Percentage Reduction In Volume Research Articles

Efficacy of Intralesional Steroid Injection in Head and Neck Hemangioma

The purpose of this article was to discuss about the use of corticosteroids in head and neck hemangioma as one of the safest noninvasive therapy, focusing on intralesional steroid injection, including perilesional and infusion, for curing or reducing tumor size. A systematic review was done by means of all English publication in PubMed during the period of 1996 to 2008 using the keywords "hemangioma" and "intralesional steroid injection." The studies involved were retrospective and prospective case reviews on using intralesional steroid injection with or without other treatment modalities. Exclusion criteria included letter to the editor, comment, and discussion. Evaluation was done covering the indication, age and sex of the patients, location of the lesion, reduction in volume and resolution after intralesional steroid injection, including perilesional and infusion, the improvement of symptoms and signs, local and systemic complications, dose, and the number of injections required to achieve the desired clinical and aesthetic results. Using the 7th ed. EndNote program, 81 abstracts were successfully retrieved. Finally, this study limited our analysis to 22 studies. A total of 749 patients received intralesional steroid injections, including perilesional and infusion, with or without other treatment modalities. Age of the participants ranged from 10 days to 4 years (mean, 4.17 months). Six references evaluated the percentage of reduction in volume and size after intralesional steroid injection; 71% revealed excellent clinical response, 23.4% good, 2.96% poor, 2% no response, and 0.6% were lost to follow-up. From the remaining, 82% of the participants revealed improvement in sign and symptoms. Three articles mentioned aesthetic evaluation, and all stated excellent to good outcome. Intralesional steroid injection is a good option for treating head and neck hemangioma at proliferative phase with relatively low complications.

Assessment of Combustion and Potash Production as Options for Management of Wood Waste

This study assessed combustion and potash production as options for management of wood waste. The percentage reduction in volume by combustion and potash generation potential of wood waste from ninedifferent common species of wood obtained from a wood factory in Ibadan were evaluated. Potash from the ashes was extracted with distilled water through a system of filtration. The amount of ash, in kilogram per cubic metre of saw dust, and the amount of potash, in kilogram per cubic metre of ash and kilogram per cubic metre of saw dust were determined. The volume of sawdust was reduced by 95% after combustion. The ash generated ranged between 1.42 – 15.18 Kg/m3; potash yield ranged between 4.74 – 53.76 Kg/m3 of ashes and 0.21 – 1.53 Kg/m3 of saw dust.

Prediction of Retroperitoneal Histology in Metastatic Nonseminomatous Testicular Cancer Patients after Chemotherapy Based on Clinical and Radiological Parameters

Introduction: We retrospectively analysed the predictive value of numerous clinical and radiological parameters to identify a predictor for either necrosis or residual tumors found by retroperitoneal lymph node dissection (RPLND) histology in a collection of nonseminomatous germ cell tumor (NSGCT) patients. Materials and Methods: A database was created containing detailed clinical, radiological and histological information of all consecutive NSGCT patients, who underwent post chemotherapy RPLND between 1984 and 2007. According to the histology of the RPLND specimen, patients were assigned to the “necrosis-only” group or the “residual tumor” group. Associations between clinical and radiological parameters and histology of RPLND were analyzed. Results: Histology of dissected masses showed complete necrosis in 57.4% of patients and residual tumors in 42.6% (3.1% viable cancer and 39.5% teratoma). Univariate analysis showed significant correlation of RPLND histology and the following parameters: teratoma-positive primary tumors, pre-chemotherapy α-fetoprotein (AFP) and – less pronounced – human chorionic gonadotropin levels, size of metastatic mass, total volume of metastatic retroperitoneal lymph nodes, and percentage of volume reduction. The best prediction for necrosis in RPLND histology was in patients with no evidence of teratomatous elements in primary tumors and with normal pre-chemotherapy AFP levels and small lymph nodes. Stepwise multivariate logistic regression analysis confirmed AFP < 10 ng/ml as the best independent predictor for only necrosis in RPLND histology. Conclusions: At the present time we still consider all patients with metastatic NSGCT as candidates for a post-chemotherapy RPLND, arguing that in experienced hands mortality is negligible and morbidity is low and therefore not relevant compared to the risk of missing a residual tumor.

