WorldWideScience

Sample records for acute total body

  1. Acute and delayed toxicities of total body irradiation

    Deeg, H.J.

    1983-12-01

    Total body irradiation is being used with increasing frequency for the treatment of lymphopoietic malignancies and in preparation for marrow transplantation. Acute toxicities include reversible gastroeneritis, mucositis, myelosuppression alopecia. As the success of treatment improves and more patients become long-term survivors, manifestations of delayed and chronic toxicity become evident. These include impairment of growth and development, gonadal failure and sterility, cataract formation and possibly secondary malignancies. The contribution of total body irradiation to the development of pneumonitis and pulmonary fibrosis is still poorly understood. Some of these changes are reversible or correctable, whereas others are permanent. Nevertheless, until equally effective but less toxic regimens become available, total body irradiation appears to be the treatment of choice to prepare patients with leukemia for marrow transplantation.

  2. Acute and delayed toxicities of total body irradiation

    Total body irradiation is being used with increasing frequency for the treatment of lymphopoietic malignancies and in preparation for marrow transplantation. Acute toxicities include reversible gastroeneritis, mucositis, myelosuppression alopecia. As the success of treatment improves and more patients become long-term survivors, manifestations of delayed and chronic toxicity become evident. These include impairment of growth and development, gonadal failure and sterility, cataract formation and possibly secondary malignancies. The contribution of total body irradiation to the development of pneumonitis and pulmonary fibrosis is still poorly understood. Some of these changes are reversible or correctable, whereas others are permanent. Nevertheless, until equally effective but less toxic regimens become available, total body irradiation appears to be the treatment of choice to prepare patients with leukemia for marrow transplantation

  3. Clinical aspects of accidents resulting in acute total body irradiation

    That the management of whole body radiation injury involves: (1) watchful waiting, (2) observation of the hematologic parameters, (3) use of antibiotics, platelet red cell and possibly granulocyte transfusions, (4) administration of hemopoietic molecular regulators of granulopoiesis, and (5) bone marrow transplantation as the last line of defense. The clinical indication for the preceding will not be discussed, since this will be a subject of later speakers in this conference. Certainly, if a radiation casualty is fortunate enough to have an identical twin, a marrow transplant may be lifesaving and certainly can do no harm to the patient, and there is little risk to the donor

  4. An Acute Transverse Myelitis Attack after Total Body Irradiation: A Rare Case

    Muzaffer Keklik

    2013-01-01

    Full Text Available Total body irradiation (TBI combined with chemotherapy is widely used as a pretreatment regimen of bone marrow transplantation (BMT in hematologic disorders. Late complications related to TBI as part of the conditioning regimen for hematopoietic stem cell transplantation have been revealed. Acute transverse myelitis (ATM is a neurological syndrome characterized by disorder of motor, sensorial, and autonomic nerves, and tracts at medulla spinalis, which is resulted from involvement of spinal cord. In this paper, we presented an ATM attack developed after TBI in a patient with acute lymphoblastic leukemia (ALL as it is a rarely seen case.

  5. An Acute Transverse Myelitis Attack after Total Body Irradiation: A Rare Case

    Ali Unal; Bulent Eser; Mustafa Cetin; Cigdem Pala; Serife Cingoz; Celalettin Eroglu; Serdar Sivgin; Leylagul Kaynar; Afra Yildirim; Muzaffer Keklik

    2013-01-01

    Total body irradiation (TBI) combined with chemotherapy is widely used as a pretreatment regimen of bone marrow transplantation (BMT) in hematologic disorders. Late complications related to TBI as part of the conditioning regimen for hematopoietic stem cell transplantation have been revealed. Acute transverse myelitis (ATM) is a neurological syndrome characterized by disorder of motor, sensorial, and autonomic nerves, and tracts at medulla spinalis, which is resulted from involvement of spina...

  6. Mitochondrial DNA alterations of peripheral lymphocytes in acute lymphoblastic leukemia patients undergoing total body irradiation therapy

    2011-01-01

    Background Mitochondrial DNA (mtDNA) alterations, including mtDNA copy number and mtDNA 4977 bp common deletion (CD), are key indicators of irradiation-induced damage. The relationship between total body irradiation (TBI) treatment and mtDNA alterations in vivo, however, has not been postulated yet. The aim of this study is to analyze mtDNA alterations in irradiated human peripheral lymphocytes from acute lymphoblastic leukemia (ALL) patients as well as to take them as predictors for radiatio...

  7. Clinical analysis of patients with acute radiation syndrome due to total body irradiation or total lymphatic irradiation

    Objective: To study the severity of iatrogenic acute radiation syndrome, treatment, hematopoietic recovery and related complications in patients subjected to total body irradiation (TBI) or total lymphatic irradiation (TLI) prior to hematopoietic stem cell transplantation. Methods: 100 tumor patients (91 with leukemia and 9 with other tumors), after receiving 500∼1000 cGy (in an average of 738.6 cGy) of TBI or TLI with super high dose chemotherapy as conditioning regimen during the process of hemopoietic stem cell transplantation, developed severe or even extremely severe, mainly bone marrow form acute radiation syndrome. Results: The patients' white blood cell count once dropped to (0∼0.15) x 109/L, platelet count fell to (1∼17) x 109/L, bone marrow was depleted with only a few non-hemopoietic cells and rare hemopoietic cells, and a high risk of complicating with infection and hemorrhage was observed. Treated with a variety of measures including protective isolation, supportive care, administration of growth factors such as GM-CSF or G-CSF, blood component transfusion and effective antibiotics, 92 cases restored their normal hemopoiesis, while 8 cases died of infection or hemorrhage. The clinical course of these patients indicated that a majority of the patients with severe and extremely severe, iatrogenic acute radiation syndrome involving bone marrow could restore their normal hemopoiesis, and hemopoietic stem cell transplantation played an important role in the treatment. Conclusion: Hemopoietic stem cell transplantation and administration of growth factors are very useful for the treatment of acute radiation syndrome

  8. Acute Radiation Syndrome Severity Score System in Mouse Total-Body Irradiation Model.

    Ossetrova, Natalia I; Ney, Patrick H; Condliffe, Donald P; Krasnopolsky, Katya; Hieber, Kevin P

    2016-08-01

    Radiation accidents or terrorist attacks can result in serious consequences for the civilian population and for military personnel responding to such emergencies. The early medical management situation requires quantitative indications for early initiation of cytokine therapy in individuals exposed to life-threatening radiation doses and effective triage tools for first responders in mass-casualty radiological incidents. Previously established animal (Mus musculus, Macaca mulatta) total-body irradiation (γ-exposure) models have evaluated a panel of radiation-responsive proteins that, together with peripheral blood cell counts, create a multiparametic dose-predictive algorithm with a threshold for detection of ~1 Gy from 1 to 7 d after exposure as well as demonstrate the acute radiation syndrome severity score systems created similar to the Medical Treatment Protocols for Radiation Accident Victims developed by Fliedner and colleagues. The authors present a further demonstration of the acute radiation sickness severity score system in a mouse (CD2F1, males) TBI model (1-14 Gy, Co γ-rays at 0.6 Gy min) based on multiple biodosimetric endpoints. This includes the acute radiation sickness severity Observational Grading System, survival rate, weight changes, temperature, peripheral blood cell counts and radiation-responsive protein expression profile: Flt-3 ligand, interleukin 6, granulocyte-colony stimulating factor, thrombopoietin, erythropoietin, and serum amyloid A. Results show that use of the multiple-parameter severity score system facilitates identification of animals requiring enhanced monitoring after irradiation and that proteomics are a complementary approach to conventional biodosimetry for early assessment of radiation exposure, enhancing accuracy and discrimination index for acute radiation sickness response categories and early prediction of outcome. PMID:27356057

  9. Total body irradiation and syngeneic marrow transplantation in an inbred rat model of acute myelogenous leukemia

    While acute myelogenous leukemia (AML) occurs rarely in laboratory animals, over 20 model systems have been reported. One of these, AML of the inbred Wistar/Furth rat, has been shown to be pathophysiologically similar to human AML. Ten days after intravenous inoculation of 1.0 x 106 cells of a tissue culture grown clonal line, rats demonstrated peripheral blood leukemia, replacement of greater than 90% of the bone marrow with distinctive malignant myeloblasts and a syndrome of hypermuramidase (lysozyme) emia and muramidasuria. Total body irradiation (TBI) at 10 days after leukemia cell passage with a marrow lethal dose (950 rad, 140 rad/min, 137Cs source, 663 kV) followed by intravenous inoculation of 5.0 x 108/kg viable syngeneic bone marrow cells produced transient complete remissions. Repopulation with transplanted marrow was detected along with increasing numbers of recognizable W/Fu AML cells in peripheral blood, marrow, and central nervous system. The delayed leukemia relapse in irradiated transplanted rats compared to irradiated non-transplanted controls suggests an interaction between surviving W/Fu AML cells and transplanted marrow. This model may be of value in studies designing a therapeutic interaction against AML by donor marrow in the chemotherapy, immunotherapy, and total body irradiated patient

  10. Long-term results of total body irradiation in adults with acute lymphoblastic leukemia

    The aim of this chart review of adult patients treated for acute lymphoblastic leukemia (ALL) with total body irradiation (TBI) was to evaluate early and late toxicity and long-term outcome. A total of 110 adult patients (34 ± 12 years) with ALL underwent TBI (6 fractions of 2 Gy for a total of 12 Gy) as a part of the treatment regimen before transplantation. Treatment-related toxicity, mortality, and hematologic outcome are reported. Mean follow-up was 70 months. The 2- and 5-year leukemia-free survival rates were 78 and 72 %, respectively. In all, 29 % (32/110) patients suffered from medullary recurrence after a median time of 7 months. Gender was the only statistically significant prognostic factor in terms of overall survival in favor of female patients. Treatment-related mortality and overall survival after 2 and 5 years were 16 and 22 %, and 60 and 52.7 %, respectively. The most frequent late reaction wascGVHD of the skin (n = 33, 30 %). In addition, 15.5 % (17/110 patients) suffered pulmonary symptoms, and 6 patients developed lung fibrosis. Eyes were frequently affected by the radiation (31/110 = 28 %); 12 of 110 patients (11 %) presented with symptoms from osteoporosis, 5 of 110 patients (4.5 %) developed hypothyreosis and 2 patients diabetes mellitus. Of the male patients, 11 % reported erectile dysfunction or loss of libido, while 2 of 36 women reported menopausal syndrome at the mean time of 28 months after treatment with requirement for substitution. No women became pregnant after treatment. No acute or late cardiac toxicities were documented in our patients. No secondary malignancies were documented. Although hematologic outcome was in the upper range of that reported in the literature, treatment-related mortality (TRM) and medullary recurrences remain a challenge. Sophisticated radiation techniques allow for decreasing toxicity to certain organs and/or dose escalation to the bone marrow in highly selected patients in order to improve therapeutic

  11. Prospective neurodevelopmental studies of two children treated with total body irradiation and bone marrow transplantation for acute leukemia in infancy

    Five-year neurodevelopmental studies of two infants with acute leukemia are presented. Both patients underwent bone marrow transplantation (BMT) after conditioning with cyclophosphamide and total body irradiation (TBI). Neither patient was treated with intrathecal chemotherapy. Their outcome is remarkable for normal development of intelligence, language, perception, and motor coordination. These results suggest that TBI and BMT should be considered in future therapeutic studies of infants with acute leukemia, who are at great risk for failure of conventional therapy

  12. Mitochondrial DNA alterations of peripheral lymphocytes in acute lymphoblastic leukemia patients undergoing total body irradiation therapy

    Ji Fuyun

    2011-10-01

    Full Text Available Abstract Background Mitochondrial DNA (mtDNA alterations, including mtDNA copy number and mtDNA 4977 bp common deletion (CD, are key indicators of irradiation-induced damage. The relationship between total body irradiation (TBI treatment and mtDNA alterations in vivo, however, has not been postulated yet. The aim of this study is to analyze mtDNA alterations in irradiated human peripheral lymphocytes from acute lymphoblastic leukemia (ALL patients as well as to take them as predictors for radiation toxicity. Methods Peripheral blood lymphocytes were isolated from 26 ALL patients 24 hours after TBI preconditioning (4.5 and 9 Gy, respectively. Extracted DNA was analyzed by real-time PCR method. Results Average 2.31 times mtDNA and 0.53 fold CD levels were observed after 4.5 Gy exposure compared to their basal levels. 9 Gy TBI produced a greater response of both mtDNA and CD levels than 4.5 Gy. Significant inverse correlation was found between mtDNA content and CD level at 4.5 and 9 Gy (P = 0.037 and 0.048. Moreover, mtDNA content of lymphocytes without irradiation was found to be correlated to age. Conclusions mtDNA and CD content may be considered as predictive factors to radiation toxicity.

