Node Chain Research Articles

Indications for tomotherapy/intensity-modulated radiation therapy in paediatric radiotherapy: extracranial disease

The potential conformality advantages of intensity-modulated radiation therapy (IMRT; TomoTherapy Hi Art system) over conventional linear accelerator based therapy was assessed in six consecutive children referred for extracranial radiotherapy. IMRT/tomotherapy was considered advantageous for (i) small abdominal tumours, compared with parallel opposed or single portal technology using a conventional linear accelerator, and (ii) re-treatment of an ethmoidal sarcoma, but not for palliation of a small spinal metastasis, or therapy for a whole deep cervical node chain or a pelvic side wall tumour in a young child. Considerations integral to the treatment decision included target volume dose conformality, "low-dose bath" effects (oncogenic and late growth sequelae) and treatment delivery time. IMRT/tomotherapy was the selected modality for therapy when the conformality advantages were perceived to outweigh any disadvantages in three out of the six cases. The dose conformality advantages of IMRT/tomotherapy are sufficient to selectively recommend its availability to the paediatric practice in accordance to the following criteria: (i) where conformality of radiation therapy to the target/tumour is critical and where the margin of safety (from gross/clinical target volume to planning target volume (PTV)) around the tumour is narrow; (ii) where adjacent organs at risk of radiation damage have a low threshold for damage; and (iii) where the "low-dose bath" phenomenon, which occurs between the upper and lower axial limits of the PTV, is not sufficiently disadvantageous (with regard to late oncogenesis or growth retardation) to outweigh the more confined (non-tumour) integral doses received in higher dose corridors through the body when utilizing conventional radiation techniques.

The value of radiotherapy on metastatic internal mammary nodes in breast cancer. Results on a large series

The ‘regional nodal mapping’, is a fundamental step to stage breast carcinoma. In addition to the axillary nodes status, the involvement of internal mammary nodes is an important prognostic factor. Six hundred and sixty-three patients with breast carcinoma, mainly in the inner quadrants, underwent a biopsy of internal mammary nodes. Positive internal mammary nodes were found in 68 out of 663 cases (10.3%) representing 27.2% of all cases with regional node metastases (250). When histologically proven metastases were detected, radiotherapy was administered to the internal mammary nodes chain. In 254 cases, the surgeon's exploration was guided by a gamma probe. Out of these cases, 28 (11.0%) showed metastatic involvement. Out of the other 409 cases, not radioguided, 40 showed positive nodes (9.8%). Patients with internal mammary metastases treated with radiotherapy and appropriate systemic treatment showed an excellent survival (95% at 5 years), a result which is in opposition to the previous experience, which stated that invasion of internal mammary nodes is an ominous prognostic sign. We assume that this excellent result is due to radiotherapy to internal mammary nodes and we propose that exploration of internal mammary nodes should be part of the staging process of carcinomas of the medial part of the breast.

Protocols for purpose-restricted anonymous communications in IP-based wireless networks

Anonymity and specifically sender anonymity have become essential requirements for many privacy-related applications (e.g. net counselling and whistle blowing). On the other hand, anonymity may be abused for various malicious activities (e.g. redistribution of copyrighted contents and illegal drug trading). In this paper, we address both by proposing protocols for authenticated anonymous communications channels. In such channels, the client can authenticate the authentication server while the latter can only authenticate the fact that the client is one of the qualified members that are eligible to use the wireless network (e.g. WLAN hot spots, WiMAX). Our protocols are based on an efficient anonymous password-based authenticated key exchange protocol and on an anonymous IP address assignment. The proposed protocols have the following advantages: (1) they can restrict the usage of the established anonymous channels to certain fair purposes; (2) they do not involve rerouting of the packets through a chain of intermediate nodes; (3) they are available right after registration of a normal password to an authentication server as for a classical non-anonymous authentication (e.g. EAP-TTLS and PEAP) and do not require any special registration procedures that would reveal initially to the authentication server that the client belongs to a small list of users of anonymous services. However, each scheme has different features with respect to the changes required of the DHCP standard, the controlled and adaptive IP address assignment, the compatibility to authentication frameworks used for wireless networks, the scalability and the number of messages involved.

Lymphoid cells in afferent and efferent intestinal lymph: lymphocyte subpopulations and cell migration.

