carboxylase and Phosphoenolpyruvate Carboxylase and C-Bicarbonate Fixation during in Vitro Culture of Pinus radiata Cotyledons

The activities of ribulose bisphosphate carboxylase (RuBPC) and phosphoenolpyruvate carboxylase (PEPC), as indicators of autotrophic and nonautotrophic CO(2) fixation, were measured in excised cotyledons of Pinus radiata D. Don cultured for 21 days under shoot-forming (SF) and nonshoot-forming (NSF) conditions. The activity of RuBPC was found to increase in both SF and NSF cultures during the initial 5 days of culture. However, it leveled off from day 5 to day 10 and subsequently began to decrease until the end of the culture period under the SF conditions. In contrast, in the NSF cultures, RuBPC activity increased until day 15, when it was twofold higher than the maximum activity found in the SF cultures. An increase in PEPC activity of about 2.5 times the level of activity in freshly excised cotyledons was observed during the initial 5 days of culture under the SF conditions. PEPC activity began to decline after day 5 until it reached the level of activity seen in NSF cotyledons by day 15. In contrast, the activity of PEPC did not show any significant increase during the initial 10 days of culture under the NSF conditions. The K(m) (phosphoenolpyruvate) of PEPC from SF cotyledons was about 35% higher than that of NSF cotyledons. Cotyledons from two culture periods (days 5 and 15) were incubated for 15 seconds with NaH(14)CO(3). The label in the malate and asparatate fractions as a percentage of total (14)C incorporation was 3 times higher in the SF cotyledons than in the NSF cotyledons. A higher incorporation of (14)C into products of photosynthesis under the NSF conditions was also observed.

Techniques for management of vulvar cancer by irradiation alone

Vulvar cancer has traditionally been managed surgically, rather than by means of irradiation, because of the poor tolerance of the vulvar skin and mucous membranes to X-ray treatment. The use of moderate dose (4,000 rad) external-beam radiotherapy (EXRT) combined with two interstitial 192iridium endocurietherapy (ECT) applications of 2,500 rad to 3,000 rad allows delivery of an adequate tumoricidal dose (9,000 rad to 10,000 rad total dose) without producing radiation vulvitis. Irradiation is an effective alternate means of treatment in elderly patients who are medically unfit for radical vulvectomy and lymphadenectomy. It also provides an alternative to surgery for those patients who desire preservation of the genitourinary anatomy.

Contrast-enhancing computed tomography ring in glioblastoma multiforme after intraoperative endocurietherapy

The significance of the contrast-enhancing ring seen on serial follow-up postirradiation computed tomograms (CT) of the brain was evaluated in a group of 41 patients with glioblastoma multiforme (GM) who were treated in a phase I/II study by means of intraoperative remote afterloading endocurietherapy (ECT) with a high activity cobalt 60 probe (20.00 Gy) in one high-dose rate fraction), and conventional fractionated external-beam (EXRT) radiotherapy (60.00 Gy in 30 fractions in 7.5 weeks). All received minimum total tumor doses of 80.00 Gy. After completion of treatment, all patients were followed with serial CT scans of the brain. Two to 6 months after treatment, 27 of 41 patients developed the similar thin-walled, regular, contrast-enhancing CT rings with low-density attenuation inside and outside the ring. Postmortem study in two of these patients revealed that the thin-walled, regular, contrast-enhancing ring represented a continuous capsule of dilated cerebral vessels with inner low-density attenuation corresponding to necrosis, and outer low-density attenuation corresponding to edema. The CT appearance of the thin-walled, regular, contrast-enhancing ring produced after high-dose rate intraoperative ECT and EXRT is distinctly different from the CT ring characteristic of untreated or recurrent GM. After high-dose rate intracranial ECT and EXRT, the appearance of a post-ECT contrast-enhancing CT ring should not be automatically interpreted as recurrent disease as previously reported after conventional fractionated EXRT.

High activity iodine 125 endocurietherapy for recurrent skull base tumors

Experience with endocurietherapy of skull base tumors is reviewed. We present our cases of recurrent pituitary hemangiopericytoma, radiation-induced recurrent meningioma, recurrent clival chordoma, recurrent nasopharyngeal cancer involving the cavernous sinus, and recurrent parotid carcinoma of the skull base which were all successfully retreated with high-activity 125iodine (I-125) permanent implantation.