  13. Mitochondrial DNA alterations of peripheral lymphocytes in acute lymphoblastic leukemia patients undergoing total body irradiation therapy

    Mitochondrial DNA (mtDNA) alterations, including mtDNA copy number and mtDNA 4977 bp common deletion (CD), are key indicators of irradiation-induced damage. The relationship between total body irradiation (TBI) treatment and mtDNA alterations in vivo, however, has not been postulated yet. The aim of this study is to analyze mtDNA alterations in irradiated human peripheral lymphocytes from acute lymphoblastic leukemia (ALL) patients as well as to take them as predictors for radiation toxicity. Peripheral blood lymphocytes were isolated from 26 ALL patients 24 hours after TBI preconditioning (4.5 and 9 Gy, respectively). Extracted DNA was analyzed by real-time PCR method. Average 2.31 times mtDNA and 0.53 fold CD levels were observed after 4.5 Gy exposure compared to their basal levels. 9 Gy TBI produced a greater response of both mtDNA and CD levels than 4.5 Gy. Significant inverse correlation was found between mtDNA content and CD level at 4.5 and 9 Gy (P = 0.037 and 0.048). Moreover, mtDNA content of lymphocytes without irradiation was found to be correlated to age. mtDNA and CD content may be considered as predictive factors to radiation toxicity

  14. Long-term results of total body irradiation in adults with acute lymphoblastic leukemia

    Marnitz, Simone; Zich, Alexander; Budach, Volker; Jahn, Ulrich; Neumann, Oliver [Charite University Medicine, Department of Radiation Oncology, Berlin (Germany); Martus, Peter [University Tuebingen, Institute of Clinical Epidemiology and Applied Biostatistics, Tuebingen (Germany); Arnold, Renate [Charite University Medicine, Campus CVK, Department of Hematology and Oncology, Bone Marrow Transplant Unit, Berlin (Germany)

    2014-05-15

    The aim of this chart review of adult patients treated for acute lymphoblastic leukemia (ALL) with total body irradiation (TBI) was to evaluate early and late toxicity and long-term outcome. A total of 110 adult patients (34 ± 12 years) with ALL underwent TBI (6 fractions of 2 Gy for a total of 12 Gy) as a part of the treatment regimen before transplantation. Treatment-related toxicity, mortality, and hematologic outcome are reported. Mean follow-up was 70 months. The 2- and 5-year leukemia-free survival rates were 78 and 72 %, respectively. In all, 29 % (32/110) patients suffered from medullary recurrence after a median time of 7 months. Gender was the only statistically significant prognostic factor in terms of overall survival in favor of female patients. Treatment-related mortality and overall survival after 2 and 5 years were 16 and 22 %, and 60 and 52.7 %, respectively. The most frequent late reaction wascGVHD of the skin (n = 33, 30 %). In addition, 15.5 % (17/110 patients) suffered pulmonary symptoms, and 6 patients developed lung fibrosis. Eyes were frequently affected by the radiation (31/110 = 28 %); 12 of 110 patients (11 %) presented with symptoms from osteoporosis, 5 of 110 patients (4.5 %) developed hypothyreosis and 2 patients diabetes mellitus. Of the male patients, 11 % reported erectile dysfunction or loss of libido, while 2 of 36 women reported menopausal syndrome at the mean time of 28 months after treatment with requirement for substitution. No women became pregnant after treatment. No acute or late cardiac toxicities were documented in our patients. No secondary malignancies were documented. Although hematologic outcome was in the upper range of that reported in the literature, treatment-related mortality (TRM) and medullary recurrences remain a challenge. Sophisticated radiation techniques allow for decreasing toxicity to certain organs and/or dose escalation to the bone marrow in highly selected patients in order to improve therapeutic

  15. The role of total body irradiation in preparation for bone marrow transplantation in acute leukaemia. A review

    From extrapolation obtained from animal studies and radiation accidents, it is assumed that for man the LD 50 (30) will be between 300-500 rads total body irradiation (TBI) and the LD 100 at least 600 rads TBI. A dose of 1000 rads TBI is generally used in man for conditioning for bone marrow transplantation. In acute leukemia, total body irradiation is usually associated with cytoreductive chemotherapy. In Seattle 110 patients underwent bone marrow transplantation for acute leukemia in relapse. 15 patients became long term survivors. The main cause of failure were GVH, interstitial pneumonitis and leukemic relapse. New attempts are being made to improve the results: (1) better cytoreductive therapy preceding transplantation, (2) bone marrow transplantation during remission of the disease, (3) prevention of interstitial pneumonitis by modifications of the TBI technique

  16. Acute central nervous system (CNS) toxicity of total body irradiation (TBI) measured using neuropsychological testing of attention functions

    Purpose: The purpose of this study was to investigate acute normal tissue damage of low irradiation doses to the healthy, adult central nervous system (CNS) using neuropsychological testing of attention functions. Methods and Materials: Neuropsychological testing (IQ, attention [modified Trail-Making Test A, Digit Symbol Test, D2 Test, Wiener Determination Machine]) was used to examine 40 patients (43 ± 10 years) before and immediately after the first fraction (1.2 Gy) of hyperfractionated total body irradiation (TBI) at the University of Heidelberg. The patients received antiemetic premedication. Test results are given as mean percentiles ± standard deviation, with 50 ± 34 being normal. Thirty-eight control patients (53 ± 15 years) were studied to quantify the influence of hospitalization, stress, and repeated testing. Results: The patients showed normal baseline test results (IQ = 101 ± 14, attention = 54 ± 28) and no decrease in test results after 1.2 Gy TBI. Attention functions improved (66 ± 25) corresponding to a practice effect of repeated testing that was seen in the control group, although alternate versions of the tests were used (IQ = 104 ± 10, attention before = 42 ± 29, attention after = 52 ± 31). Conclusion: Our data show no deterioration of neuropsychologic test results acutely after 1.2 Gy whole body exposure in adult patients without CNS disease receiving antiemetic medication

  17. Helical tomotherapy targeting total bone marrow after total body irradiation for patients with relapsed acute leukemia undergoing an allogeneic stem cell transplant

    Background and purpose: To report our clinical experience in planning and delivering total marrow irradiation (TMI) after total body irradiation (TBI) in patients with relapsed acute leukemia undergoing an allogeneic stem-cell transplant (SCT). Materials and Methods: Patients received conventional TBI as 2 Gy BID/day for 3 days boosted the next day by TMI (2 Gy in a single fraction) and followed by cyclophosphamide (Cy) 60 mg/kg for 2 days. While TBI was delivered with linear accelerator, TMI was performed with helical tomotherapy (HT). Results: Fifteen patients were treated from July 2009 till May 2010, ten with acute myeloid leukemia, and five with acute lymphoid leukemia. At the time of radiotherapy eight patients were in relapse and seven in second or third complete remission (CR) after relapse. The donor was a matched sibling in 7 cases and an unrelated donor in 8 cases. Median organ-at-risk dose reduction with TMI ranged from 30% to 65% with the largest reduction (-50%-65%) achieved for brain, larynx, liver, lungs and kidneys. Target areas (bone marrow sites and spleen in selected cases) were irradiated with an optimal conformity and an excellent homogeneity. Follow-up is short ranging from 180 to 510 days (median 310 days). However, tolerance was not different from a conventional TBI-Cy. All patients treated with TBI/TMI reached CR after SCT. Three patients have died (2 for severe GvHD, 1 for infection) and 2 patients showed relapsed leukemia. Twelve patients are alive with ten survivors in clinical remission of disease. Conclusions: This study confirms the clinical feasibility of using HT to deliver TMI as selective dose boost modality after TBI. For patients with advanced leukemia targeted TMI after TBI may be a novel approach to increase radiation dose with low risk of severe toxicity.

  18. An experimental model of acute encephalopathy after total body irradiation in the rat: effect of Ginkgo biloba extract (EGb 761)

    To define the therapeutic effect of Ginkgo biloba extract (EGb 761) in an experimental model of acute encephalopathy following total body irradiation in rats. Ninety four-month-old rats received 4.5 Gy total body irradiation (TBI) at day 1 while 15 rats received sham irradiation. A behavioural study based on a conditioning test of negative reinforcement, the one-way avoidance test, was performed test, was performed after irradiation. Orally treatment was started one day (study A) or twenty two days (study B) after irradiation and repeated daily for twelve days. In the irradiated group, three subgroups were defined according to the treatment received: EGb 761 (50 mg/kg), EGb 761 (100 mg/kg), water. This work comprised two consecutive studies. In study A (45 rats) the one-way avoidance test was administered daily from day 7 to day 14. In study B (45 rats) the behavioural test was performed from day 28 to day 35. Study A (three groups of 15 rats): following TBI, irradiated rats treated with water demonstrated a significant delay in a learning the one-way avoidance test in comparison with sham-irradiated rats (P < 0.0002) or irradiated rats treated with EGb 761 (50 mg/kg; P < 0.007) or EGb 761 (100 mg/kg; P < 0.0002). The irradiated rats, treated with EGb 761 (50 or 100 mg/kg) did not differ from the sham-irradiated controls. Study B (three groups of 15 rats): the irradiated rats, treated with water of EGb 761 (50 or 100 mg/kg) did not differ from the sham-irradiated controls. (authors)

  19. Hyperfractionated high-dose total body irradiation in bone marrow transplantation for Ph{sup 1}-positive acute lymphoblastic leukemia

    Kikuchi, Akira; Ebihara, Yasuhiro; Mitsui, Tetsuo [Tokyo Univ. (Japan). Hospital of the Institute of Medical Science] [and others

    1998-12-01

    In two cases of Philadelphia-positive childhood acute lymphoblastic leukemia (Ph{sup 1} ALL), we performed allogeneic bone marrow transplantation (AlloBMT) with preconditioning regimen, including hyperfractionated high-dose total body irradiation (TBI) (13.5 Gy, in 9 fractions). Their disease statuses at BMT were hematological relapse in case 1 and molecular relapse in case 2. Bone marrow donors were unrelated in case 1, and HLA was a partially mismatched mother in case 2. Regimen-related toxicity was tolerable in both cases. Hematological recovery was rapid, and engraftment was obtained on day 14 in case 1 and on day 12 in case 2. BCR/ABL message in bone marrow disappeared on day 89 in case 1 and on day 19 in case 2 and throughout their subsequent clinical courses. Although short-term MTX and Cy-A continuous infusion were used for GVHD prophylaxis, grade IV GVHD was observed in case 1 and grade III in case 2. Both cases experienced hemorrhagic cystitis because of adenovirus type 11 infection. Although case 1 died of interstitial pneumonitis on day 442, case 2 has been free of disease through day 231. AlloBMT for Ph{sup 1} ALL with preconditioning regimen including hyperfractionated high-dose TBI is considered to be worth further investigation. (author)

  20. Utility of cranial boost in addition to total body irradiation in the treatment of high risk acute lymphoblastic leukemia

