Katherine Freeman

Isotope selection for patients undergoing prostate brachytherapy.

PURPOSEnUltrasound-guided transperineal interstitial permanent prostate brachytherapy (TIPPB) is generally performed with either 103Pd or 125I. The use of 125I for low Gleason score tumors and 103Pd for higher Gleason scores has been suggested based on isotope dose rate and cell doubling time observed in in vitro studies. While many centers follow these isotope selection criteria, other centers have elected to use only a single isotope, regardless of Gleason score. No clinical data have been published comparing these isotopes. This study was undertaken to compare outcomes between 125I and 103Pd in a matched pair analysis for patients undergoing prostate brachytherapy.nnnMETHODS AND MATERIALSnSix hundred forty-eight consecutively treated patients with clinically confined prostate cancer underwent TIPPB between June 1992 and February 1997. Five hundred thirty-two patients underwent TIPPB alone, whereas 116 received pelvic external beam irradiation and TIPPB. Ninety-three patients received androgen deprivation therapy prior to TIPPB. The prescribed doses for TIPPB were 160 Gy for 125I (pre-TG43) and 120 Gy for 103Pd. Patients treated with combination therapy received 41.4 or 45 Gy (1.8 Gy/fraction) external beam irradiation followed by a 3- to 5-week break and then received either a 120-Gy 125I or a 90-Gy 103Pd implant. Until November 1994, all patients underwent an 125I implant after which the isotope selection was based on either Gleason score (Gleason score 2-5:125I; Gleason 5-8:103Pd) or isotope availability. A matched pair analysis was performed to assess any difference between isotopes. Two hundred twenty-two patients were matched according to Gleason score, prostate-specific antigen (PSA), and stage. PSA relapse-free survival (PSA-RFS) was calculated based on the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus Group definition of failure. Kaplan-Meier actuarial survival curves were compared to assess differences in pretreatment PSA and Gleason score.nnnRESULTSnUnivariate analysis of the 648 patients identified Gleason score, pretreatment PSA value, and stage as significant factors to predict PSA-RFS, but failed to identify isotope selection as significant. To address the significance of isotope selection further, the matched pair groupings were performed. The minimum follow-up for all 222 matched patients is 24 months with a median follow-up of 42 months (24-82). The actuarial PSA-RFS at 5 years for all 222 patients is 86.5%. One hundred eleven of the 222 matched patients received a 103Pd implant with an 87.1% 5-year PSA-RFS. The remaining 111 patients underwent a 125I implant with an 85.9% 5-year PSA-RFS (p = n.s.). Analysis of Gleason score subgroups 2-4, 5-6, and 7-9 failed to show any significant difference in PSA-RFS comparing isotopes. Pretreatment PSA subgroups of < or = 10 or > 10 ng/ml also failed to show any significant difference in PSA-RFS survival comparing isotopes. Analysis of postimplant dosimetry using dose delivered to 90% of the prostate volume (D90) did not identify any difference between the isotope groups.nnnCONCLUSIONSnThis matched pair analysis failed to demonstrate a difference for 125I and 103Pd in PSA-RFS for patients undergoing TIPPB. In addition, there were no observed advantages for either 125I or 103Pd in either the low or high Gleason score groups. This data indicates that the role of isotope selection for patients undergoing TIPPB requires further clarification.

Relationship between adiponectin and ambulatory blood pressure in obese adolescents.

Obesity is associated with elevated blood pressure (BP), insulin resistance, and altered plasma adiponectin levels; the relationship between the biochemical features of obesity and 24-h ambulatory blood pressure (24-h ABP) parameters in adolescents remains unknown. Anthropometric measurements and 24-h ABP monitoring were obtained on 41 obese adolescents with and without type 2 diabetes mellitus (T2DM). Serum adiponectin, high sensitivity C-reactive protein (hs-CRP), lipid profile, insulin, fasting glucose, liver enzymes, Hb A1c (HbA1c), and two random urine samples were obtained for creatinine and microalbumin measurements. The determinants of 24-h systolic (SBP) and diastolic (DBP) BP were examined using multivariate linear regression models with BP parameters as outcome variables. Forty-one obese adolescents were studied. Adiponectin levels were reduced and hs-CRP levels were elevated, and were inversely and significantly correlated (rho = −0.3, p = 0.05). ABP showed blunted nocturnal SBP dipping. Twenty-four hour SBP and DBP indexes were significantly (p < 0.05) and inversely correlated with adiponectin (rho = −0.4 and −0.42), respectively. In multivariate models, lower adiponectin level was independently associated with 24-h SBP and DBP. Adiponectin inversely correlate with ABP parameters in obese adolescents. Larger studies are needed to examine the relationship between adiponectin and mechanisms of BP regulation.

The role of external beam irradiation in patients undergoing prostate brachytherapy

6. From this cohort, a matched-pair analysis was performed to better assess the role of EBT and TIPPB (n = 215). PSA relapse-free survival was based on the American Society for Therapeutic Radiology and Oncology Consensus Panel definition. Kaplan-Meier actuarial survival curves were compared to assess various prognostic factors. The median follow-up for all 215 matched patients was 44 months (range, 24-81) with an actuarial PSA relapse-free survival (RFS) at 5 years of 81.1%. Patients treated with EBT and TIPPB had a 5-year PSA RFS of 83.5% whereas patients treated with TIPPB only had a 5-year PSA RFS of 79.4% (p = 0.715)10 ng/ml. Risk group analysis combining PSA, Gleason score, and stage failed to identify any risk group for which the addition of EBT was significant. Analysis of postimplant dosimetry using the dose to 90% of the prostate volume (D90) failed to distinguish any difference between groups. A significant advantage for combining EBT and TIPPB could not be demonstrated in this retrospective matched-pair analysis. These data indicate that the role and rationale of combined treatment in prostate brachytherapy requires better clarification, with a prospective randomized trial.