Treatment response assessment of breast masses on dynamic contrast‐enhanced magnetic resonance scans using fuzzy ‐means clustering and level set segmentation

The goal of this study was to develop an automated method to segment breast masses on dynamic contrast-enhanced (DCE) magnetic resonance (MR) scans and to evaluate its potential for estimating tumor volume on pre- and postchemotherapy images and tumor change in response to treatment. A radiologist experienced in interpreting breast MR scans defined a cuboid volume of interest (VOI) enclosing the mass in the MR volume at one time point within the sequence of DCE-MR scans. The corresponding VOIs over the entire time sequence were then automatically extracted. A new 3D VOI representing the local pharmacokinetic activities in the VOI was generated from the 4D VOI sequence by summarizing the temporal intensity enhancement curve of each voxel with its standard deviation. The method then used the fuzzy c-means (FCM) clustering algorithm followed by morphological filtering for initial mass segmentation. The initial segmentation was refined by the 3D level set (LS) method. The velocity field of the LS method was formulated in terms of the mean curvature which guaranteed the smoothness of the surface, the Sobel edge information which attracted the zero LS to the desired mass margin, and the FCM membership function which improved segmentation accuracy. The method was evaluated on 50 DCE-MR scans of 25 patients who underwent neoadjuvant chemotherapy. Each patient had pre- and postchemotherapy DCE-MR scans on a 1.5 T magnet. The in-plane pixel size ranged from 0.546 to 0.703 mm and the slice thickness ranged from 2.5 to 4.5 mm. The flip angle was 15 degrees, repetition time ranged from 5.98 to 6.7 ms, and echo time ranged from 1.2 to 1.3 ms. Computer segmentation was applied to the coronal T1-weighted images. For comparison, the same radiologist who marked the VOI also manually segmented the mass on each slice. The performance of the automated method was quantified using an overlap measure, defined as the ratio of the intersection of the computer and the manual segmentation volumes to the manual segmentation volume. Pre- and postchemotherapy masses had overlap measures of 0.81 +/- 0.13 (mean +/- s.d.) and 0.71 +/- 0.22, respectively. The percentage volume reduction (PVR) estimated by computer and the radiologist were 55.5 +/- 43.0% (mean +/- s.d.) and 57.8 +/- 51.3%, respectively. Paired Student's t test indicated that the difference between the mean PVRs estimated by computer and the radiologist did not reach statistical significance (p = 0.641). The automated mass segmentation method may have the potential to assist physicians in monitoring volume change in breast masses in response to treatment.

The role of mean diffusivity (MD) as a predictive index of the response to chemotherapy in locally advanced breast cancer: a preliminary study

To evaluate the role of mean diffusivity (MD) as a predictive index of the response to chemotherapy in locally advanced breast cancer. Twenty-one women referred to our institution with a diagnosis of locally advanced breast cancer underwent magnetic resonance imaging (MRI) studies at 1.5 T before beginning and after completing combined neoadjuvant chemotherapy. The examination protocol included an EPI sequence sensitised to diffusion (b-value 1,000 s/mm(2)) and three-dimensional (3D) coronal T1 sequences before and after intravenous contrast medium. Tumours were delineated by using dynamic MR acquisition before and after chemotherapy. The percentage of tumour volume reduction (PVR) and pre-(MD(pre)) and post-therapy (MD(post)) MD values were computed for each lesion. PVR >or= 65% was observed in 17/21 patients (responders). MD(pre) of responders (0.99 +/- 0.27 10(-3) mm(2)/s) was significantly (p = 0.025) lower than MD(pre) of non-responders (1.46 +/- 0.33 10(-3) mm(2)/s). Moreover, in patients as a whole PVR significantly correlated (p = 0.01, r = -0.54) with MD(pre). MD(post) (1.26 +/- 0.39 10(-3) mm(2)/s) of responders was significantly(p = 0.024) higher than MD(pre) (0.99 +/- 0.27 mm(2) 10(-3) mm(2)/s), whereas non-responders MD(post) (1.00 +/- 0.14 10(-3) mm(2)/s)did not increase compared with MD(pre) (1.46 +/- 0.33 10(-3) mm(2)/s). This preliminary study seems to indicate that low values of pre-chemotherapy MD may identify, before starting treatment, the patients with higher probability of response in terms of percentage of volume reduction of the lesion. MD may represent a complementary parameter useful to correctly select patients for neoadjuvant chemotherapy.