    Purpose: Total body irradiation (TBI) as part of a conditioning regimen before hematopoietic stem cell transplant (HSCT) is an important component in the management of acute lymphoblastic leukemia (ALL) that has relapsed or has other certain high-risk features. Controversy exists, however, as to whether a cranial boost in addition to TBI is necessary to prevent central nervous system (CNS) recurrences in these high-risk cases. Previous national trials have included a cranial boost in the absence of data to justify its use. Therefore, the aim of this study was to assess risk of CNS recurrence in ALL patients treated with TBI, to identify subsets of these high-risk patients at an increased or decreased risk of CNS recurrence after TBI, and to investigate whether regimens with higher doses of cranial irradiation further reduce the risk of CNS recurrence. Methods and Materials: Charts of 67 consecutively treated patients with ALL who received TBI before HSCT were reviewed. Data including patient demographics, clinical features at presentation, conditioning regimen, donor source, use of a cranial boost, remission stage at transplant, histologic subtype, cytogenetics, and extramedullary site of presentation were retrospectively collected and correlated with the risk of subsequent CNS recurrence. Results: At the time of analysis, 30 (45%) patients were alive with no evidence of disease, 8 (12%) were alive with recurrence of leukemia, 7 (10.5%) had recurrent ALL but with successful salvage, 7 (11%) died subsequent to recurrence, 14 (21%) died from complications related to HCST, and 1 patient was lost to follow-up (1.5%). Of the patients who recurred after HSCT, the relapses were hematologic in 13 (57%), CNS with or without simultaneous marrow involvement in 3 (13%), and other sites in 7 (30%). Forty-one (61%) patients did not receive an extracranial boost of irradiation with TBI. Two of these patients (4.9%) suffered CNS failures compared with 1 of 26 (3.8%) who received a

  1. Role of total body irradiation as based on the comparison of preparation regimens for allogeneic bone marrow transplantation for acute leukemia in first complete remission

    The role of total body irradiation (TBI) for allogeneic bone marrow transplantation (BMT) for acute leukemia in first complete remission was reevaluated in this study. From Japanese BMT Registry, data of 123 acute leukemia patients in first complete remission who underwent allogeneic bone marrow transplantation in 22 hospitals between 1988 and 1990 were available for the present comparative study of preparation regimens with or without total body irradiation. Two-year survivals were 77% and 51% in the TBI containing regimen group and in the non-TBI regimen group, respectively (p=0.0010). Corresponding two-year relapse rates were 16% and 37%, respectively (p=0.0197). Corresponding probabilities of developing interstitial pneumonitis were 21% and 24%, respectively (p=0.8127). The analysis of causes of death indicated that non-TBI regimen increased the incidence of septicemia and lethal organ failures, such as liver, heart, lung and other multiple sites. It was emphasized that an additional role of total body irradiation was to disperse the treatment-related toxicity in allogeneic bone marrow transplantation for acute leukemia. (orig.)

  2. Effects of total body irradiation-based conditioning allogenic sem cell transplantation for pediatric acute leukemia: A single-institution study

    To evaluate the effects of total body irradiation (TBI), as a conditioning regimen prior to allogeneic stem cell transplantation (allo-SCT), in pediatric acute leukemia patients. From January 2001 to December 2011, 28 patients, aged less than 18 years, were treated with TBI-based conditioning for allo-SCT in our institution. Of the 28 patients, 21 patients were diagnosed with acute lymphoblastic leukemia (ALL, 75%) and 7 were diagnosed with acute myeloid leukemia (AML, 25%). TBI was completed 4 days or 1 day before stem cell infusion. Patients underwent radiation therapy with bilateral parallel opposing fields and 6-MV X-rays. The Kaplan-Meier method was used to calculate survival outcomes. The 2-year event-free survival and overall survival rates were 66% and 56%, respectively (71.4% and 60.0% in AML patients vs. 64.3% and 52.4% in ALL patients, respectively). Treatment related mortality rate were 25%. Acute and chronic graft-versus-host disease was a major complication; other complications included endocrine dysfunction and pulmonary complications. Common complications from TBI were nausea (89%) and cataracts (7.1%). The efficacy and toxicity data in this study of TBI-based conditioning to pediatric acute leukemia patients were comparable with previous studies. However, clinicians need to focus on the acute and chronic complications related to allo-SCT.

  3. Effects of total body irradiation-based conditioning allogenic sem cell transplantation for pediatric acute leukemia: A single-institution study

    Park, Jong Moo; Choi, Eun Kyung; Kim, Jong Hoon [Dept.of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); and others

    2014-09-15

    To evaluate the effects of total body irradiation (TBI), as a conditioning regimen prior to allogeneic stem cell transplantation (allo-SCT), in pediatric acute leukemia patients. From January 2001 to December 2011, 28 patients, aged less than 18 years, were treated with TBI-based conditioning for allo-SCT in our institution. Of the 28 patients, 21 patients were diagnosed with acute lymphoblastic leukemia (ALL, 75%) and 7 were diagnosed with acute myeloid leukemia (AML, 25%). TBI was completed 4 days or 1 day before stem cell infusion. Patients underwent radiation therapy with bilateral parallel opposing fields and 6-MV X-rays. The Kaplan-Meier method was used to calculate survival outcomes. The 2-year event-free survival and overall survival rates were 66% and 56%, respectively (71.4% and 60.0% in AML patients vs. 64.3% and 52.4% in ALL patients, respectively). Treatment related mortality rate were 25%. Acute and chronic graft-versus-host disease was a major complication; other complications included endocrine dysfunction and pulmonary complications. Common complications from TBI were nausea (89%) and cataracts (7.1%). The efficacy and toxicity data in this study of TBI-based conditioning to pediatric acute leukemia patients were comparable with previous studies. However, clinicians need to focus on the acute and chronic complications related to allo-SCT.

  4. A comparison of busulphan versus total body irradiation combined with cyclophosphamide as conditioning for autograft or allograft bone marrow transplantation in patients with acute leukaemia

    We retrospectively compared the outcome in patients in the EBMT database transplanted for acute leukaemia from January 1987 to January 1994 who received busulphan and cyclophosphamide (BU/CY) as a pretransplant regimen versus those who received cyclophosphamide and total-body irradiation (CY-TBI). The patients were matched for type of transplant (autologous bone marrow transplantation (ABMT) versus allogenic (BMT)), diagnosis (acute lymphoblast leukaemia (ALL) ora cute myeloid leukaemia (AML)), status (early first complete remission, CR-1) versus intermediate (second or later remission, first relapse)), age, FAB classification for AML, prevention of graft-versus-host disease and year of transplantation. BU/CY and CY/TBI as pretransplant regimens gave similar results in all situations, except ABMT for ALL intermediate stages with more than 2 years from diagnosis to transplantation, where a lower RI and a higher LFS were associated with CY/TBI. (author)

  5. Dosimetry of total body irradiation

    In the treatment of disseminated malignancies an improvement in the curability and reduction of complication rates require high precision total body irradiation (TBI) and correct reporting of relevant treatment parameters. Optimal TBI dosimetry is the basis. Radiooncological and radiobiological requirements as well as the special physical situation have to be considered. To review the efforts of medical physicists, highlights from TBI workshops and publications are summarized. Additionally, dosimetric data from 34 European radiooncological centres contributing to the recent ESTRO inquiry on TBI are analysed. The topics are: absorbed dose and dose monitor calibration, determination of absolute and relative doses, dose ratios, attenuation data and heterogeneity corrections; TBI dose calculation methods regarding patient position, beam incidence, body shape and thickness, lung size and density; methods of TBI treatment planning including calculated dose modification and of TBI quality assurance. In conclusion, the following recommendations can be given: TBI dosimetry shall be performed under TBI conditions, close to the real treatment situation. The absorbed dose to water must be determined. The dose monitor should be calibrated against dose measurements at the centre of a water equivalent phantom of TBI equivalent size and typical thickness. Photon fluence profiles have to be measured with small phantoms. Influences on the local dose must be investigated systematically. A reproducible AP/PA TBI technique should be used. The TBI dose shall be specified to mid-abdomen and reported in units of gray. The single and total dose and the dose rate to the lungs, the number of fractions and the treatment time schedule must be stated. In vivo dosimetry is required if non-reliable TBI techniques are used. An international TBI dosimetry intercomparison could assist these efforts to improve the treatment of acute leukaemia. (author). 89 refs, 3 figs, 13 tabs

  6. A review of total body irradiation

    This review of total body irradiation discusses the optimization of the prescription, relevant radiobiological research, cytotoxic drugs and TBI, and the delivery of TBI and its complications, with particular reference to acute effects, neurological sequelae, endocrine effects, cataracts, and secondary malignancies. (U.K.)

  7. High-dose total-body irradiation and autologous marrow reconstitution in dogs: dose-rate-related acute toxicity and fractionation-dependent long-term survival

    Beagle dogs treated by total-body irradiation (TBI) were given autologous marrow grafts in order to avoid death from marrow toxicity. Acute and delayed non-marrow toxicities of high single-dose (27 dogs) and fractionated TBI (20 dogs) delivered at 0.05 or 0.1 Gy/min were compared. Fractionated TBI was given in increments of 2 Gy every 6 hr for three increments per day. Acute toxicity and early mortality (<1 month) at identical total irradiation doses were comparable for dogs given fractionated or single-dose TBI. With single-dose TBI, 14, 16, and 18 Gy, respectively, given at 0.05 Gy/min, 0/5, 5/5, and 2/2 dogs died from acute toxicity; with 10, 12, and 14 Gy, respectively, given at 0.1 Gy/min, 1/5, 4/5, and 5/5 dogs died acutely. With fractionated TBI, 14 and 16 Gy, respectively, given at 0.1 Gy/min, 1/5, 4/5, and 2/2 dogs died auctely. Early deaths were due to radiation enteritis with or without associated septicemia (29 dogs; less than or equal to Day 10). Three dogs given 10 Gy of TBI at 0.1 Gy/min died from bacterial pneumonia; one (Day 18) had been given fractionated and two (Days 14, 22) single-dose TBI. Fifteen dogs survived beyond 1 month; eight of these had single-dose TBI (10-14 Gy) and all died within 7 months of irradiation from a syndrome consisting of hepatic damage, pancreatic fibrosis, malnutrition, wasting, and anemia. Seven of the 15 had fractionated TBI, and only one (14 Gy) died on Day 33 from hepatic failure, whereas 6 (10-14 Gy) are alive and well 250 to 500 days after irradiation. In conclusion, fractionated TBI did not offer advantages over single-dose TBI with regard to acute toxicity and early mortality; rather, these were dependent upon the total dose of TBI. The total acutely tolerated dose was dependent upon the exposure rate; however, only dogs given fractionated TBI became healthy long-term survivors

  8. Cell biological effects of total body irradiation on growth and differentiation of acute myelogenous leukemia cells compared to normal bone marrow

    Greenberger, J.S.; Weichselbaum, R.R.; Botnick, L.E.; Sakakeeny, M.; Moloney, W.C.

    1979-01-01

    Radiation therapy is used as total body treatment in preparation of the acute myelogenous leukemia (AML) patient for bone marrow transplantation. Many AML patients will have residual leukemia cells at the time of total body irradiation (TBI). In the present study, the effect of TBI on leukemic myeloid cells was compared to the effect on normal marrow granulocytic stem cells (CFUc) in vitro. Little difference from that of normal CFUc was found in the radiosensitivity of two mouse myeloid leukemia cell lines. The effect of TBI on growth of WEHI-3 or J774 cells in millipore diffusion chambers was stimulatory. These AML cell lines as well as others derived from Friend or Abelson virus infected in vitro long term mouse marrow cultures showed some morphologic differentiation by 7 days growth in diffusion chambers in irradiated heterologous rat hosts, but immature cells predominated by day 21. Thus, evidence in murine models of AML indicates that residual AML cells surviving chemotherapy will show no greater susceptibility to radiation killing compared to normal stem cells and will rapidly repopulate the irradiated host.