Gut wall emigrating cells have been characterized in the intestinal lymph. The intestinal lymph duct was cannulated in 6-month-old minipigs. Under non-restraining conditions the efferent lymph from the mesenteric lymph nodes was collected in seven normal animals. Lymph coming directly from the gut (afferent lymph) was also collected in 18 pigs after resection of the mesenteric lymph node chains 3 months previously. The intestinal lymph flow was similar in both groups (around 18 ml/h). The lymphoid cell yield was 1.2 +/- 1.0 x 10(6)/h in control animals, while in mesenteric lymph node resected pigs it was around 20 times higher (26.2 +/- 17.6 x 10(6)/h). In the gut-derived lymph 76.5 +/- 8.8% T lymphocytes were observed (CD4+, 48.1 +/- 15.5%; CD8+, 53.6 +/- 12.7%). The percentage of immunoglobulin-positive cells was lower (IgM+, 10.1 +/- 4.5; IgA+, 1.7 +/- 1.1). In 14 mesenteric lymph node resected pigs a mean of 5.6 +/- 3.1 x 10(8) lymphocytes from the gut lymph were labelled in vitro with a fluorescent dye and retransfused. The labelling index of fluorescent cells in the intestinal lymph increased rapidly and remained at a high level until 44 h after cell transfusion. A four-to-ten times lower labelling index was found in the spleen, various lymph nodes and Peyer's patches. Most of the recovered lymphocytes were T cells. This model provides access to the cell pool leaving the gut wall, thus allowing an examination of its role in the gastrointestinal tract and other mucosal-lined organs.

The impact of IMC nodal drainage on primary breast cancer outcome

534 Background: Involvement of the internal mammary node chain (IMC) portends a poor prognosis in primary breast cancer. Theoretically, internal mammary node involvement cannot be present in the absence of primary tumor lymphatic drainage to these nodes. We examined whether the presence of IMC drainage negatively impacted regional and systemic recurrence and overall survival (OS). Methods: We performed a retrospective review of a prospective surgical database of patients with invasive breast cancer (Stage I-III) who underwent preoperative lymphoscintigraphy (LSG) with peritumoral injection and subsequent intraoperative lymphatic mapping from 1996-2002. The study was limited to 1,854 patients who demonstrated drainage on LSG and did not undergo IMC nodal biopsy. Medical records were reviewed for demographics, clinicopathologic data, and medical and surgical treatment data. Outcomes were evaluated including regional and systemic recurrence and overall survival (OS). Patients with any IMC drainage (IM+, alone or with axillary drainage) were compared to those without IMC drainage (IM-) as identified on LSG. Median follow-up was 57.9 months. Results: Three hundred forty-four (18.5%) patients showed IM drainage. Patients with IM drainage were younger and less likely to have upper outer quadrant tumors than those with non-IM drainage (p< 0.0001 for both). Tumor size and axillary sentinel node status were not significantly different between both groups (p=0.08 and p=0.39, respectively). There was no difference in IM irradiation rates of patients who were IM+ versus patients who were IM-. The 5-year systemic recurrence rate was 3.8% for IM+ patients and 2.1% for IM- patients (p=0.07). The 5-year regional recurrence rate was 0.9% for IM+ patients and 0.5% for IM- patients (p=0.46). Only one patient recurred in the IM nodal chain. There was no statistically significant difference in the 5-year OS rates of IM+ versus IM- patients in the entire study cohort as well as in the axillary node positive patients. Conclusions: A finding of IM drainage on LSG was not a significant predictor of OS during this study period. This finding needs to be confirmed at longer follow-up. Further studies are needed to determine the role of the IM sentinel node biopsy. No significant financial relationships to disclose.

HIV Modelling - Parallel Implementation Strategies

We report on the development of a model to understand why the range of experience with respect to HIV infection is so diverse, especially with respect to the latency period. To investigate this, an agent-based approach is used to extract highlevel behaviour which cannot be described analytically from the set of interaction rules at the cellular level. A network of independent matrices mimics the chain of lymph nodes. Dealing with massively multi-agent systems requires major computational effort. However, parallelisation methods are a natural consequence and advantage of the multi-agent approach and, using the MPI library, are here implemented, tested and optimized. Our current focus is on the various implementations of the data transfer across the network. Three communications strategies are proposed and tested, showing that the most efficient approach is communication based on the natural lymph-network connectivity.