Locally Advanced Rectal Cancer: MR Imaging in Prediction of Response after Preoperative Chemotherapy and Radiation Therapy

To prospectively differentiate, at magnetic resonance (MR) imaging, patients with locally advanced nonmucinous rectal cancer who will respond to long-course chemotherapy and radiation therapy (CRT) from those who will not respond, with histopathologic results as the reference standard. Institutional review board approval for this study was obtained, and all patients provided written informed consent. High-spatial-resolution T2-weighted MR images were acquired before and 6-8 weeks after CRT in 53 patients (33 men, 20 women; mean age, 63 years; age range, 42-79 years). Patients were categorized as responders to CRT (patients with T3 cancer that converted to T2 or a lower stage, patients with T4 cancer that converted to T3 or a lower stage) or as nonresponders (patients with stable or progressive disease). At the posttreatment MR imaging examination, a decrease in signal intensity was considered to represent a morphologic response with fibrosis. Before CRT and surgery, tumor volume was calculated at MR imaging by multiplying cross-sectional area by section thickness. Tumor length was measured at MR imaging and in the histopathologic specimen. Nodal downstaging was evaluated. The relationship between pathologic response, morphologic MR imaging response, and percentage volume reduction was evaluated with the Mann-Whitney-Wilcoxon two-sample test. Morphologic response assessment with MR imaging achieved a positive predictive value (PPV) of 84.2% (32 of 38) and a negative predictive value (NPV) of 66.7% (10 of 15). Volume reduction extent (> or = 70%) was significantly different between patients in whom disease was downstaged and those in whom it was not downstaged (P = .000005) and showed additional diagnostic value, with an overall accuracy of 86.8% (46 of 53). Presurgical MR imaging and histopathologic tumor length did not show a significant difference. MR imaging accuracy for lymph node (N) stage was 86.8% (46 of 53) on the basis of morphologic criteria. After CRT, morphologic and volumetric evaluation at MR imaging had a high PPV and a low NPV for response assessment. The detection of small clusters of residual tumor cells within fibrosis remains a problem. http://radiology.rsnajnls.org/cgi/content/full/250/3/730/DC1.

A Volumetric Magnetic Resonance Imaging Study of Entorhinal Cortex Volume in Dementia with Lewy Bodies

Aims: To investigate whether subjects with dementia with Lewy bodies (DLB), Alzheimer’s disease (AD) and Parkinson’s disease with dementia (PDD) have reduced entorhinal cortex (EC) volumes compared to controls and cognitively intact Parkinson’s disease (PD) subjects. Methods: Volumes of the EC were measured on magnetic resonance imaging (MRI) scans of 144 individuals (aged over 65 years): 20 with DLB, 26 with AD, 30 with PDD, 31 with PD and 37 normal age-matched controls. Results: Total normalised EC volumes were significantly smaller in DLB, AD and PDD patients compared to controls, and in DLB and AD patients compared to PD patients (p < 0.001). The percentage volume reduction in EC volume in the dementia groups relative to controls was 19.9% in DLB, 21.9% in AD and 14.7% in PDD. Conclusions: MRI measurements of the EC have shown that volumes are smaller in dementia subjects compared to controls and patients with non-dementia disorders. Further research is required to recognise those at risk of dementia and to differentiate between the dementias.