  9. Total body water and total body potassium in anorexia nervosa

    In the ill hospitalized patient with clinically relevant malnutrition, there is a measurable decrease in the ratio of the total body potassium to total body water (TBK/TBW) and a detectable increase in the ratio of total exchangeable sodium to total exchangeable potassium (Nae/Ke). To evaluate body composition analyses in anorexia nervosa patients with chronic uncomplicated semistarvation, TBK and TBW were measured by whole body K40 counting and deuterium oxide dilution in 10 females with stable anorexia nervosa and 10 age-matched female controls. The ratio of TBK/TBW was significantly (p less than 0.05) higher in anorexia nervosa patients than controls. The close inverse correlation found in published studies between TBK/TBW and Nae/Ke together with our results suggest that in anorexia nervosa, Nae/Ke may be low or normal. A decreased TBK/TBW is not a good indicator of malnutrition in the anorexia nervosa patient. The use of a decreased TBK/TBW ratio or an elevated Nae/Ke ratio as a definition of malnutrition may result in inappropriate nutritional management in the patient with severe nonstressed chronic semistarvation

  10. Total body water and total body potassium in anorexia nervosa

    Dempsey, D.T.; Crosby, L.O.; Lusk, E.; Oberlander, J.L.; Pertschuk, M.J.; Mullen, J.L.

    1984-08-01

    In the ill hospitalized patient with clinically relevant malnutrition, there is a measurable decrease in the ratio of the total body potassium to total body water (TBK/TBW) and a detectable increase in the ratio of total exchangeable sodium to total exchangeable potassium (Nae/Ke). To evaluate body composition analyses in anorexia nervosa patients with chronic uncomplicated semistarvation, TBK and TBW were measured by whole body K40 counting and deuterium oxide dilution in 10 females with stable anorexia nervosa and 10 age-matched female controls. The ratio of TBK/TBW was significantly (p less than 0.05) higher in anorexia nervosa patients than controls. The close inverse correlation found in published studies between TBK/TBW and Nae/Ke together with our results suggest that in anorexia nervosa, Nae/Ke may be low or normal. A decreased TBK/TBW is not a good indicator of malnutrition in the anorexia nervosa patient. The use of a decreased TBK/TBW ratio or an elevated Nae/Ke ratio as a definition of malnutrition may result in inappropriate nutritional management in the patient with severe nonstressed chronic semistarvation.

  11. Similar Survival for Patients Undergoing Reduced-Intensity Total Body Irradiation (TBI) Versus Myeloablative TBI as Conditioning for Allogeneic Transplant in Acute Leukemia

    Purpose: Hematopoietic stem cell transplantation (HSCT) is the mainstay of treatment for adults with acute leukemia. Total body irradiation (TBI) remains an important part of the conditioning regimen for HCST. For those patients unable to tolerate myeloablative TBI (mTBI), reduced intensity TBI (riTBI) is commonly used. In this study we compared outcomes of patients undergoing mTBI with those of patients undergoing riTBI in our institution. Methods and Materials: We performed a retrospective review of all patients with acute leukemia who underwent TBI-based conditioning, using a prospectively acquired database of HSCT patients treated at our institution. Patient data including details of the transplantation procedure, disease status, Karnofsky performance status (KPS), response rates, toxicity, survival time, and time to progression were extracted. Patient outcomes for various radiation therapy regimens were examined. Descriptive statistical analysis was performed. Results: Between June 1985 and July 2012, 226 patients with acute leukemia underwent TBI as conditioning for HSCT. Of those patients, 180 had full radiation therapy data available; 83 had acute lymphoblastic leukemia and 94 had acute myelogenous leukemia; 45 patients received riTBI, and 135 received mTBI. Median overall survival (OS) was 13.7 months. Median relapse-free survival (RFS) for all patients was 10.2 months. Controlling for age, sex, KPS, disease status, and diagnosis, there were no significant differences in OS or RFS between patients who underwent riTBI and those who underwent mTBI (P=.402, P=.499, respectively). Median length of hospital stay was shorter for patients who received riTBI than for those who received mTBI (16 days vs 23 days, respectively; P<.001), and intensive care unit admissions were less frequent following riTBI than mTBI (2.22% vs 12.69%, respectively, P=.043). Nonrelapse survival rates were also similar (P=.186). Conclusions: No differences in OS or RFS were seen between

  12. Similar Survival for Patients Undergoing Reduced-Intensity Total Body Irradiation (TBI) Versus Myeloablative TBI as Conditioning for Allogeneic Transplant in Acute Leukemia

    Mikell, John L., E-mail: jmikell@emory.edu [Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Waller, Edmund K. [Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Switchenko, Jeffrey M. [Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Rangaraju, Sravanti; Ali, Zahir; Graiser, Michael [Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Hall, William A. [Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Langston, Amelia A. [Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Esiashvili, Natia [Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Khoury, H. Jean [Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Khan, Mohammad K. [Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2014-06-01

    Purpose: Hematopoietic stem cell transplantation (HSCT) is the mainstay of treatment for adults with acute leukemia. Total body irradiation (TBI) remains an important part of the conditioning regimen for HCST. For those patients unable to tolerate myeloablative TBI (mTBI), reduced intensity TBI (riTBI) is commonly used. In this study we compared outcomes of patients undergoing mTBI with those of patients undergoing riTBI in our institution. Methods and Materials: We performed a retrospective review of all patients with acute leukemia who underwent TBI-based conditioning, using a prospectively acquired database of HSCT patients treated at our institution. Patient data including details of the transplantation procedure, disease status, Karnofsky performance status (KPS), response rates, toxicity, survival time, and time to progression were extracted. Patient outcomes for various radiation therapy regimens were examined. Descriptive statistical analysis was performed. Results: Between June 1985 and July 2012, 226 patients with acute leukemia underwent TBI as conditioning for HSCT. Of those patients, 180 had full radiation therapy data available; 83 had acute lymphoblastic leukemia and 94 had acute myelogenous leukemia; 45 patients received riTBI, and 135 received mTBI. Median overall survival (OS) was 13.7 months. Median relapse-free survival (RFS) for all patients was 10.2 months. Controlling for age, sex, KPS, disease status, and diagnosis, there were no significant differences in OS or RFS between patients who underwent riTBI and those who underwent mTBI (P=.402, P=.499, respectively). Median length of hospital stay was shorter for patients who received riTBI than for those who received mTBI (16 days vs 23 days, respectively; P<.001), and intensive care unit admissions were less frequent following riTBI than mTBI (2.22% vs 12.69%, respectively, P=.043). Nonrelapse survival rates were also similar (P=.186). Conclusions: No differences in OS or RFS were seen between

  13. Total-body irradiation with high-LET particles: acute and chronic effects on the immune system

    Gridley, Daila S.; Pecaut, Michael J.; Nelson, Gregory A.

    2002-01-01

    Although the immune system is highly susceptible to radiation-induced damage, consequences of high linear energy transfer (LET) radiation remain unclear. This study evaluated the effects of 0.1 gray (Gy), 0.5 Gy, and 2.0 Gy iron ion (56Fe(26)) radiation on lymphoid cells and organs of C57BL/6 mice on days 4 and 113 after whole body exposure; a group irradiated with 2.0 Gy silicon ions (28Si) was euthanized on day 113. On day 4 after 56Fe irradiation, dose-dependent decreases were noted in spleen and thymus masses and all major leukocyte populations in blood and spleen. The CD19(+) B lymphocytes were most radiosensitive and NK1.1(+) natural killer (NK) cells were most resistant. CD3(+) T cells were moderately radiosensitive and a greater loss of CD3(+)/CD8(+) T(C) cells than CD3(+)/CD4(+) T(H) cells was noted. Basal DNA synthesis was elevated on day 4, but response to mitogens and secretion of interleukin-2 and tumor necrosis factor-alpha were unaffected. Signs of anemia were noted. By day 113, high B cell numbers and low T(C) cell and monocyte percents were found in the 2.0 Gy 56Fe group; the 2.0 Gy 2)Si mice had low NK cells, decreased basal DNA synthesis, and a somewhat increased response to two mitogens. Collectively, the data show that lymphoid cells and tissues are markedly affected by high linear energy transfer (LET) radiation at relatively low doses, that some aberrations persist long after exposure, and that different consequences may be induced by various densely ionizing particles. Thus simultaneous exposure to multiple radiation sources could lead to a broader spectrum of immune dysfunction than currently anticipated.

  14. Total body irradiation correlates with chronic graft versus host disease and affects prognosis of patients with acute lymphoblastic leukemia receiving an HLA identical allogeneic bone marrow transplant

    Purpose: To investigate whether different procedure variables involved in the delivery of fractionated total body irradiation (TBI) impact on prognosis of patients affected by acute lymphoblastic leukemia (ALL) receiving allogeneic bone marrow transplant (BMT). Methods and Materials: Ninety-three consecutive patients with ALL receiving a human leukocyte antigen (HLA) identical allogeneic BMT between 1 August 1983 and 30 September 1995 were conditioned with the same protocol consisting of cyclophosphamide and fractionated TBI. The planned total dose of TBI was 12 Gy (2 Gy, twice a day for 3 days). Along the 12-year period, variations in delivering TBI schedule occurred with regard to used radiation source, instantaneous dose rate, technical setting, and actual total dose received by the patient. We tested these different TBI variables as well as factors related to patient, state of disease, and transplant-induced disease to investigate their influence on transplant-related mortality, leukemia relapse, and survival. Results: At median follow-up of 7 years (range 3-15 years) the probabilities of leukemia-free survival (LFS) and overall survival (OS) for the 93 patients were 60% and 41%, respectively. At univariate analysis, chronic graft versus host disease (cGvHd) (p = 0.0005), age (p = 0.01), and state of disease (p 0.03) were factors affecting LFS whereas chronic GvHd (p = 0.0005), acute GvHd (p = 0.03), age (p = 0.0001), and GvHd prophylaxis (p = 0.01) were factors affecting overall survival. The occurrence of chronic GvHd was correlated with actually delivered TBI dose (p = 0.04). Combined stratification of prognostic factors showed that patients who received the planned total dose of TBI (12 Gy) and were affected by chronic GvHd had higher probabilities of LFS (p = 0.01) and OS (p = n.s.) than patients receiving less than 12 Gy and/or without occurrence of chronic GvHd. Moreover, TBI dose had a significant impact on LFS in patients transplanted in first

  15. Current status of total body irradiation in conditioning regimen for childhood acute lymphoblastic leukemia. Survey in the Japan Association of Childhood Leukemia Study (JACLS) Group

    We surveyed methods of total body irradiation (TB I) in conditioning regimens of stem cell transplantation (SCT) for children with acute lymphoblastic leukemia (ALL) at participating institutions of the Japan Association of Childhood Leukemia Study (JACLS) ALL-97 protocol. We obtained information about TBI from 25 institutions. Total dose of 12 Gy fractionated by four to six in two to three days for TBI was conducted in 22 of 25 institutions. High-risk patients, such as patients with Philadelphia positive ALL, received over 12 Gy in five institutions. Beam direction and patient's positioning were horizontal and lateral respectively in 15 institutions. Shielding of lung and/or eyes and boost irradiation to central nervous system and/or testis were done in 24 and 11 institutions respectively, but in various ways. We have to keep in mind that a great variety of TBI have been undergone in each institution when we intend to interpret multi-institutional trials of treatment including SCT for patients with ALL. (author)

  16. C-reactive protein and serum amyloid A as early-phase and prognostic indicators of acute radiation exposure in nonhuman primate total-body irradiation model

    Terrorist radiological attacks or nuclear accidents could expose large numbers of people to ionizing radiation. In mass-casualty radiological incidents early medical-management requires triage tools for first-responders to quantitatively identify individuals exposed to life-threatening radiation doses and for early initiation (i.e., within one day after radiation exposure) of cytokine therapy for treatment of bone marrow acute radiation syndrome. Herein, we present results from 30 rhesus macaques total-body irradiated (TBI) to a broad dose range of 1-8.5 Gy with 60Co γ-rays (0.55 Gy min-1) and demonstrate dose- and time-dependent changes in blood of C-reactive protein (CRP), serum amyloid A (SAA), and interleukin 6 (IL-6) measured by enzyme linked immunosorbent assay (ELISA). CRP and SAA dose-response results are consistent with ∼1 Gy and ∼0.2 Gy thresholds for photon-exposure at 24 h after TBI, respectively. Highly significant elevations of CRP and SAA (p = 0.00017 and p = 0.0024, respectively) were found in animal plasma at 6 h after all TBI doses suggesting their potential use as early-phase biodosimeters. Results also show that the dynamics and content of CRP and SAA levels reflect the course and severity of the acute radiation sickness (ARS) and may function as prognostic indicators of ARS outcome. These results demonstrate proof-of-concept that these radiation-responsive proteins show promise as a complementary approach to conventional biodosimetry for early assessment of radiation exposures and may also contribute as diagnostic indices in the medical management of radiation accidents.