Phase I-II Study of Intraoperative Radiation Therapy (IORT) After Radical Prostatectomy for Prostate Cancer

Recent studies have suggested an alpha/beta ratio in prostate cancer of 1.5-3 Gy, which is lower than that assumed for late-responsive normal tissues. Therefore the administration of a single, intraoperative dose of irradiation should represent a convenient irradiation modality in prostate cancer. Between February 2002 and June 2004, 34 patients with localized prostate cancer with only one risk factor (Gleason score > or =7, Clinical Stage [cT] > or =2c, or prostate-specific antigen [PSA] of 11-20 ng/mL) and without clinical evidence of lymph node metastases were treated with radical prostatectomy (RP) and intraoperative radiotherapy on the tumor bed. A dose-finding procedure based on the Fibonacci method was employed. Dose levels of 16, 18, and 20 Gy were selected, which are biologically equivalent to total doses of about 60-80 Gy administered with conventional fractionation, using an alpha/beta ratio value of 3. At a median follow-up of 41 months, 24 (71%) patients were alive with an undetectable PSA value. No patients died from disease, whereas 2 patients died from other malignancies. Locoregional failures were detected in 3 (9%) patients, 2 in the prostate bed and 1 in the common iliac node chain outside the radiation field. A PSA rise without local or distant disease was observed in 7 (21%) cases. The overall 3-year biochemical progression-free survival rate was 77.3%. Our dose-finding study demonstrated the feasibility of intraoperative radiotherapy in prostate cancer also at the highest administered dose.

Making money at the blessed place of Manila: Armenians in the Madras–Manila trade in the eighteenth century

AbstractThe question of ‘nodes’ in the Armenian commercial network, it is argued here, cannot be separated from a larger process, which helped places such as Madras to rise as alternatives to New Julfa, from as early as the beginning of the eighteenth century. The network of Armenian commerce did not have a single strong centre with many peripheries, but a chain of multiple nodes functioning as crucial linking points. This paper focuses on one particular trade route, from Madras to Manila, in the eighteenth century. The Philippines attracted Spanish American silver, which was then pumped into various regional economies of Asia – China and India in particular – in the shape of investment. A Spanish ban on European shipping at Manila made Armenians (and Indians) indispensable partners for European trade to Manila. This gave Armenian trade to Manila a strong European flavour. Armenians helped to camouflage this trade, and enriched themselves from it at the same time, operating often independently of New Julfa.However an active network once frustrated always has a tendency to compensate for its losses. Driven out of one region, it may press its capital and the advantages it offers upon another. This seems at any rate to have been the rule whenever a really vigorous and accumulative form of capitalism was concerned.1

A novel method for CT-scan-based localization of the internal mammary chain by internal mammary catheterization: an aid in breast cancer radiation therapy planning

The purpose of the study was to evaluate the localization of the internal mammary lymph node chain (IMC) using CT scan data acquired after intraoperative placement of a catheter into the internal mammary vessel (IMV). CT data sets comprising 58 suitable patients with breast carcinoma undergoing placement of a catheter into the IMV during breast conservative surgery were evaluated for the study. CT was performed with a radio-opaque dummy wire placed into the IMC catheter. The following measurements were recorded in the second, third and the fourth intercostal spaces: anteroposterior distance from skin to the IMC catheter; transverse distance from mid-sternum to the IMC catheter; and anteroposterior distance from the skin to the heart. Finally, the IMC angle was determined. At the second intercostal space, the mean anteroposterior distance (range) was 29.0 mm (14.6-48.6 mm) and mean transverse distance was 26.1 mm (18.2-36.3 mm). The corresponding mean values for the third space were 32.5 mm (20.0-45.6 mm) and 24.1 mm (17.8-39.7 mm) and for the fourth intercostal space were 31.6 mm (21.1-45.6 mm) and 24.3 mm (15.6-34.3 mm), respectively. The mean skin to heart distance was 36.2 mm on the left side and 47.8 mm on the right side (p < 0.001). The mean IMC angle was 40.3 degrees (95% confidence interval: 25-55.6). There appears to be a wide variation in the depth and location of the IMC, as recorded by CT measurements of the catheter in the IMV, demonstrating the need for individual planning. The IMC nodal area is likely to be out of the tangential portals employed in conventional practice.