Local control of recurrent clival and sacral chordoma after interstitial irradiation with iodine-125: new techniques for treatment of recurrent or unresectable chordomas

Using new 125I brachytherapy techniques, we were able to deliver safely a tumor volume dose of 16,000 rads to a previous irradiated, large, recurrent sacral chordoma by means of the intraoperative interstitial implantation of 229 low activity 125I seeds and 40,000 rads to a previously irradiated, small, recurrent clival chordoma by means of the transnasal needle implantation of two high activity 125I seeds. Iodine-125 brachytherapy was followed by regression of tumor, lessening of symptoms, and bony recalcification in both cases.

Choice of afterloading endocurietherapy techniques for vaginal carcinoma

Vaginal cancer is highly curable in all stages by combining the proper interstitial or intracavitary endocurietherapy (ECT) techniques and external beam radiation therapy (EXRT). Each case must be individualized following careful evaluation of stage and local extent of disease. We describe three afterloading ECT techniques used for treatment of various presentations of vaginal cancer: 1) 137cesium vaginal obturator used for superficial lesions; 2) afterloading 192iridium tube and button technique used for localized lesions of the lower one-third of the vagina which do not involve more than one-half of the circumference; and 3) afterloading transperineal interstitial 192iridium template technique used for thick invasive lesions of the upper two-thirds of the vagina. Our technique for EXRT is also described.

Low morbidity following 9,000-rad intracavitary endocurietherapy (ECT) using the Kumar Cervical Applicator and external-beam radiotherapy (EXRT) in the management of carcinoma of the uterine cervix

The Kumar Cervical Applicator minimizes patient discomfort and improves patient mobility while reducing the tendency of the applicator to rotate during the 40 to 50 hours of uterine intracavitary endocurietherapy. Patients with previously untreated invasive carcinoma of the uterine cervix, F.I.G.O. stages IB-IVA, were treated with two Kumar intracavitary endocurietherapy (ECT) applications of 2,500 rad each to point "A," and 4,000 rad external-beam radiotherapy (EXRT) to midplane, for a total dose of 9,000 rad. The major complication rate was 2.7%, and the local control rate was 85% (22/26 patients) for stage I and II, and 91% (10/11 patients) for stage III and IVA.

Rotational total skin electron beam therapy

Our technique for dual-field rotational total skin electron beam therapy (TSEBT) is described in detail. The need for boost to different sites due to self-shielding or artificial shielding is also described in detail.

Spine-sparing postmastectomy irradiation

Postoperative irradiation of the chest wall and regional lymphatics following mastectomy for operable breast carcinoma is an effective means of reducing the chance of postoperative locoregional recurrence. The majority of patients who fail will ultimately develop bony metastases, especially in the thoracic and lumbar spinal regions. Our technique of postoperative irradiation avoids exit irradiation of the spine. This is important for patients who may later develop bony metastases or epidural spinal cord compression and require spinal irradiation. The details of the technique are presented.

Spinal metastases from pituitary hemangiopericytic meningioma

A rare, previously irradiated, recurrent malignant angioblastic meningioma of the pituitary, hemangiopericytic type, was locally controlled by a new endocurietherapy technique that allows delivery of very high (10,000 cGy), sharply localized irradiation. Rather than succumbing to the local tumor recurrence, as would otherwise be expected, the patient developed distant spinal metastases several years later.

Extended-field isocentric irradiation for Hodgkin's disease

Extended-field therapeutic irradiation is the treatment of choice for the majority of patients diagnosed with pathologic stages I and II Hodgkin's disease, and total nodal irradiation can be effectively used to treat selected stage III Hodgkin's patients. Standard 100-cm source-to-axis distance extended-field isocentric technique and results are presented.

Dual-field rotational (DFR) technique for total-skin electron-beam therapy (TSEBT)

Comparison of dosimetry measured in a noncylindrical Rando-Alderson phantom by two-field, four-field, and six-field total-skin electron-beam therapy (TSEBT) techniques with our dual-field rotational (DFR) technique reveals a superior dosimetry for the latter. Our technique of dual-field rotational DFR-TSEBT is described in detail, and its advantages and indications for the primary management of cutaneous T-cell lymphoma (CTCL) and Kaposi's sarcoma (KS) are discussed.