  17. C-reactive protein and serum amyloid A as early-phase and prognostic indicators of acute radiation exposure in nonhuman primate total-body irradiation model

    Ossetrova, N.I., E-mail: ossetrova@afrri.usuhs.mil [Armed Forces Radiobiology Research Institute, 8901 Wisconsin Avenue, Bldg. 42, Bethesda, MD 20889-5603 (United States); Sandgren, D.J.; Blakely, W.F. [Armed Forces Radiobiology Research Institute, 8901 Wisconsin Avenue, Bldg. 42, Bethesda, MD 20889-5603 (United States)

    2011-09-15

    Terrorist radiological attacks or nuclear accidents could expose large numbers of people to ionizing radiation. In mass-casualty radiological incidents early medical-management requires triage tools for first-responders to quantitatively identify individuals exposed to life-threatening radiation doses and for early initiation (i.e., within one day after radiation exposure) of cytokine therapy for treatment of bone marrow acute radiation syndrome. Herein, we present results from 30 rhesus macaques total-body irradiated (TBI) to a broad dose range of 1-8.5 Gy with {sup 60}Co {gamma}-rays (0.55 Gy min{sup -1}) and demonstrate dose- and time-dependent changes in blood of C-reactive protein (CRP), serum amyloid A (SAA), and interleukin 6 (IL-6) measured by enzyme linked immunosorbent assay (ELISA). CRP and SAA dose-response results are consistent with {approx}1 Gy and {approx}0.2 Gy thresholds for photon-exposure at 24 h after TBI, respectively. Highly significant elevations of CRP and SAA (p = 0.00017 and p = 0.0024, respectively) were found in animal plasma at 6 h after all TBI doses suggesting their potential use as early-phase biodosimeters. Results also show that the dynamics and content of CRP and SAA levels reflect the course and severity of the acute radiation sickness (ARS) and may function as prognostic indicators of ARS outcome. These results demonstrate proof-of-concept that these radiation-responsive proteins show promise as a complementary approach to conventional biodosimetry for early assessment of radiation exposures and may also contribute as diagnostic indices in the medical management of radiation accidents.

  18. Cataractogenesis after total body irradiation

    Purpose: To evaluate the prognostic factors and the ophthalmologic follow-up on cataract formation following total body irradiation (TBI) prior to bone marrow transplantation (BMT). Methods and Materials: Between 1980 and 1992, 494 patients were referred to our department for TBI prior to BMT. The mean age was 32 ± 11 (median: 32, range: 2-63) years and the male to female ratio was 1.6 (304:190). The majority of patients were treated for acute leukemia (lymphoblastic, n = 177, 36%; or nonlymphoblastic, n = 139, 28%); 80 (16%) for chronic myeloid leukemia, 60 (12%) for non-Hodgkin's lymphoma, 23 (5%) for multiple myeloma, and 15 (3%) for other malignancies. Two hundred and fifty-four (51%) patients were grafted in the first complete remission (CR), 118 (24%) in second CR. Allogeneic BMT was performed in 210 (43%) patients, and autologous BMT in 284 (57%). Methotrexate combined to steroids (n = 47, 22%) or to cyclosporine (n = 163, 78%) was administered for graft-versus-host disease (GvHD) prophylaxis. In 188 patients (38%), heparin was used in the prevention of veno-occlusive disease (VOD) of the liver. Furthermore, steroid administration was registered in 223 patients (45%). The conditioning chemotherapy consisted of cyclophosphamide (Cy) alone in 332 (67%) patients. Total-body irradiation was administered either in single dose (STBI; 10 Gy in 1 day, n = 291) or in six fractions (FTBI; 12 Gy over 3 consecutive days, n = 203) before BMT. The mean instantaneous dose rate was 0.0574 ± 0.0289 Gy/min (0.024-0.1783). It was < 0.048 Gy/min in 157 patients (LOW group), ≥ 0.048 Gy/min and < 0.09 Gy/min in 301 patients (MEDIUM group), and ≥ 0.09 Gy/min in 36 patients (HIGH group). Results: When considering all patients, 42 (8.5%) patients developed cataracts after 13 to 72 months (median: 42 months) with a 5-year estimated cataract incidence (ECI) of 23%. Thirty-three (11.3%) out of 291 patients in the STBI group, and 9 (4.4%) out of 203 patients in the FTBI group

  19. Acute renal toxicity of 2 conditioning regimens in patients undergoing autologous peripheral blood stem-cell transplantation. Total body irradiation-cyclophosphamide versus ifosfamide, carboplatin, etoposide

    Objective was to compare renal toxicity of 2 conditioning regimens of total body irradiation/cyclophosphamide TBI-Cy and Ifosfamide, Carboplatin, Etoposide ICE. Between August 1996 and February 2004, patients treated with autologous peripheral stem cell transplantation in the Department of Medical and radiation Oncology, Gulhane Military Medical School, Ankara, Turkey with 2 different conditioning regimens was comparatively analyzed for acute renal toxicity in the early post-transplant period. Forty-even patients received ICE regimen with 12 g/m2; 1.2 g/m2 and 1.2 g/m2 divided to 6 consecutive days, whereas 21 patients received 12 Gy TBI 6 fractions twice daily in 3 consecutive days and 60 mg/m2/day cyclophosphamide for 2 days. Sixty-eight patients were evaluated in this study. There was no significant difference in baseline renal function between patients in the ICE and TBI-Cy groups. Eleven patients developed nephrotoxicity 23.4% in the ICE group while one patient 4.8% in the TBI-Cy group developed nephrotoxicity in ICEgroup required hemodialysis and subsequently 48.5% of them died. In contrast, one patient 4.8% died due to nephrotoxicity despite hemodialysis in the TBI-Cy arm. This study reveals that the TBI-Cy conditioning regimen seems no more nephrotoxic than an ICE regimen particularly in patients who had used cisplatin prior to transplantation. (author)

  20. Cataract incidence after total-body irradiation

    Purpose: Aim of this retrospective study was to evaluate cataract incidence in a homogeneous group of patients after total-body irradiation followed by autologous bone marrow transplantation or peripheral blood stem cell transplantation. Method and Materials: Between 11/1982 and 6/1994 in total 260 patients received in our hospital total-body irradiation for treatment of haematological malignancy. In 1996-96 patients out of these 260 patients were still alive. 85 from these still living patients (52 men, 33 women) answered evaluable on a questionnaire and could be examined ophthalmologically. Median age of these patients was 38,5 years (15 - 59 years) at time of total-body irradiation. Radiotherapy was applied as hyperfractionated total-body irradiation with a median dose of 14,4 Gy in 12 fractions over 4 days. Minimum time between fractions was 4 hours, photons with a energy of 23 MeV were used, and the dose rate was 7 - 18 cGy/min. Results: Median follow-up is now 5,8 years (1,7 - 13 years). Cataract occurred in (28(85)) patients after a median time of 47 months (1 - 104 months). In 6 out of these 28 patients who developed a cataract, surgery of the cataract was performed. Whole-brain irradiation prior to total-body irradiation was more often in the group of patients developing a cataract (14,3%) vs. 10,7% in the group of patients without cataract. Conclusion: Cataract is a common side effect of total-body irradiation. Cataract incidence found in our patients is comparable to results of other centres using a fractionated regimen for total-body irradiation. The hyperfractionated regimen used in our hospital does obviously not result in a even lower cataract incidence. In contrast to acute and late toxicity in other organ/organsystems, hyperfractionation of total-body irradiation does not further reduce toxicity for the eye-lens. Dose rate may have more influence on cataract incidence

  1. Total body irradiation for children with malignancies

    Sanuki, Eiichi; Maeno, Toshio; Kamata, Rikisaburo; Tanaka, Yoshiaki; Mugishima, Hideo [Nihon Univ., Tokyo (Japan). School of Medicine

    1995-12-01

    Total body irradiation combined with high dose chemotherapy has been performed just before bone marrow transplantation in 35 children with advanced malignancies, with the object of achieving successful transplantation and improving the prognosis. Simulation was performed as follows: back scatter, flatness, dose accumulation using randophantom and dose distribution using a thermo-luminescence dosimeter and linac-graphy. The standard error of dose distribution was within 10%. In neuroblastoma, of which there were 14 cases in stage IV and one case in stage III, the 5-year survival rate was 55%. In leukemia, of which all cases were in the high-risk group (7 cases of acute lymphoblastic leukemia and 2 of acute myeloblastic leukemia) the 5-year survival rate was 55%. The 5 cases having first remission survived disease-free while the 4 cases having non-first remission died. In malignant lymphoma (6 cases in stage IV and one case in stage III, with bulky mass) the 5-year survival rate was 67%. Four cases with other diagnoses (severe aplastic anemia, and others) all survived. As yet no side effects resulting from total body irradiation have been recognized in our cases, but a longer follow-up period is necessary to observe possible late side effects. (author).

  2. Total body irradiation in bone marrow transplantation

    Total body irradiation was used in 22 patients as part of their conditioning regimen for bone marrow transplantation. Nine patients with acute leukemia received 1000 cGy TBI in addition with chemotherapy. None of them survived and the main cause of death was interstitial pneumonitis (50%). 4 patients received 1000 cGy with a lung shielding of 500 cGy. Two patients with acute leukemia died of leukemia and sepsis, two patients had aplastic anemia, one is surviving, the other died of severe GVHD and infectious complications. Nine patients with severe aplastic anemia strongly immunized by previous blood transfusions received 800 cGy TBI with a lung shielding of 400 cGy. No rejection was observed and 7 patients (63%) are currently alive. One patient died of interstitial pneumonitis probably related to CMV infection, one of subacute necrotizing hepatitis, two of severe acute GVHD. It is concluded from this study that TBI remains the best immunosuppressive conditioning regimen even in strongly immunized patients. It may be a contributing factor of the incidence and severity of interstitial pneumonitis. A reduction of the dose of the lung to 400-500 cGy seems to decrease the severity of this complication

  3. Cataracts after total body irradiation and bone marrow transplantation in patients with acute leukemia in complete remission: a study of the european group for blood and marrow transplantation

    Purpose: Advances in bone marrow transplantation (BMT) have consistently improved long-term survival. Therefore, evaluation of late complications such as cataracts is of paramount importance. Methods and Materials: We analyzed data of 2149 patients from the EBMT registry. A cohort of 1063 patients were evaluable for survival and ophthalmologic status after transplant for acute leukemia (AL) in first or second complete remission. Conditioning therapy included either single-dose total body irradiation (STBI) or fractionated TBI (FTBI) grouped in different dose rates (low: LDR ≤ 0.04 Gy/min; high: HDR > 0.04 Gy/min). Results: The overall 10-year estimated cataract incidence (ECI) was 50%. It was 60% in the STBI group, 43% in the FTBI group ≤ 6 fractions, and 7% in the FTBI group > 6 fractions (p -4). It was significantly lower (30%) in the LDR than in the HDR groups (59%; p -4). Patients receiving heparin for veno-occlusive disease prophylaxis had fewer cataracts than those who did not (10-year ECI: 33% vs. 53%, respectively; p = 0.04). The 10-year ECI was 65% in the allogeneic vs. 46% in the autologous BMT patients (p = 0.0018). Factors independently associated with an increased risk of cataract were an older age (> 23 years), higher dose rate (> 0.04 Gy/min), allogeneic BMT, and steroid administration (> 100 days). The use of FTBI was associated with a decreased risk of cataract. Heparin administration was a protective factor in patients receiving STBI. In terms of cataract surgery, the unfavorable factors for requiring surgery were: age > 23 yr, STBI, dose rate > 0.04 Gy/min, chronic graft-vs.-host disease (cGvHD), and absence of heparin administration. Among the patients who required cataract surgery (111 out of 257), secondary posterior capsular opacification was observed in 15.7%. Conclusion: High dose rate and STBI are the main risk factors for cataract development and the need for surgery, and the administration of heparin has a protective role in