Chain motifs: The tails and handles of complex networks

A great part of the interest in complex networks has been motivated by the presence of structured, frequently nonuniform, connectivity. Because diverse connectivity patterns tend to result in distinct network dynamics, and also because they provide the means to identify and classify several types of complex network, it becomes important to obtain meaningful measurements of the local network topology. In addition to traditional features such as the node degree, clustering coefficient, and shortest path, motifs have been introduced in the literature in order to provide complementary descriptions of the network connectivity. The current work proposes a different type of motif, namely, chains of nodes, that is, sequences of connected nodes with degree 2. These chains have been subdivided into cords, tails, rings, and handles, depending on the type of their extremities (e.g., open or connected). A theoretical analysis of the density of such motifs in random and scale-free networks is described, and an algorithm for identifying these motifs in general networks is presented. The potential of considering chains for network characterization has been illustrated with respect to five categories of real-world networks including 16 cases. Several interesting findings were obtained, including the fact that several chains were observed in real-world networks, especially the world wide web, books, and the power grid. The possibility of chains resulting from incompletely sampled networks is also investigated.

Anatomic Excision of Anterior Prostatic Fat at Radical Prostatectomy: Implications for Pathologic Upstaging

After exposure of the retropubic space, the surgeon commonly dissects the fat overlying the prostate and usually discards it. We have previously described the importance of dissecting this fat to completely visualize the dorsal venous complex (DVC) and prostatic apex. In this study, we describe a technique to dissect and remove the anterior prostatic fat pad (APF) and its anatomic and pathologic significance. After the retropubic space was prepared, we dissected the fat overlying the puboprostatic ligaments and the DVC to fully expose these structures. The superficial branch of the DVC was then transected, and the fat was dissected cephalad to the junction with the bladder. The fat was then further dissected laterally toward the lateral pelvic sidewall. Video analysis of the lateral dissection of the fat revealed a direct link to the obturator lymph node chain, where it was transected. Pathologic analysis demonstrated that 30 (14.7%) of 204 patients had one or more APF lymph nodes, of which four were positive for metastatic prostate cancer. The cancer of 3 of these 4 patients was upstaged as a result of the detection of these positive nodes. The dissection of the APF facilitates visualization of the apex and bladder neck. Anatomically, we have demonstrated that the APF contains lymph nodes approximately 15% of the time that are in communication with the obturator lymph node chain and DVC. We found that removal of the APF and its pathologic analysis can result in pathologic upstaging.

O valor da tomografia computadorizada na mudança do paradigma cirúrgico do carcinoma epidermóide de boca e orofaringe

OBJETIVO: Determinar a importância da tomografia computadorizada na mudança do paradigma cirúrgico no carcinoma espinocelular (CEC) da boca e orofaringe. MÉTODO: De 1991 e 2004, nos Departamentos de Cirurgia de Cabeça e Pescoço/ORL e Radiologia do Hospital Heliópolis, foram analisados, retrospectivamente, tomografias computadorizadas de 30 pacientes, 25 homens e cinco mulheres, com idades variando de 25 a 77 anos, todos com diagnóstico de carcinoma epidermóide do soalho da boca e/ou da língua oral e orofaringe. Todos os exames foram avaliados por dois radiologistas, separadamente, sem o conhecimento prévio do estadiamento clínico, sendo analisada a disseminação local-regional para os diferentes sítios. Para análise interobservadores, o índice Kappa foi calculado para estimar a concordância entre os mesmos, sendo o nível de significância adotado o valor de 0,05. RESULTADO: A análise da concordância entre os observadores foi considerada excelente (Kappa: 0,81 - 1,00) para três subsítios (linha média, espaço mastigador e cadeia linfonodal jugulo-carotídea alta); boa (Kappa: 0,61 - 0,80) para 10 subsítios (soalho da boca e língua oral, ramo da mandíbula, trígono retromolar, espaço submandibular, loja amigdalina e cadeias linfonodais submentoniana, submandibular, jugulo-carotídea média, jugulo-carotídea baixa e espinal); moderada (Kappa: 0,41 - 0,60) para dois subsítios (corpo da mandíbula e base da língua) e não foi possível calcular o Kappa para um subsítio (cadeia linfonodal retrofaríngea). CONCLUSÃO: A concordância interobservadores predominou de boa a excelente, sendo os valores estatisticamente significantes.