Semiquantitative Assessment of MR Imaging in Prediction of Efficacy of Gonadotropin-releasing Hormone Agonist for Volume Reduction of Uterine Leiomyoma: Initial Experience

To prospectively determine if semiquantitative assessment of R2* images and T1-weighted magnetic resonance (MR) images of leiomyomas correlates with the efficacy of gonadotropin-releasing hormone (GnRH) agonist treatment for volume reduction. Internal review board approval and informed consent were obtained for this study. Twenty women (mean age, 36.3 years) with intramyometrial leiomyomas were enrolled in this study. Single-section double-echo dynamic MR imaging was performed before GnRH agonist administration. T2-weighted images were obtained before and after two or three GnRH agonist injections (1.88 mg leuprorelin acetate). The steepest signal intensity (SI) upslope on T1-weighted images and the area under the curve (AUC) on R2* images were determined by using a 16 x 16-voxel matrix that was placed in the center of a leiomyoma. Pearson correlation analysis was performed to compare the percentage of volume reduction with SI upslope and AUC. Unpaired t test was performed to evaluate the difference between leiomyomas with AUC and SI upslope values that were less than or greater than the mean. Percentage of volume reduction ranged from 6.2% to 51.1%. The mean AUC and mean SI upslope were 39.2 and 9.83% per second, respectively. There was a significant correlation between the AUC and the percentage of volume reduction (r = 0.81, P < .001), although no significant correlation was observed between the SI upslope and the percentage of volume reduction. A significant difference in percentage of volume reduction was observed in leiomyomas by using mean AUC as a cutoff value (P = .003). AUC on R2* images correlates with the efficacy of GnRH agonist before initiation of treatment for volume reduction of leiomyoma.

Usefulness of CT volumetry for primary gastric lesions in predicting pathologic response to neoadjuvant chemotherapy in advanced gastric cancer

To investigate the utility of CT volumetry for primary gastric lesions in the prediction of pathologic response to neoadjuvant chemotherapy in patients with resectable advanced gastric cancer (AGC). Thirty-three consecutive patients with resectable AGC stage >or=T2 and N1), who had been treated with neoadjuvant chemotherapy and radical gastric resection, were prospectively enrolled in this study. There were 30 men and 3 women with a mean age of 53.8 years. Contrast-enhanced CT was obtained after gastric distention with air before and after chemotherapy using a MDCT scanner. Pre- and post-chemotherapy thickness or short diameter and volume of the primary gastric tumor and largest lymph node (LN), were measured using a dedicated 3D software by two radiologists in consensus. PET/CT was also performed and the peak standardized uptake value (SUV) of primary gastric tumor and largest LN before and after chemotherapy was measured. The percentage diameter, volume, and SUV reduction rates for both the primary gastric tumor and the LN, were calculated and correlated with the histopathologic grades of regression using the Spearman correlation test. Differentiation between pathologic responders and nonresponders was assessed using receiver operating characteristic (ROC) analysis. Among the three CT parameters which showed significant correlation with the histopathologic grades of regression, the correlation factor was highest in the percentage volume reduction rate of primary gastric tumor (rho = 0.484, P = 0.004) followed by percentage volume reduction of the index node (rho = 0.397, P = 0.022), and percentage diameter reduction of the index node (rho = 0.359, P = 0.04). However, the percentage thickness decrease rate (P = 0.208) and the percentage SUV reduction rate (P = 0.619) of primary gastric tumor were not significantly correlated with the histopathologic grades of regression. When the optimal cutoff value of the percentage volume reduction rate of primary gastric tumor was determined to be 35.6%, a sensitivity of 100% (16/16) and a specificity of 58.8% (10/17) were achieved. CT volumetry for primary gastric tumor may be the most accurate tool in the prediction of pathologic response following neoadjuvant chemotherapy in patients with resectable AGC.

WE-D-351-08: Integrated Subvolume Boosting Technique to Reduce Normal Tissue Irradiation During SBRT Treatment Planning Using Helical Tomotherapy