  4. Dose-effect relationship for cataract induction after single-dose total body irradiation and bone marrow transplantation for acute leukemia

    Purpose: To determine a dose-effect relationship for cataract induction, the tissue-specific parameter, α/β, and the rate of repair of sublethal damage, μ value, in the linear-quadratic formula have to be known. To obtain these parameters for the human eye lens, a large series of patients treated with different doses and dose rates is required. The data of patients with acute leukemia treated with single-dose total body irradiation (STBI) and bone marrow transplantation (BMT) collected by the European Group for Blood and Marrow Transplantation were analyzed. Methods and Materials: The data of 495 patients who underwent BMT for acute leukemia, who had STBI as part of their conditioning regimen, were analyzed using the linear-quadratic concept. The end point was the incidence of cataract formation after BMT. Of the analyzed patients, 175 were registered as having cataracts. Biologic effective doses (BEDs) for different sets of values for α/β and μ were calculated for each patient. With Cox regression analysis, using the overall chi-square test as the parameter evaluating the goodness of fit, α/β and μ values were found. Risk factors for cataract induction were the BED of the applied TBI regimen, allogeneic BMT, steroid therapy for >14 weeks, and heparin administration. To avoid the influence of steroid therapy and heparin on cataract induction, patients who received steroid or heparin treatment were excluded, leaving only the BED as a risk factor. Next, the most likely set of α/β and μ values was obtained. With this set, the cataract-free survival rates were calculated for specific BED intervals, according to the Kaplan-Meier method. From these calculations, cataract incidences were obtained as function of the BED at 120 months after STBI. Results: The use of BED instead of the TBI dose enabled the incidence of cataract formation to be predicted in a reasonably consistent way. With Cox regression analysis for all STBI data, a maximal chi-square value was

  5. Decitabine and Total-Body Irradiation Followed By Donor Bone Marrow Transplant and Cyclophosphamide in Treating Patients With Relapsed or Refractory Acute Myeloid Leukemia

    2016-07-08

    Acute Myeloid Leukemia With Multilineage Dysplasia Following Myelodysplastic Syndrome; Adult Acute Myeloid Leukemia in Remission; Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); de Novo Myelodysplastic Syndromes; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Myeloid Leukemia; Secondary Acute Myeloid Leukemia

  6. The relation of body mass index, demographic and health-related variables to length of stay for patients at an acute rehabilitation hospital after total hip arthroplasty

    Kroll, Thilo

    2010-01-01

    Karin Greenberg1, Thilo Kroll21Medical Rehabilitation, Inc, Pittsburgh, PA, USA; 2National Rehabilitation Hospital (NRH), Washington DC, WA, USAAbstract: Obesity is a growing public health concern world-wide. At the same time, knee and hip replacements are becoming an increasingly regular treatment for osteoarthritis. There are conflicting reports in the literature as to what extent body mass affects the length of stay (LOS) of patients undergoing total hip replacements. This chart review aim...

  7. Treosulfan, Fludarabine Phosphate, and Total Body Irradiation Before Donor Stem Cell Transplant in Treating Patients With Myelodysplastic Syndrome or Acute Myeloid Leukemia

    2016-06-20

    Acute Myeloid Leukemia in Remission; Chronic Myelomonocytic Leukemia; Minimal Residual Disease; Myelodysplastic Syndrome; Myelodysplastic/Myeloproliferative Neoplasm; Myelodysplastic/Myeloproliferative Neoplasm, Unclassifiable

  8. Total body irradiation: technical and clinical aspects

    Total-body irradiation (TBI) has an established role in many preparative regimens used before marrow transplantation (BMT) in the treatment of hematological malignancies in children and adults. Better choice in TBI techniques and dosimetry have permitted better homogeneity of dose, and therefore a significant sparing of critical tissues. Advances in treatments over the past 20 years have greatly improved survival; therefore, the evaluation of early and late complications with a sufficient follow-up, according to different conditioning regimens is important. In this article, we review and compare different TBI techniques and dosimetry, and their influence on the distribution and homogeneity of dose, and the possible relationship to the risk of complications. We also describe the acute and late effects of TBI in children and adults appearing in the first month post-BMT as veno-occlusive disease, interstitial pneumonitis, or after 3 months, i.e., endocrinal late effects and growth in children, cataracts, neurological and bone or other complications, secondary tumors and alteration in the quality of life. The responsibility of TBI in the increased rate of certain complications is difficult to assess from chemotherapy or allograft side effects (chronic graft vs. host disease) or from other associated medical treatments, such as long term steroid therapy. (authors)

  9. Radiobiological speculations on therapeutic total body irradiation

    Unexpected total body irradiation (TBI) of human beings, involved in nuclear warfare or in accidents in nuclear reactors can be lethal. In the 1950s, bone marrow transplantation was discovered as a potentially life saving procedure after TBI in the dose range of 5.0 to 12.0 Gy. Since that time, deliberate or therapeutic TBI has been used to condition patients with a lethal bone marrow disorder for bone marrow replacement. The therapeutic ratio of TBI followed by bone marrow transplantation is small. Many potentially lethal complications can occur, such as acute TBI side effects, late TBI side effects or immunological complications of bone marrow transplantation such as graft versus host disease or graft rejection. The benefits of TBI and bone marrow transplantation are that they offer a chance for cure of previously lethal bone marrow disorders. The optimal parameters for TBI remain to be defined. The review discusses the current clinical and experimental animal data, as they relate to the future definition of less toxic TBI procedures with a better therapeutic ratio. Different TBI procedures are required for patients with malignant vs. non-malignant disorders or for patients with histoincompatible vs. histocompatible bone marrow donors.77 references

  10. Total body irradiation for bone marrow transplantation

    Purpose/Objective: The primary goal of this course is to develop an understanding of the rationale for the use of total body irradiation (TBI) as a component of cytoreduction for bone marrow transplantation, the techniques used, and the results of changing important parameters, such as dose, dose rate, and fractionation. Materials and Methods: Basic radiobiological principles relevant to TBI are reviewed; in particular, emphasis is placed on cell and animal studies which suggest means of optimizing TBI delivery to achieve maximum tumor cell kill and immunosuppression along with minimal normal tissue damage. Techniques utilized at various centers are described, with some discussion of achieving homogeneity, as well as inhomogeneity when desired with partial shielding or 'boosting'. A review of clinical studies, both randomized and non-randomized, is done; these are then interpreted in terms of potential optimization of the TBI parameters. Finally, comparison of TBI-containing regimens with chemotherapy-only regimens is done. Results: Radiobiological studies suggest a potential advantage for fractionated TBI over single dose TBI. Clinical studies support this view: highly fractionated regimens have allowed higher total doses to be used to increase malignant cell kill and immunosuppression without increasing toxicity. Randomized studies of TBI combined with VP-16 or cyclophosphamide versus busulfan combined with cyclophosphamide have either shown an advantage with TBI (in acute myelocytic leukemia in first remission) or no difference (in chronic myelogenous leukemia, chronic phase). Conclusion: TBI has been an effective component of cytoreductive regimens for marrow transplantation in patients with malignant disease, especially leukemias, which constitute 73% of all marrow transplants worldwide. Evidence supports fractionated TBI, to doses ≥ 13 Gy, when compared with single dose TBI. Randomized studies support the continued use of TBI in AML, and suggest that

  11. High-dose vincristine, fractionated total-body irradiation and cyclophosphamide as conditioning regimen in allogeneic and autologous bone marrow transplantation for childhood acute lymphoblastic leukaemia in second remission: a 7-year Italian multicentre study

    We investigated the feasibility and efficacy of high-dose vincristine (4 mg/m2 over 4 d) combined with fractionated total body irradiation (F-TBI) (200 cGy x 2 over 3 d) and cyclophosphamide (60 mg/kg for 2 d) as a preparative regimen in allogeneic (AlloBMT) and autologous (ABMT) bone marrow transplantation for 75 consecutive children (median age at transplant 8.5 years) with acute lymphoblastic leukaemia in second complete remission (CR). Median duration of first CR was 26 and 25 months in the AlloBMT and ABMT group, respectively. We conclude that the conditioning regimen with high-dose vincrostine combined with cyclophosphamide and F-TBI is feasible and promising although its therapeutic advantage should be tested in larger series of patients enrolled in randomized studies. (author)

  12. The Gottingen Minipig Is a Model of the Hematopoietic Acute Radiation Syndrome: G-Colony Stimulating Factor Stimulates Hematopoiesis and Enhances Survival From Lethal Total-Body γ-Irradiation

    Purpose: We are characterizing the Gottingen minipig as an additional large animal model for advanced drug testing for the acute radiation syndrome (ARS) to enhance the discovery and development of novel radiation countermeasures. Among the advantages provided by this model, the similarities to human hematologic parameters and dynamics of cell loss/recovery after irradiation provide a convenient means to compare the efficacy of drugs known to affect bone marrow cellularity and hematopoiesis. Methods and Materials: Male Gottingen minipigs, 4 to 5 months old and weighing 9 to 11 kg, were used for this study. We tested the standard off-label treatment for ARS, rhG-CSF (Neupogen, 10 μg/kg/day for 17 days), at the estimated LD70/30 total-body γ-irradiation (TBI) radiation dose for the hematopoietic syndrome, starting 24 hours after irradiation. Results: The results indicated that granulocyte colony stimulating factor (G-CSF) enhanced survival, stimulated recovery from neutropenia, and induced mobilization of hematopoietic progenitor cells. In addition, the administration of G-CSF resulted in maturation of monocytes/macrophages. Conclusions: These results support continuing efforts toward validation of the minipig as a large animal model for advanced testing of radiation countermeasures and characterization of the pathophysiology of ARS, and they suggest that the efficacy of G-CSF in improving survival after total body irradiation may involve mechanisms other than increasing the numbers of circulating granulocytes

  13. The Gottingen Minipig Is a Model of the Hematopoietic Acute Radiation Syndrome: G-Colony Stimulating Factor Stimulates Hematopoiesis and Enhances Survival From Lethal Total-Body γ-Irradiation

    Moroni, Maria, E-mail: maria.moroni@usuhs.edu [Radiation Countermeasures Program, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland (United States); Ngudiankama, Barbara F. [Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland (United States); Christensen, Christine [Division of Comparative Pathology, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland (United States); Olsen, Cara H. [Biostatistics Consulting Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland (United States); Owens, Rossitsa [Radiation Countermeasures Program, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland (United States); Lombardini, Eric D. [Veterinary Medicine Department, Armed Forces Research Institute of Medical Sciences, Bangkok (Thailand); Holt, Rebecca K. [Veterinary Science Department, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland (United States); Whitnall, Mark H. [Radiation Countermeasures Program, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland (United States)

    2013-08-01

    Purpose: We are characterizing the Gottingen minipig as an additional large animal model for advanced drug testing for the acute radiation syndrome (ARS) to enhance the discovery and development of novel radiation countermeasures. Among the advantages provided by this model, the similarities to human hematologic parameters and dynamics of cell loss/recovery after irradiation provide a convenient means to compare the efficacy of drugs known to affect bone marrow cellularity and hematopoiesis. Methods and Materials: Male Gottingen minipigs, 4 to 5 months old and weighing 9 to 11 kg, were used for this study. We tested the standard off-label treatment for ARS, rhG-CSF (Neupogen, 10 μg/kg/day for 17 days), at the estimated LD70/30 total-body γ-irradiation (TBI) radiation dose for the hematopoietic syndrome, starting 24 hours after irradiation. Results: The results indicated that granulocyte colony stimulating factor (G-CSF) enhanced survival, stimulated recovery from neutropenia, and induced mobilization of hematopoietic progenitor cells. In addition, the administration of G-CSF resulted in maturation of monocytes/macrophages. Conclusions: These results support continuing efforts toward validation of the minipig as a large animal model for advanced testing of radiation countermeasures and characterization of the pathophysiology of ARS, and they suggest that the efficacy of G-CSF in improving survival after total body irradiation may involve mechanisms other than increasing the numbers of circulating granulocytes.