Relationship of Cigarette Smoking to Dental Caries in a Population of Female Inmates

This study investigates the relationship of cigarette smoking to dental caries among female inmates of a federal correctional institution. Two-hundred inmates (age range 19-62) entering the institution were given an oral examination and a self-administered questionnaire. A high percentage, 64%, of inmates were current or former smokers. In the bivariate analyses, tobacco use, as measured by the number of pack-years smoked, was significantly correlated with a higher DMFT (decayed, missing, and filled teeth) index (r = .46, p < .0001). The difference in mean DMFT scores for current smokers and nonsmokers, 12.1 (SD = 7.0) and 10.1 (SD = 7.4), respectively, was significant (p = .02). In the multiple regression analysis, sociodemographic and sociobehavioral risk indicators (age, country of birth, number of pack-years smoked, consumption of coffee or tea with sugar, and the perception of risks of oral cancer from smoking) explained 41% of the variance in the DMFT index. Although this study did not establish a causative relationship, cigarette smoking was shown to be associated with the experience of caries.

Interloop fluid in intussusception: What is its significance?

BackgroundSonography has been used to predict pneumatic reduction outcome in children with intussusception.ObjectiveTo assess the prognostic significance of fluid between the intussusceptum and intussuscepiens with respect to reduction outcome, lead point or necrosis.Materials and methodsSonograms of children with a discharge diagnosis of intussusception from four institutions were reviewed for interloop fluid and correlated with results of pneumatic reduction and surgical/pathological findings when available. Maximal dimension of interloop fluid on a transverse image and fluid complexity were evaluated.ResultsOf 166 cases, 36 (21.7%) had interloop fluid. Pneumatic reduction was successful in 21 (58.3%) with fluid and 113 (87.6%) without. The average largest fluid dimension was 8.7xa0mm (range 5xa0mm–19xa0mm, median 8xa0mm) in cases with successful reduction and 12.8xa0mm (range 4xa0mm–26xa0mm, median 12.5xa0mm) in unsuccessful reduction (pu2009<u20090.05). Fluid dimension equal to or greater than 9xa0mm correlated with failed reduction (pu2009<u20090.0001;odds ratio13:1). In 36 cases with interloop fluid that required surgery, there were four lead points and three necrosis. In cases without fluid with surgical reduction, there was one lead point and one necrosis. Interloop fluid correlated with lead point (pu2009<u20090.04) or necrosis (pu2009<u20090.03). Its significance increased with larger amounts of fluid (pu2009<u20090.0001). Patient age/fluid complexity did not correlate with reduction outcome (pu2009=u20090.9).ConclusionInterloop fluid was associated with increased failure of pneumatic reduction and increased likelihood of lead point or necrosis, particularly when the maximum dimension exceeded 9mm.

Can lab data be used to reduce abdominal computed tomography (CT) usage in young adults presenting to the emergency department with nontraumatic abdominal pain

We sought to determine whether laboratory parameters could be found, predictive of a negative abdominal CT scan in young adults with nontraumatic abdominal pain. Following institutional review board approval, we evaluated CT reports of 522 patients, aged 21–35xa0years old, who presented to the Emergency Department with nontraumatic abdominal pain. Bivariate analyses relating ten laboratory parameters to whether the CT detected a cause for abdominal pain were conducted. A multivariate logistic regression model was then derived, with all variables in the final model significant at pu2009<u20090.05. Variables were dichotomized to yield odds ratios and 95% confidence intervals. Of the 522 patients meeting inclusion criteria, 45% had a cause for pain demonstrated by CT. Predictors of a negative CT in men were normal hematocrit and negative urine blood (pu2009=u20090.045, pu2009=u20090.016, respectively), and in women normal hematocrit, granulocyte percent, and alkaline phosphatase (pu2009=u20090.023, pu2009=u20090.039, pu2009<u20090.0001, respectively). When standard normal values were used to calculate descriptive statistics, only granulocyte percent in women had a significant confidence interval (odds ratio 2.5, confidence interval 1.6–4.0). Among the 208 women with normal granulocyte percent, the final clinical diagnosis was appendicitis, cholecystitis, and diverticulitis, in three, three, and two cases, respectively (4% combined). In summary, no laboratory test was sufficient to offer reassurance that a CT is not necessary in a young adult patient with nontraumatic abdominal pain. Alternative strategies should be considered to decrease the use of CT, and its associated radiation exposure, in young adults with nontraumatic abdominal pain.

Prediction models for insulin resistance in girls with premature adrenarche. The premature adrenarche insulin resistance score: PAIR score.

Aim: The purpose of this study was to develop an accurate regression model to predict insulin resistance in girls with premature adrenarche. Methods: The insulin sensitivity index was calculated from the frequently sampled intravenous glucose tolerance test with tolbutamide. Thirty-five prepubertal girls (23 Caribbean-Hispanic and 12 African-American; mean age 6.8 years) were studied. The insulin sensitivity index was compared to birth weight, body mass index (BMI), the presence of acanthosis nigricans (AN), insulin-like growth factor 1, insulin-like growth factor binding protein 1, sex hormone binding globulin, lipid profile, and adrenocorticotropic hormone stimulated androgens. Results: The best prediction models included birth weight, BMI, and AN (model 1: R2 = 0.78) and BMI, AN, and serum 17-OH pregnenolone (model 2: R2 = 0.76). When viewed as screening tests, a cutoff value <5.5 (premature adrenarche insulin resistance score) in both equations showed a sensitivity of 100% and a specificity of 85%. Conclusion: Born small for gestational age, premature adrenarche, obesity, AN, and higher serum 17-OH pregnenolone levels may confer negative, but independent, health risks.