Purpose: To characterize the reduction in normal tissue volume irradiated in a SBRT treatment plan by delivering an inhomogeneous dose to the PTV—via integrated subvolumes prescribed to increasing doses above prescription dose—instead of a homogeneous dose using helical tomotherapy. Method and Materials: Three patients were retrospectively planned using helical tomotherapy with two treatment plans: (1) homogenous plan delivering a uniform prescription dose to the PTV and (2) inhomogeneous plan delivering a non‐uniform dose to the PTV. Subvolumes were created by volumetrically contracting the PTV by 4mm resulting in three subvolumes within the PTV (PTVi, PTVii, and PTViii). Dose prescriptions to the various targets were as follows: Homogenous: PTV: 95% of volume to receive 60.0Gy; Inhomogeneous: PTViii: 20% of volume to receive 80.0Gy, PTVii: 50% of volume to receive 75.0Gy, PTVi: 50% of volume to receive 70.0Gy, PTV: 95% of volume to receive 60.0Gy. The homogenous and inhomogeneous plans were compared on the basis of normal tissue volume reductions to various dose levels assuming identical target coverage of the PTV. Results: A significant reduction in the volume of normal tissue irradiated to high doses was achieved for all patients. Average reduction of V90%, V80%, V50%, and V20% were 18, 15, 9, and 7%, respectively. It was noted that as the dose level decreases, the percent volume reduction between the homogeneous and inhomogeneous plans decreases. Conclusion: The study served to quantify the volumetric reduction of normal tissue irradiated during lungSBRT treatments with helical tomotherapy when delivering non‐uniform doses to the PTV as compared to uniform doses. Our results indicate that an inhomogeneous dose distribution generated by the creation of integrated subvolumes prescribed to higher doses within the PTV significantly reduces the volume of normal tissue irradiated, especially at higher doses (>50% of prescription dose).

Long-term Outcome of Uterine Artery Embolization for Symptomatic Uterine Leiomyomas

To evaluate long-term outcomes and factors associated with treatment failure after uterine artery embolization (UAE) in women with symptomatic uterine leiomyomas. One hundred consecutive women treated with UAE for symptomatic uterine leiomyomas participated. Clinical outcome data (ie, changes in symptoms, menstrual status, subsequent therapies) and satisfaction data were collected. Treatment failure was defined by subsequent major surgery (ie, hysterectomy or myomectomy), a second embolization, or a lack of symptom improvement at the patient's final follow-up interval. Possible predictors of failure were age, clinical baseline characteristics (ie, bleeding, pain, and bulk), and imaging results (eg, percent volume reduction of the dominant tumor). Cox proportional-hazards analysis was used to determine factors associated with failure. Follow-up was available in 93 women (median follow-up, 54 months; range, 45-87 y). Continued symptom relief was observed in 72% of patients (n = 67). Among the 26 women with treatment failure (28%), 11 (42%) underwent hysterectomy, four (15%) myomectomy, and eight (31%) repeat embolization. Three (12%) reported no improvement. In women without any additional surgery (n = 70), heavy menstrual bleeding, pain, and bulk-related symptoms improved in 97%, 93%, and 92%. Ninety percent of all women (n = 93) were satisfied or very satisfied at final follow-up. Predictors of failure were a lack of improvement in bleeding (hazard ratio [HR], 9.0; 95% CI, 3.1-26.3; P < .001) or pain (HR, 7.4; 95% CI, 2.2-24.4; P < .001) at 1 year after UAE and the percent reduction in dominant tumor volume (HR, 0.97; 95% CI, 0.95-0.99; P = .007). UAE in women with symptomatic leiomyomas leads to long-term symptom improvement. Predictors of failure were a lack of improvement in bleeding or pain at 1 year and the percent reduction in dominant tumor volume.

Photoselective Potassium Titanyl Phosphate (KTP) Laser Vaporization Versus Transurethral Resection of the Prostate for Prostates Larger Than 70 mL: A Short-Term Prospective Randomized Trial

