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Brachytherapy Treatment Planning
Published in W. P. M. Mayles, A. E. Nahum, J.-C. Rosenwald, Handbook of Radiotherapy Physics, 2021
Margaret Bidmead, Dorothy Ingham, Peter Bownes, Chris D. Lee
The type of situation where this technique has been employed is in the treatment of small solitary brain lesions. A limited number of catheters are implanted under image guidance. The surface of the treatment volume is defined by a number of points, and the dwell times within the catheters are optimised to give as uniform a dose as possible to these points and within the volume defined. This method must be applied with caution, because, depending on the distance from the catheters to the volume surface, some very high-dose regions can exist within the volume. Figure 54.20 demonstrates the inappropriate use of this type of optimisation in an implant to the rectum containing insufficient catheters to encompass the target volume. The dose distribution has been optimised to deliver the prescribed dose to the surface of the outlined target volume. This has resulted in massive regions of overdosage within the target volume.
Renal Cell Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
The presence of brain metastases at presentation is a poor prognostic factor. Analysis of the SEER and National Cancer Databases in the United States estimated 1.5% of cases presented with brain lesions. Routine imaging of the CNS is not recommended in most guidelines for RCC so the prevalence is likely to have been underestimated as it would not include those with asymptomatic brain metastases. Median OS was 6.4 months in the brain metastasis cohort versus not reached in those without CNS disease at presentation.42 With the development of new treatments, particularly immunotherapy agents which have shown activity in the melanoma population in the CNS, and the increasing uses of SRS for local control we may see improvements in OS in future.
The effects of epilepsy and its treatments on affect and emotion
Published in Howard J. Rosen, Robert W. Levenson, Neurocase, 2020
John D. Hixson, Heidi E. Kirsch
Extensive lesion-based research has been used to characterize the functions of the amygdala and the hippocampus. Amygdala damage often correlates with deficits in emotional perception, expression and memory, especially when stimuli have a negative valence (Adolphs et al., 2005; Brierley, Medford, Shaw, & David, 2004; LaBar, LeDoux, Spencer, & Phelps, 1995; Morris, Ohman, & Dolan, 1998). Hippocampal lesions can cause verbal or visual memory impairments, depending on the side of the damage. Much of this work has been based on subjects whose brain lesions caused complete loss-of-function; examples include strokes, trauma, and surgical resections. It remains unclear if the mixed structural-electrical lesion in people with mesial temporal sclerosis (MTS) represents a loss-of-function phenomenon; several studies have examined this possibility.
The prognostic and predictive significance of serum thiols and disulfide levels in advanced non-small cell lung cancer
Published in The Aging Male, 2020
Fatih Karatas, Murat Acat, Suleyman Sahin, Fatih Inci, Gulsah Karatas, Salim Neselioglu, Ismail Haskul, Ozcan Erel
In staging of patients with NSCLC, Positron Emission Tomography (PET) and contrast-enhanced brain Magnetic Resonance Imaging (MRI) were used as standard; the presence of metastases in lesions, detected in PET or by clinical findings, were histopathologically confirmed, or ruled out through Computed tomography-guided tru-cut needle biopsies. In brain MRI, malignant-looking brain lesions which were thought to be non-primary brain tumors or multiple parenchymal lesions compatible with metastasis were considered as metastasis, whereas solitary lesions were pathologically diagnosed as metastasis from excision material. Survival information was obtained through the database for population registration and tracking system of our country. The control group consisted of demographically-matched volunteers who were selected from the subjects applying to our hospital for general health screening. The exclusion criteria for both groups were defined as follows: any history of a presence of a second primary cancer, an uncontrolled severe symptomatic cardiovascular or metabolic disease, having organ dysfunction such as liver, kidney, and thyroid, patients unable to feed orally, any presence of rheumatic disorder, use of anti-inflammatory or immunosuppressive drugs (i.e. non-steroidal anti-inflammatory drugs, corticosteroids, anti-tumor necrosis factor alpha, or colchicine), and receiving hormone replacement therapies.
Multidisciplinary approach to degenerative cervical myelopathy
Published in Expert Review of Neurotherapeutics, 2020
Ali Moghaddamjou, Jamie R.F. Wilson, Allan R. Martin, Harry Gebhard, Michael G. Fehlings
DCM has a broad differential diagnosis that requires a clinician with neurological expertise to decipher. This includes radiculopathy, polyradiculopathy, stroke, inflammation (e.g. multiple sclerosis, transverse myelitis), tumor, Chiari malformation, diabetic neuropathy, peripheral nerve entrapment (e.g. carpal tunnel), and amyotrophic lateral sclerosis (ALS). The diagnosis can typically be made based on the clinical and imaging criteria discussed above, but the possibility of a brain lesion should always be considered and ruled out by a complete neurological examination combined with brain imaging, when necessary. As a result, input from a neurologist, physiatrist, or spine surgeon is necessary to help confirm the diagnosis. In some cases, it is useful for the neurologist or physiatrist to perform electromyography (EMG), nerve conduction studies, and other electrophysiology tests (e.g. somatosensory evoked potentials) to rule out alternative diagnoses. Unfortunately, these tests have poor sensitivity to diagnose cervical myelopathy, but a promising new technique called contact heat evoked potentials (CHEPs) may overcome these limitations [44].
Neuroanatomical and behavioural factors associated with the effectiveness of two weekly sessions of prism adaptation in the treatment of unilateral neglect
Published in Neuropsychological Rehabilitation, 2020
Maria Gutierrez-Herrera, Simone Eger, Ingo Keller, Joachim Hermsdörfer, Styrmir Saevarsson
Brain lesions were confirmed in all 19 patients by means of MRI (magnetic resonance imaging) and structural CT (computed tomography) scans. MRI scans were available for nine patients and CT scans for 10. Using the MRIcron software (Rorden, Karnath, & Bonilha, 2007), a trained researcher blinded to patients’ neuropsychological performance delineated the lesion borders on a slice-by-slice basis, either directly onto the T2-weighted fluid-attenuated inversion recovery image (FLAIR; 5 mm slice thickness) or onto the CT scan (2.5 mm slice thickness). In order to examine a three-dimensional lesion, the resulting two-dimensional map was then converted into a volume of interest. Subsequently, both the anatomical scan and the lesion volume were normalised to a standard brain template created from older adults using the Clinical Toolbox (Rorden, Bonilha, Fridriksson, Bender, & Karnath, 2012) running under SPM8 (Statistical Parametric Mapping Software package; http://www.fil.ion.ucl.ac.uk/spm). This toolbox provides age-specific templates oriented in MNI space for both CT and MRI scans (Rorden et al., 2012). If available, high-resolution T1-weighted anatomical scans were coregistered with the MRI scans during the normalisation process. The amount of lesion overlap among all patients is shown in Figure 2.