Linfadenocromatografia perigástrica com carbono ativado (CH40): estudo clínico

RACIONAL: Operação bem instituída e planejada constitui ainda a única terapêutica efetiva para o câncer gástrico, porém os resultados de cura não têm melhorado significativamente nas últimas quatro décadas, principalmente no mundo ocidental. O principal benefício de introdução endoscópica de corantes na submucosa gástrica está na facilitação de linfadenectomias regradas, podendo auxiliar a localização acurada das cadeias linfonodais. Além disso, a linfadenocromatografia possibilita futuras pesquisas para a detecção do linfonodo sentinela e sua aplicabilidade racional e seletiva na indicação precisa da linfadenectomia, principalmente dos grupos de linfonodos de ressecção mais trabalhosa e com maiores possibilidades de complicações. A linfadenocromatografia perigástrica com carbono ativado (CH40) no câncer gástrico foi analisada neste estudo clínico (fase 2). OBJETIVOS: 1) Determinar a percentagem de linfonodos corados após injeção endoscópica de CH40 na camada submucosa do estômago peritumoral; 2) determinar a percentagem dos linfonodos perigástricos corados pelo CH40 com metástases; 3) avaliar a coloração linfonodal com CH40 como marcador de metástase tumoral. MÉTODOS: Dez pacientes com câncer gástrico, em diversos estádios, foram avaliados. Carbono ativado (CH40) foi introduzido por via endoscópica no pré-operatório, na camada submucosa do estômago, na região peritumoral. Todos os pacientes foram operados e os grupos de linfonodos das diversas cadeias perigástricas foram dissecados e ressecados, isolados no pós-operatório imediato e separados, conforme agrupamento estabelecido conceitualmente pela Sociedade Japonesa de Pesquisa em Câncer. RESULTADOS: A idade variou de 50 a 68 anos, com média de 58,9 anos. Foram incluídos quatro pacientes do sexo feminino e seis do masculino. Foram ressecados 481 linfonodos, média de 48,1 linfonodos por operação. Foram corados 368 (76,50%) linfonodos, não sendo corados 113 (23,50%). Linfonodos perigástricos com metástases foram 68, sendo 51 (75,00%) corados e 17 (25,00%) não corados pelo CH40. CONCLUSÕES: Linfadenocromatografia com CH40 não se apresentou como marcador eficiente de metástase tumoral.

Aspectos da tomografia computadorizada no linfoma em pacientes abaixo de 20 anos de idade

OBJETIVO: Descrever os achados gerais do linfoma em pacientes abaixo de 20 anos de idade e por subtipo histológico. MATERIAIS E MÉTODOS: Estudo retrospectivo do arquivo digital de tomografia computadorizada do Centro de Controle do Câncer do Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro, no período de março de 2003 a julho de 2005. Dos 22 casos - 16 do sexo masculino e 6 do sexo feminino, com média de idade de 11,5 anos -, 12 eram do subtipo Hodgkin e 10 eram não-Hodgkin. RESULTADOS: Dos achados gerais, verificamos as linfonodomegalias mediastinais como o mais freqüente (59%), com predomínio no grupo Hodgkin (75%), seguido por hepatoesplenomegalia (50%) e linfonodomegalias cervicais e retroperitoneais (27,3%). No subtipo Hodgkin houve predomínio do acometimento linfonodal, em sucessivas cadeias, seguido pela hepatoesplenomegalia (50%). Verificamos um caso de massa tonsilar unilateral, opacidade pulmonar em "vidro-fosco" e nódulos renais. No subtipo não-Hodgkin houve predomínio extranodal caracterizado por hepatoesplenomegalia (50%), espessamento de alça intestinal (40%), derrame pleural (30%), nódulo pulmonar (20%), ascite (10%), derrame pericárdico (10%) e lesões ósseas mistas (10%). CONCLUSÃO: A tomografia computadorizada é de grande valia no diagnóstico, estadiamento e seguimento do linfoma, com achados de alerta como massa linfonodal, notadamente mediastinal, hepatoesplenomegalia, massa unilateral na tonsila e espessamento parietal de alça intestinal.