To compare the short term outcomes of photoselective vaporization (PVP) and transurethral resection of the prostate (TURP) for glands larger than 70 mL in a prospective randomized trial. Seventy-six consecutive patients with enlarged prostatic adenomas of 70 to 100 mL were randomly assigned for surgical treatment with TURP (n = 37) or PVP (n = 39). International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5) scores, maximum flow rates (Qmax), postvoid urine residues (PVR), and transrectal ultrasound (TRUS) volumes were recorded. Operative data, complications, catheter removal, and hospitalization periods were also recorded. Patients were reassessed at 3 and 6 months. Baseline characteristics of both groups were similar. Mean preoperative TRUS volume was 88 +/- 9.2 mL in the TURP group and 86.1 +/- 8.8 mL in the PVP group. The procedure was significantly shorter for the TURP group (51 +/- 17.2 minutes versus 87 +/- 18.3 minutes, P <0.05), catheter removal (3.9 +/- 1.2 days and 1.7 +/- 0.8 days, P <0.05), and hospital stay (4.8 +/- 1.2 days versus 2 +/- 0.7 days, P <0.05) were shorter in the PVP group. A significant difference in IPSS, Qmax and PVR values was observed within the follow-up period in favor of the TURP. The percentage volume reduction was significantly higher in TURP group. Reoperation was necessary in 7 patients in PVP but none in TURP group. Although PVP offers advantageous over TURP with regard to intraoperative and perioperative safety, early functional results of TURP are superior to PVP in patients with enlarged prostates larger than 70 mL.

Use of Noncontact Low-Frequency Ultrasound in the Treatment of Chronic Foot and Leg Ulcerations

A feasibility study was conducted to characterize the effects of noncontact low-frequency ultrasound therapy for chronic, recalcitrant lower-leg and foot ulcerations. The study was an open-label, nonrandomized, baseline-controlled clinical case series. Patients were initially treated with the Mayo Clinic standard of care before the addition of or the switch to noncontact low-frequency ultrasound therapy. We analyzed the medical records of 51 patients (median +/- SD age, 72 +/- 15 years) with one or more of the following conditions: diabetes mellitus, neuropathy, limb ischemia, chronic renal insufficiency, venous disease, and inflammatory connective tissue disease. All of the patients had lower-extremity ulcers, 20% had a history of amputation, and 65% had diabetes. Of all the wounds, 63% had a multifactorial etiology, and 65% had associated transcutaneous oximetry levels below 30 mm Hg. The mean +/- SD treatment time of wounds during the baseline standard of care control period versus the noncontact low-frequency ultrasound therapy period was 9.8 +/- 5.5 weeks versus 5.5 +/- 2.8 weeks (P < .0001). Initial and end measurements were recorded, and percent volume reduction of the wound was calculated. The mean +/- SD percent volume reduction in the baseline standard of care control period versus the noncontact low-frequency ultrasound therapy period was 37.3% +/- 18.6% versus 94.9% +/- 9.8% (P < .0001). Using noncontact low-frequency ultrasound improved the rate of healing and closure in recalcitrant lower-extremity ulcerations.

Effect of System Parameters and Cutter heads on Processing of Water Hyacinth

The effect of two system parameters namely, cutter head speeds and feed rates on compression characteristics of water hyacinth viz percent reduction in volume and weight were studied. The cylindrical cutter with shear bar gave maximum volume reduction 01'

Predictive Factors of Response to Intensive Decongestive Physiotherapy in Upper Limb Lymphedema After Breast Cancer Treatment: a Cohort Study

Lymphedema is a frequent complication after breast cancer treatment. Reduction of lymphedema volume is obtained during an intensive phase with daily physiotherapy. Response to treatment remains unknown prior treatment. We purposed to analyze predictors of response of lymphedema treatment throughout the first course of physiotherapy. Patients with secondary arm lymphedema were recruited in a single lymphology unit between 2001 and 2004. For each patient, the following data were recorded: characteristics of breast cancer treatment, patient characteristics, body mass index and lymphedema volume prior and at the end of treatment. Three hundred and fifty-seven women (mean age: 53+/-11 years) were included. Initial excess volume of lymphedema was correlated to body mass index and duration of lymphedema. Mean duration of intensive decongestive therapy was 11.8+/-3.3 days. Mean excess volume of lymphedema was 1067+/-622 ml prior treatment and 663+/-366 ml after treatment (p<0.001), percentage of excess volume of lymphedema was 59+/-34% and 36+/-19%, respectively. Absolute volume reduction was 404+/-33 ml (p<0.001). Body mass index and duration of lymphedema before treatment were the two predictors of absolute reduction of lymphedema volume. Higher was the body mass index or the duration of lymphedema, more important was the absolute reduction of lymphedema volume. Mean relative percentage of volume reduction was 36+/-14% whatever mass index or the duration of lymphedema was. Duration of lymphedema from cancer treatment and body mass index were the only two predictors of absolute reduction of lymphedema volume after intensive decongestive physiotherapy. For all patients this latter treatment is highly effective in management of secondary upper limb lymphedema after breast cancer.