  14. Iodine I 131 Monoclonal Antibody BC8, Fludarabine Phosphate, Cyclophosphamide, Total-Body Irradiation and Donor Bone Marrow Transplant in Treating Patients With Advanced Acute Myeloid Leukemia, Acute Lymphoblastic Leukemia, or High-Risk Myelodysplastic Syndrome

    2016-07-18

    Acute Myeloid Leukemia Arising From Previous Myelodysplastic Syndrome; Adult Acute Lymphoblastic Leukemia in Remission; Adult Acute Myeloid Leukemia in Remission; Chronic Myelomonocytic Leukemia; Previously Treated Myelodysplastic Syndrome; Refractory Anemia With Excess Blasts; Refractory Anemia With Ring Sideroblasts; Refractory Cytopenia With Multilineage Dysplasia; Refractory Cytopenia With Multilineage Dysplasia and Ring Sideroblasts

  15. Implantation of total body irradiation in radiotherapy

    Before implementing a treatment technique, the characteristics of the beam under irradiation conditions must be well acknowledged and studied. Each one of the parameters used to calculate the dose has to be measured and validated before its utilization in clinical practice. This is particularly necessary when dealing with special techniques. In this work, all necessary parameters and measurements are described for the total body irradiation implementation in facilities designed for conventional treatments that make use of unconventional geometries to generate desired enlarged field sizes. Furthermore, this work presents commissioning data of this modality at Hospital das Clinicas of Sao Paulo using comparison of three detectors types for measurements of entrance dose during total body irradiation treatment. (author)

  16. Significance of Phi bodies in acute leukaemia.

    Cardullo, L de S; Morilla, R; Catovsky, D

    1981-01-01

    Material from 39 patients with acute leukaemia was investigated with the peroxidase cytochemical reaction using 3,3'diaminobenzidine (DAB) and other substrates in order to test their sensitivity in detecting myeloid differentiation. The proportion of positive blasts and of cases with Auer rods in acute myeloid leukaemia (AML) was significantly greater with DAB than with benzidine. In addition, Phi bodies were demonstrated in AML blasts only when DAB was used; Phi bodies were also observed in two out of seven cases of chronic granulocytic leukaemia in "myeloid" blast crisis but were not seen in any case of acute lymphoblastic leukaemia. Phi bodies were more numerous when the reaction was carried out at pH 9.7, and their number was significantly reduced in the presence of 3-amino 1,2,4-triazole. Both findings suggest that the Phi bodies derive from catalase-containing granules (microperoxisomes) and are distinct from Auer rods, which derive from peroxidase-containing (primary) granules. Like Auer rods, Phi bodies appear to be characteristics of immature myeloid cells in leukaemia but are seen with a higher frequency than Auer rods in acute myeloid leukemia. Images p154-a PMID:6262384

  17. Low Dose Total Body Irradiation Combined With Recombinant CD19-Ligand × Soluble TRAIL Fusion Protein is Highly Effective Against Radiation-resistant B-precursor Acute Lymphoblastic Leukemia in Mice

    Fatih M. Uckun

    2015-04-01

    Full Text Available In high-risk remission B-precursor acute lymphoblastic leukemia (BPL patients, relapse rates have remained high post-hematopoietic stem cell transplantation (HSCT even after the use of very intensive total body irradiation (TBI-based conditioning regimens, especially in patients with a high “minimal residual disease” (MRD burden. New agents capable of killing radiation-resistant BPL cells and selectively augmenting their radiation sensitivity are therefore urgently needed. We report preclinical proof-of-principle that the potency of radiation therapy against BPL can be augmented by combining radiation with recombinant human CD19-Ligand × soluble TRAIL (“CD19L–sTRAIL” fusion protein. CD19L–sTRAIL consistently killed radiation-resistant primary leukemia cells from BPL patients as well as BPL xenograft cells and their leukemia-initiating in vivo clonogenic fraction. Low dose total body irradiation (TBI combined with CD19L–sTRAIL was highly effective against (1 xenografted CD19+ radiochemotherapy-resistant human BPL in NOD/SCID (NS mice challenged with an otherwise invariably fatal dose of xenograft cells derived from relapsed BPL patients as well as (2 radiation-resistant advanced stage CD19+ murine BPL with lymphomatous features in CD22ΔE12xBCR-ABL double transgenic mice. We hypothesize that the incorporation of CD19L–sTRAIL into the pre-transplant TBI regimens of patients with very high-risk BPL will improve their survival outcome after HSCT.

  18. Measurement of total body radioactivity in man

    Techniques for the determination of whole-body radioactivity in man using uncollimated NaI(Tl) detectors have been studied. Geometrical effects and photon attenuation effects due to the different shapes of humans as well as due to varying in-vivo radioactivity distributions have been evaluated particularly for scanning-bed geometries and the chair geometry. Theoretically it is shown that the attenuation effects are generally dominating, for full-energy-peak pulse-range methods. For the application in radiation protection a cheap and simple chair-geometry unit has been constructed and used at various places distantly from the home-laboratory, for studies of body activity of Cs-137 in northern Sweden. High body activities were found particularly in reindeer-breeding Lapps. The elimination rate of Cs-137 in man was studied in the stationary whole-body counter in Lund as well as with the field-system. For the study of the performances at low and high photon energies clinical applications of methods for gastro-intestinal absorption of vitamin B12 (Co-57; 122 keV) and total body potassium determination (K-40; 1.46 MeV, K-42; 1.52 MeV) have been evaluated. Theoretical and experimental results as well as experiences of applications in radiation protection and medicine show that the scanning-bed geometry effectively evens out redistributional effects. For optimum results, however, scatter-energy pulse-ranges rather than full-energy-peak ranges should be used. (Auth.)

  19. Tissue air ratio in total body irradiation

    On the basis of dose readings in 102 patients treated with total body irradiation (TBI), a 'tissue air ratio (TAR) curve' has been produced. It could be useful to precalculate treatment time in TBI, for dose prescription to a specific point, provided the same source (60Co) and treatment setting (lateral irradiation; 3 m source-axis distance; reference point at thighs bifurcation, neat the perineum) is used. The TAR curve produced, and the formula relating tissue depth to TAR value, are presented, and compared to preexisting data for 'magna fields' treatments. This curve is exponential, and in semilog representation becomes straight, as every classic TAR curve; it is lower than others, reflecting non full-scatter situation in patient irradiation. (orig.)

  20. Biological basis of total body irradiation

    A comprehensive understanding of the radiobiological bases of total body irradiation (TBI) is made difficult by the large number of normal and malignant tissues that must be taken into account. In addition, tissue responses to irradiation are also sensitive to associated treatments, type of graft and a number of patient characteristics. Experimental studies have yielded a large body of data, the clinical relevance of which still requires definite validation through randomized trials. Fractionated TBI schemes are able to reduce late normal tissue toxicity, but the ultimate consequences of the fractional dose reduction do not appear to be equivocal. Thus, leukemia and lymphoma cells are probably more radio-biologically heterogeneous than previously thought, with several cell lines displaying relatively high radioresistance and repair capability patterns. The most primitive host-type hematopoietic stem cells are likely to be at least partly protected by TBI fractionation and may hamper late engraftment. Similarly, but with possibly conflicting consequences on the probability of engraftment, the persistence of a functional marrow stroma may also be fractionation-sensitive, while higher rejection rates have been reported after T-depletion grafts and fractionated TBI. in clinical practice (as for performance of relevant clinical trials), the influence of these results are rather limited by the heavy logistic constraints created by a sophisticated and time-consuming procedure. Lastly, clinicians are now facing an increasing incidence of second cancers, at least partly induced by irradiation, which jeopardize the long-term prospects of otherwise cured patients. (authors)

  1. Bone Marrow Transplantation, 20 years of experience with total body irradiation in the 'Hermanos Ameijeiras' hospital

    Using Total Body Irradiation (ICT) for bone marrow transplants is indicated in several hematological malignancies such as Acute and Chronic Myeloid Leukemia, Acute Lymphocytic Leukemia, Lymphoma and Myelodysplastic Syndrome. The odds of survival with this procedure than those obtained with standard treatments in this type of condition, ensuring a better life expectancy for these patients. (Author)

  2. Thermoluminescent dosimetry in total body irradiation

    The aim of this paper was to develop a thermoluminescent dosimetry method for the absorbed dose determination of 6 MeV high-energy electron beams by thermoluminescent dosimetry. Total body irradiation (TBI) was performed using four dual fields angled at 252° and 285° in high-dose rate (HDR) mode. TBI measurements were investigated to estimate the absorbed dose in different anatomical parts of the patient. Experimental results were obtained using thermoluminescent detectors and solid water phantoms. The TL response of the dosimeters, as a function of the high-energy electron beam (HEEB) absorbed dose, was linear, from 0.1 to 500 cGy. The entrance skin dose (ESD) and isodose distribution on the surface of the treatment were investigated graphically. - Highlights: ► The total patient skin electron dose was determined. ► The patient skin dose distribution was measured by TL. ► TBID in treatment planning and QA for radiation therapy are suggested. ► TLD system is a good candidate for TBI dosimetry.

  3. Osteochondroma after total body irradiation in bone marrow transplant recipients. Report of two cases

    We present two cases of osteochondroma after total body irradiation in bone marrow recipients, the first in a 6-year-old boy with juvenile chronic myelogenous leukemia and the second in a 13-year-old boy with acute myelogenous leukemia. The patients developed multiple osteochondromas three years and seven years, respectively, after 12 Gy of total body irradiation. Neither had a family history of hereditary multiple osteochondromatosis. A review of the English literature revealed only one report describing five cases of osteochondroma after 12 Gy of total body irradiation in bone marrow transplant recipients. Osteochondroma should be considered as an additional adverse effect of total body irradiation. (author)

  4. Low-dose total body irradiation and G-CSF without hematopoietic stem cell support in the treatment of relapsed or refractory acute myelogenous leukemia (AML), or AML in second or subsequent remission

    Purpose: Patients with relapsed acute myelogenous leukemia (AML), who are not eligible for bone marrow transplantation, have a poor prognosis when treated with chemotherapy alone. Total body irradiation (TBI) is an effective modality against AML when used in doses of 1000-1400 cGy with hematopoietic stem cell support. We undertook a phase I study of TBI with granulocyte-colony-stimulating factor (G-CSF) support, without stem cell support in patients with AML either in relapse or second or subsequent remission. Methods and Materials: Patients with relapsed AML, or AML in second or subsequent remission were treated in a phase I study of TBI followed by G-CSF. The first dose level was 200 cGy. After the initial cohort of patients it was clear that patients with overt leukemia did not benefit from this treatment, and subsequent patients were required to be in remission at the time of TBI. Results: Eleven patients were treated, 4 in overt relapse, and 7 in remission. 200 cGy was used in all, and dose escalation was not possible due to prolonged thrombocytopenia in all patients but one. Neutrophil recovery was adequate in those patients who remained in remission after TBI. Patients with overt leukemia had transient reduction in blast counts, but rapid recurrence of their leukemia. Patients treated in remission had short remissions, with the exception of one patient who is in remission 32 months after treatment. Conclusion: There is some antileukemic effect of TBI even at 200 cGy, though this dose appears to be too low to help a significant number of patients. If TBI is to be escalated without stem cell support, then a thrombopoietic agent will need to be used