European Organization for Research and Treatment of Cancer – Breast Cancer Group (EORTC BCG)

This section provides current contact details and a summary of recent or ongoing clinical trials being coordinated by European Organization for Research and Treatment of Cancer – Breast Cancer Group (EORTC BCG). Clinical trials include: Postoperative adjuvant chemotherapy followed by adjuvant tamoxifen versus nil for node-negative and node-positive patients with operable breast cancer. EORTC Study No. 10901Randomized phase III study comparing short, intensive preoperative combination chemotherapy with similar therapy given postoperatively. EORTC Trial No. 10902Phase III randomized trial investigating the role of internal mammary and medial supraclavicular (IM-MS) lymph node chain irradiation in stage I–III breast cancer (joint study of the EORTC Radiotherapy Cooperative Group and the EORTC Breast Cancer Cooperative Group). EORTC Study No. 10925/22922A survey of the Breast International Group (BIG) to assess the attitude of patients aged &lt;35 years, with early breast cancer, toward the risk of loss of fertility related to adjuvant therapies. BIG 3-98/EORTC 10002LAMANOMA: Conservative local treatment versus mastectomy after induction chemotherapy in locally advanced breast cancer: a randomized phase III study. BIG 2-00/EORTC Study No. 10974/22002p53 study: First prospective intergroup translational research trial assessing the potential predictive value of p53 using a functional assay in yeast in patients with locally advanced/inflammatory or large operable breast cancer, prospectively randomized to a taxane versus non-taxane regimen. BIG 1-00/EORTC 10994After mapping of the axilla: radiotherapy or surgery AMAROS. EORTC 10981/22023A randomized phase II–III trial evaluating the efficacy of capecitabine and vinorelbine in anthracycline and taxane pretreated metastatic breast cancer. EORTC 10001/160010Phase I study of lonafarnib (SCH 66336) in combination with Herceptin plus paclitaxel in HER-2 neu overexpressing breast cancer. EORTC 10051/16023MINDACT trial: A prospective, randomized study comparing the Amsterdam 70-gene expression signature (Mammaprint) with common clinical pathological criteria in selecting patients for adjuvant chemotherapy in node-negative breast cancer. BIG 3-04/EORTC 10041

Performance evaluation of high speed TCP over optical burst switching networks

Study of TCP performance over OBS networks has been an important problem of research lately and it was found that due to the congestion control mechanism of TCP and the inherent bursty losses in the Optical Burst Switching (OBS) network, the throughput of TCP connections degrade. On the other hand, High Speed TCP (HSTCP) was proposed as an alternative to the use of TCP in high bandwidth-delay product networks. HSTCP aggressively increases the congestion window used in TCP, when the available bandwidth is high and decreases the window cautiously in response to a congestion event. In this work, we make a thorough simulation study of HSTCP over OBS networks. While the earlier works in the literature used a linear chain of nodes as the network topology for the simulation, we use the popular 14-node NSFNET topology that represents an arbitrary mesh network in our study. We also study the performance of HSTCP over OBS for different bandwidths of access networks. We use two different cases for simulations where in the first HSTCP connections are routed on disjoint paths while in the second they contend for resources in the network links. These cases of simulations along with the mesh topology help us clearly distinguish between the congestion and contention losses in the OBS network and their effect on HSTCP throughput. For completeness of study, we also simulate TCP traffic over OBS networks in all these cases and compare its throughput with that of HSTCP. We observe that irrespective of the access network bandwidth and the burst loss rate in the network, HSTCP outperforms TCP in terms of the throughput and robustness against multiple burst losses up to the expected theoretical burst loss probability of 10 −3.

Fisioterapia en las secuelas oncológicas a proposito de un caso

Secondary lymphedema of the inferior limb after abdominal sugery, due to endometrial carcinoma is an acute effect of this oncologic condition. The surgical technique used was the total hysterotomy. It included not only the removal of the uterus, but also the removal of some chains of inguinal lymph nodes, becoming the lymphatic drainage of the limb affected. As a consecuence, a mechanical lymphedema was caused by obstruction, as the remaining inguinal chains were not enough to drain the lymph generated in said limb. Objectives a) presentation of the possibilities of Physiotherapeutic Treatment for the secondary lymphedema of the limb, and b) evaluation of the evolution during a period of time. The subject of this case research is a patient of 56 years of age, diagnosed and oprated by means of a total hysterotomy, being the afte-effect a secondary lymphedema of the inferior limb. The therapeutic treatment received by the patient was the Leduc Method, through M.L.D, presotherapy and a compression bandage. The duration of the research was from October 2001 to October 2002 and it was carried out in the Hospital Universitario Virgen de las Nieves, Granada. Result Reduction of lymphedema fibrosis and volume in 60 %, with an improvement quality of life.