Volume Analysis of Arthroscopic Capsular Shift

To determine how much volume reduction can be obtained with varying amounts of arthroscopic capsular plication. Six fresh-frozen, cadaveric specimens were used. Specimens were rejected if a rotator cuff tear was present. The volume of each shoulder joint was measured under 3 conditions: no capsular shift, 5-mm capsular shift, and 10-mm capsular shift. For each shift, 4 sutures were placed arthroscopically, 2 anteriorly and 2 posteriorly. Repeated measures were used to confirm the validity of the measurements. Data were analyzed with parametric and nonparametric tests. The average percentage of volume reduction at 5 mm of capsular plication from control was 16.2% (range, 9.7% to 21.5%). The percentage of volume reduction from control to 10 mm of capsular plication averaged 33.7% (range, 25.3% to 44.6%). Statistical significance was found with both parametric (P < .0001) and nonparametric tests (P < .0313). The current study found that capsular volume reduction was related to the amount of capsular plication with reproducible results. Capsular plication can produce volume reduction comparable to other techniques. The data could be used to determine the potential number of sutures and amount of tissue plication needed for the amount of laxity found at surgery.

Compressibilidade de um Latossolo Vermelho argiloso de acordo com a tensão de água no solo, uso e manejo

Uma das principais conseqüências do manejo inadequado do solo é a sua compactação, que leva à perda da sustentabilidade agrícola. O objetivo deste trabalho foi o de estudar o comportamento compressivo de um Latossolo Vermelho argiloso, sob quatro tensões de água no solo, sob cerrado, sob plantio direto e cultivo convencional, utilizando-se o arado de discos, após duas décadas de uso. Amostras não deformadas foram utilizadas na caracterização da porosidade do solo e nos ensaios de compressão uniaxial. As pressões de preconsolidação e os índices de compressão foram obtidos das curvas de compressão do solo. A densidade do solo foi também avaliada. Amostras deformadas foram utilizadas nas análises físicas e químicas do solo. As tensões de água no solo dentro da faixa compreendida entre capacidade de campo e ponto de murcha permanente e os sistemas de uso e manejo influíram na intensidade de deformação do solo, sendo os valores mais elevados na capacidade de campo do solo (6 kPa) e no cerrado. Os valores de pressões que podem reduzir a porosidade do solo a níveis críticos ao crescimento de plantas variaram em todos os sistemas de manejo, mas apresentaram os menores valores para as condições mais úmidas, sendo função também da porosidade inicial do solo. Independentemente do sistema de manejo, tensão de água e profundidade do solo, os valores percentuais da redução do volume total de poros nas pressões que não provocam compactação adicional do solo (pressão de preconsolidação) foram praticamente constantes e, em geral, abaixo de 10 %.

Prostate Volume Reduction With Androgen Deprivation Therapy Before Interstitial Brachytherapy

We assessed the degree of prostate downsizing using androgen deprivation, and determined its relation to clinical and pathological variables. From June 1994 to January 2000, 107 patients with prostate cancer received androgen deprivation before interstitial brachytherapy at our hospital. All charts were reviewed for clinical, pathological and treatment related variables. Prostate volume was measured using transrectal ultrasound. All variables were analyzed with regard to the degree of prostate downsizing. Mean percent volume reduction of the prostate was 33% after a 3.7-month average duration of androgen deprivation. Larger prostate volume before androgen deprivation and longer deprivation duration statistically correlated with mean percent volume reduction. Simple linear and multiple regression analyses revealed that these 2 variables remained significant predictors of percent volume reduction. Subgroup analysis indicated that a significant difference was seen in patients who received androgen deprivation with luteinizing hormone releasing hormone agonists alone versus those who received treatment with total androgen blockade (luteinizing hormone releasing hormone agonists plus antiandrogens 30% versus 35%, p = 0.04), and when prostate volume before androgen deprivation was less than 50 cc versus larger volumes (30% versus 35%, p = 0.01). Of patients with an initial prostate volume of greater than 50 cc 82% achieved a volume of less than 50 cc after androgen deprivation therapy. Androgen deprivation therapy before brachytherapy is a method of downsizing the prostate to overcome anatomical limitations, including larger gland volume and pubic arch interference.