Quality Assurance in the EORTC Randomized Trial 22922/10925 Investigating the Role of Irradiation of the Internal Mammary and Medial Supraclavicular Lymph Node Chain Works

A quality assurance (QA) program in conjunction with the EORTC trial investigating the role of adjuvant internal mammary and medial supraclavicular irradiation in stage I-III breast cancer is presented. The results of a dummy run procedure and of an individual case review are compared to each other. The effects of recommendations based on QA procedures on the protocol compliance are evaluated. Prior to protocol activation all participating institutes were asked to produce treatment plans according to the guidelines of the protocol based on manual outlines of an average patient. Thereafter, they were asked to provide data on each of their first six randomized patients. The dummy run provided a lot of information on specific treatment techniques. In the individual case review, additional patient- and tumor-related data were collected, showing the use of anatomic information for treatment planning. A comparison between both procedures revealed that the individual case reports concurred more accurately with protocol guidelines than the dummy run. It was observed that the number of systematic protocol deviations was substantially decreased in trial patients compared to the dummy run case. Therefore, it is concluded that this extensive QA program had a positive effect on the consistency of all institutes participating in the trial.

Mathematical folding of node chains in a molecular network

Under the framework of network artificial chemistry (NAC), a method to construct a phenotypic machine from genotypic information is proposed. The genotype is expressed as a sequence of nodes (a node chain) with symbol data. According to an implemented algorithm, a chain is agglomerated, tangled, and finally folded into a node cluster that works as a control-flow machine in the network. Two examples of control-flow clusters, splitase and replicase, are presented and their functionality is demonstrated. Several meanings and future research directions are discussed.

A Case of Pancreatic Tuberculosis Mimicking Malignancy

We present a rare case of isolated pancreatic TB masquerading as a malignant neoplasm. A 21-year-old Somali female, with unremarkable past medical history, presented with a 2 months history of progressively worsening right-sided flank pain. She denied any fever, chills, night-sweats, weight-loss, and adverse gastrointestinal or urinary symptoms. An abdomen/pelvis CT showed multiple enhancing masses (largest mass size: 2.2 × 2.7 cm) within the body and tail of the pancreas, splenic-vein thromboses and isolated gastric varices. The superior mesenteric vein (SMV) and portal vein were patent. A low-density mass/fluid collection (4.5 × 6.3 cm) was noted within the right psoas muscle. Multiple enhancing low-density lesions were noted along the iliac lymph-node chain. The CT findings were highly suspicious of metastatic mucinous cystadenocarcinoma of the pancreas. Laboratory data was significant for WBC 8.5 × 10 (9)/L, hemoglobin 12.3 g/dL, ESR 86 mm/1 h, CRP 5.3 mg/dL, CA-125 66 U/mL, normal amylase/lipase and liver function test. Esophagogastroduodenoscopy with endoscopic ultrasound (EUS) showed a diffusely enlarged lobular pancreas with a hypoechoic appearance. A complex, partially cystic mass was noted in the posterior wall of pancreatic body. There was loss of echoplane between the pancreatic mass and the SMV. Adjacent to stomach, there were multiple large nodes (> 2 cm), most of which had cystic spaces within them. No mediastinal adenopathy was seen. Fine needle aspiration (FNA) from perigastric lymph nodes and tru-cut biopsy from the pancreatic mass showed reactive lymphoid hyperplasia and acutely inflamed pancreatic parenchyma negative for malignancy. A CT-guided drainage of the right psoas fluid collection was performed. The cultures from the right psoas abscess fluid and the peri-gastric lymph node aspirate returned positive for Mycobacterium tuberculosis complex (MTB). A CT Chest and multiple induced sputum samples remained negative for acid-fast bacilli smear, MTB probe, and culture. Resistance to isoniazid and rifampin was noted. Pancreatic mass lesion resolved on a 24 months course of five anti-tuberculous drug therapy including amikacin, levofloxacin, pyrazinamide, ethambutol, and cycloserine. This case highlights the fact that TB should be considered in the differentials of complex pancreatic cystic lesion even in the immunocompetent individuals. EUS FNA culture can help confirm the diagnosis.