Leiomyomata treated with uterine artery embolization: factors associated with successful symptom and imaging outcome.

To determine whether baseline variables are associated with treatment success after uterine artery embolization for treatment of uterine leiomyoma. Two hundred consecutive patients who underwent uterine artery embolization at one institution were prospectively examined. Baseline clinical variables measured included age, race, prior oral contraceptive use or progesterone treatment, prior gonadotropin-releasing hormone agonist treatment, and prior births. Imaging parameters were baseline uterine volume, baseline leiomyoma volume and location, and number of leiomyomas. After treatment, follow-up imaging and questionnaire data were obtained at 3 and 12 months. Associations between baseline characteristics and outcome variables of interest were assessed by using linear regression, logistic regression, Pearson product moment correlation coefficients, and Kendal tau correlation coefficients, with adjustment for confounding variables when indicated. Regression models indicated that larger dominant leiomyoma volume was associated with a smaller percentage reduction in volume at 3 months (P =.03). A submucosal leiomyoma location was associated with a greater volume reduction at 3 months (P =.04), but this difference did not persist at 12 months (P =.09). The odds of reported menstrual bleeding improvement at 3 months were higher with a submucosal leiomyoma location (P =.04); however, this association was not statistically significant after adjustment (P =.07). The odds of improved bulk-related symptoms were not associated with leiomyoma volume change or location. Smaller baseline leiomyoma size and submucosal location are more likely to result in a positive imaging outcome. There are limited associations between other baseline parameters and either symptom change or imaging outcome.

Radioiodine and percutaneous ethanol injection in the treatment of large toxic thyroid nodule: a long-term study.

Surgery is generally recommended for large thyroid toxic nodules (TTNs). When surgery is not applicable, both radioactive iodine (RAI) and percutaneous ethanol injection (PEI) are alternative treatments. In this retrospective study, the long-term efficacy of nonsurgical treatments was evaluated in 43 patients with TTN, selected on the basis of presence of hyperthyroidism and a fairly large nodule (3- and 4-cm in diameter) completely inhibiting controlateral lobe captation during scintigraphy. Twenty-one patients were treated by RAI (administered dose 670+/-160 MBq; range 555-925) and twenty-two were treated by PEI (6+/-1 sessions; range 5-9). FT4, FT3, thyrotropin (TSH), and nodule volume were assessed before and at fixed intervals after treatment. Median follow-up was 36 months (range, 12-84). Compared to baseline values, with both therapies, serum FT4, FT3, and nodule volume were decreased (p < 0.01) and serum TSH was increased (p < 0.01), after 3 months and during the entire follow-up. Nodule volume reduction percentage was 66.8+/-22.0 and 78.4+/-18.0, in the RAI- and PEI-treated groups, respectively. At the end of follow-up, 34 patients were euthyroid (16 RAI- and 18 PEI-treated). Four RAI-treated patients (19%) showed slightly high TSH levels (4.2-5.3 mU/L), whereas three PEI-treated patients (13.6%) still had suppressed TSH levels, although being clinically asymptomatic. One RAI-treated patient (4.8%) showed overt hypothyroidism during the follow-up period and was then treated with L-thyroxin. One patient (4.6%), who was initially cured by PEI, became newly hyperthyroid during the follow-up period. Both treatments were well-tolerated. In conclusion, both of these nonsurgical treatments are effective and may be chosen also for relatively large TTNs. Specifically, RAI seems to be more effective for treating hyperthyroidism but has minimal sequelae of subclinical or clinical hypothyroidism, while, after PEI treatment the possibility of stable subclinical hyperthyroidism or hyperthyroidism relapse should be taken into account.