  5. Cataract incidence after total-body irradiation

    Purpose: The aim of this retrospective study was to evaluate cataract incidence in a homogeneously-treated group of patients after total-body irradiation (TBI) followed by autologous bone marrow transplantation or peripheral blood stem cell transplantation. Methods and Materials: Between 1982 and 1994, a total of 260 patients received either autologous bone marrow or blood stem cell transplantation for hematological malignancy at the University of Heidelberg. Two hundred nine of these patients received TBI in our hospital. Radiotherapy was applied as hyperfractionated TBI, with a median dose of 14.4 Gy in 12 fractions over 4 days. Minimum time between fractions was 4 h. Photons with an energy of 23 MeV were used with a dose rate of 7-18 cGy/min. Ninety-six of the 209 irradiated patients were still alive in 1996; 86 of these patients (52 men, 33 women) answered a questionnaire and could be examined ophthalmologically. The median age at time of TBI was 38.5 years, with a range of 15-59 years. Results: The median follow-up is now 5.8 years, with a range of 1.7-13 years. Cataract occurred in 28/85 patients (32.9%) after a median of 47 months (1-104 months). In 6 of 28 patients who developed a cataract, surgery of the cataract was performed. Whole-brain irradiation prior to TBI had been performed more often in the group of patients developing cataract (14.3%) versus 10.7% in the group of patients without cataract. However, there was no statistical difference (Chi-square, p > 0.05). Conclusion: Cataract is a common side effect of TBI. Cataract incidence found in our patients is comparable to results of other centers using a fractionated regimen for TBI. To assess the incidence of cataract after TBI, a long-term follow-up is required

  6. Biological problems of total body irradiation

    We have considered the dose required for meeting the aims of total body irradiation as well as its significance in terms of cell survival for bone marrow stem cells leukaemia, intestinal mucosa and lung. The necessity of a relative protection of the critical tissues with respect to the target populations the irradiation is aiming at, is emphasized. Localized shielding of the lung results in a reduction of the dose to a part of the target population; its biological consequence is discussed. Fractionation and protraction of the irradiation can achieve a significant protection of the critical tissues. Radiobiological data allow estimating the benefit of reducing the fraction size to 1.25 Gy or the dose rate to 0.05 Gy/mn. The benefit of smaller fraction size or dose rate is probably small. Fractionation or low dose rate appear equivalent for the protection of the critical tissues. A larger clinical experience is necessary for a definite comparison of their biological and practical advantages

  7. Multiple osteochondromata after total body irradiation. A case report

    We present a rare case of multiple osteochondromata after total body irradiation (TBI) in a bone marrow recipient. The patient was a 9-year-old boy. He had been given 13.2 Gy of TBI before allogeneic bone marrow transplantation (BMT) at the age of one because of acute lymphoblastic leukemia (ALL). He did not have a family history of hereditary multiple osteochondromatosis. Osteochondromata presented at the left clavicle, bilateral scapulae, right distal femur, and right proximal tibia. The lesions of the left clavicle and bilateral scapulae were excised. Histological features of resected specimens were those of osteochondroma, showing no evidence of malignant transformation. Although radiation is recognized to be a cause of osteochondroma, reports of TBI are rare. TBI should be considered as one of the causes of multiple osteochondromata. (author)

  8. Fludarabine Phosphate and Total-Body Irradiation Followed by Donor Peripheral Blood Stem Cell Transplant in Treating Patients With Acute Lymphoblastic Leukemia or Chronic Myelogenous Leukemia That Has Responded to Treatment With Imatinib Mesylate, Dasatinib, or Nilotinib

    2015-07-20

    Adult Acute Lymphoblastic Leukemia in Remission; Blastic Phase Chronic Myelogenous Leukemia; Childhood Acute Lymphoblastic Leukemia in Remission; Chronic Myelogenous Leukemia, BCR-ABL1 Positive; Chronic Phase Chronic Myelogenous Leukemia; Philadelphia Chromosome Positive Adult Precursor Acute Lymphoblastic Leukemia; Philadelphia Chromosome Positive Childhood Precursor Acute Lymphoblastic Leukemia; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Lymphoblastic Leukemia; Relapsing Chronic Myelogenous Leukemia

  9. An experimental model of acute encephalopathy after total body irradiation in the rat: effect of Ginkgo biloba extract (EGb 761); Effet de l'extrait de Ginkgo biloba (EGb 761) chez le rat sur un modele experimental d'encephalopathie aigue apres irradiation corporelle totale

    Lamproglou, I.; Bok, B. [Hopital Bichat, 75 - Paris (France); Boisserie, G.; Mazeron, J.J.; Baillet, F. [Hopital Pitie-Salpetriere, 75 - Paris (France); Drieu, K. [IHB-IPSEN, 75 - Paris (France)

    2000-06-01

    To define the therapeutic effect of Ginkgo biloba extract (EGb 761) in an experimental model of acute encephalopathy following total body irradiation in rats. Ninety four-month-old rats received 4.5 Gy total body irradiation (TBI) at day 1 while 15 rats received sham irradiation. A behavioural study based on a conditioning test of negative reinforcement, the one-way avoidance test, was performed test, was performed after irradiation. Orally treatment was started one day (study A) or twenty two days (study B) after irradiation and repeated daily for twelve days. In the irradiated group, three subgroups were defined according to the treatment received: EGb 761 (50 mg/kg), EGb 761 (100 mg/kg), water. This work comprised two consecutive studies. In study A (45 rats) the one-way avoidance test was administered daily from day 7 to day 14. In study B (45 rats) the behavioural test was performed from day 28 to day 35. Study A (three groups of 15 rats): following TBI, irradiated rats treated with water demonstrated a significant delay in a learning the one-way avoidance test in comparison with sham-irradiated rats (P < 0.0002) or irradiated rats treated with EGb 761 (50 mg/kg; P < 0.007) or EGb 761 (100 mg/kg; P < 0.0002). The irradiated rats, treated with EGb 761 (50 or 100 mg/kg) did not differ from the sham-irradiated controls. Study B (three groups of 15 rats): the irradiated rats, treated with water of EGb 761 (50 or 100 mg/kg) did not differ from the sham-irradiated controls. (authors)

  10. Total body irradiation and allogeneic bone-marrow transplantation

    The aim of the present study is to present the first case in the Bulgarian oncological practice of total-body irradiation (TBI) followed by allogeneic transplantation of hemopoietic peripheral steam cells from a haploidentical family donor to a patient with acute lymphoblastic leukemia. The patient was a 10-year old boy with a verified non-Hodgkin lymphoma - IV clinical stage (leukemia-lymphoma syndrome) with initial mediastinal and bone-marrow engagement. After the disease recurrence the patient was hospitalized in the Transplantation Department of the Specialized Pediatric Hospital for Active Treatment of Oncological Diseases for realizing allogeneic transplantation. The application of the conditioning regime includes Melphalan, Fludarabine, ATG and TBI with 5x2 Gy. The patient was discharged on the 30th day in a good general condition with compensated haematological parameters and stable function of the transplant, and with instructions for the control check-ups and examinations each 14 days till the day + 100. The TBI method applied by the team was simple for realization and did not require special equipment. The patient received irradiation by a vertical radiation beam in a small procedure room in a comfortable spinal and prone position, which allowed the realization of sufficiently homogeneous dose in the body and effective lung protection. The irradiation time was acceptable, compared with the time for the application of horizontal radiation beams at large distances. (authors)

  11. Estimation of Total Body Fat from Potassium-40 Content

    This paper concerns on estimation of total body fat from potassium 40 content using total body counting technique. The work performed using fast scan whole body counter. Calibration of that system for K-40 was carried out under assumption that uniformity distribution of radioactivity of potassium was distributed in 10 polyethylene bottles phantom. Different body sizes were represented by 2, 4, 6, 8 and 10 polyethylene bottles; each bottle has a volume of 0.04 m3. The counting efficiency for each body size was determined. Lean body weight (LBW) was calculated for ten males and ten females using appropriate mathematical equation. Total Body Potassium, TBK for the same selected group was measured using whole body counter. A mathematical relationship between lean body weight and potassium content was deduced .Fat contents for some individuals were calculated and weight/height ratio was indicated for fatness.

  12. Myeloproliferative disorders in patients with rheumatoid arthritis treated with total body irradiation

    Four patients with refractory rheumatoid arthritis were treated with total body irradiation administered in two sittings, 300 to 400 rads to each half of the body. All four patients had taken antimetabolites prior to receiving total body irradiation, and two continued to use them after total body irradiation. Two patients had taken alkylating agents before, and one had used them after total body irradiation. All patients showed clinical improvement. However, in two patients myeloproliferative disorders developed: a myelodysplastic preleukemia at 40 months after total body irradiation in one and acute myelogenous leukemia at 25 months in the other. Total body irradiation differs from total nodal irradiation in the total dose of irradiation (300 to 400 rads versus 2,000 to 3,000), and in the duration of the therapy (two sittings versus treatment over several weeks to months). Furthermore, the patients in the total body irradiation study frequently used cytotoxic drugs before and/or after irradiation, whereas in one total nodal irradiation study, azathioprine (2 mg/kg per day or less) was permitted, but no other cytotoxic agents were allowed. Rheumatologists may therefore face a binding decision when deciding to treat a patient with rheumatoid arthritis with either a cytotoxic drug or irradiation

  13. Myeloproliferative disorders in patients with rheumatoid arthritis treated with total body irradiation

    Urowitz, M.B.; Rider, W.D.

    1985-01-21

    Four patients with refractory rheumatoid arthritis were treated with total body irradiation administered in two sittings, 300 to 400 rads to each half of the body. All four patients had taken antimetabolites prior to receiving total body irradiation, and two continued to use them after total body irradiation. Two patients had taken alkylating agents before, and one had used them after total body irradiation. All patients showed clinical improvement. However, in two patients myeloproliferative disorders developed: a myelodysplastic preleukemia at 40 months after total body irradiation in one and acute myelogenous leukemia at 25 months in the other. Total body irradiation differs from total nodal irradiation in the total dose of irradiation (300 to 400 rads versus 2,000 to 3,000), and in the duration of the therapy (two sittings versus treatment over several weeks to months). Furthermore, the patients in the total body irradiation study frequently used cytotoxic drugs before and/or after irradiation, whereas in one total nodal irradiation study, azathioprine (2 mg/kg per day or less) was permitted, but no other cytotoxic agents were allowed. Rheumatologists may therefore face a binding decision when deciding to treat a patient with rheumatoid arthritis with either a cytotoxic drug or irradiation.

  14. Total body irradiation: present and future; Irradiation corporelle totale: present et avenir

    Zilli, T.; Miralbell, R.; Ozsahin, M. [Hopitaux Universitaires de Geneve, Service de Radio-Oncologie (Switzerland); Ozsahin, M. [Centre Hospitalier Universitaire Vaudois, Service de Radio-Oncologie, Lausanne (Switzerland)

    2009-09-15

    Total body irradiation (T.B.I.) has an established role as preparative regimen for bone-marrow transplantation in the treatment of hematological malignancies. Many randomized trials demonstrated that the clinical outcomes obtained from the association of T.B.I. and cyclophosphamide are equivalent, or, sometimes, better than those based on chemotherapeutic agents. Despite the therapeutic progress of the last years, and the consequent improvement in the overall survival, this preparative regimen remains always associated with a relatively high rate of acute and late toxicity. In this article, we review the actual indications of T.B.I. in clinical practice, and analyze the technological progress in this domain. We focus on the hypothesis that a selective irradiation of the hematopoietic or lymphoid organs is actually possible with intensity-modulated radiotherapy. Technical limits and preliminary results in terms of acute and late toxicities of intensity-modulated T.B.I. are analyzed. With these new technologies, treatment-related toxicity is not anymore a major limiting factor in the preparative regimens for bone-marrow transplantation, allowing for a larger spectrum of T.B.I. indications, a possible extension to patients older than 50 years, or a dose escalation. Preliminary results warrant, however, further evaluation in clinical trials to better assess the impact of this new approach on disease control and the long-term toxicity. (authors)

  15. An unusual foreign body producing acute laryngeal obstruction

    Kalan, A.; Tariqs, M.

    1999-01-01

    This paper present an unusual case of acute upper respiratory obstruction due to an inhaled grape necessitating acute surgical measures. Study of the literature proves laryngeal foreign bodies to be a rare occurrence but infinitely more dramatic and life-threatening than either oesophageal or bronchial foreign bodies. Successful management entails prompt surgical intervention coupled with at times, surgical ingenuity.

  16. Total body irradiation with a 10 MV linear accelerator in conjunction with bone marrow transplantation

    Total body irradiation (1000 rad, single dose) in conjunction with chemotherapy and bone marrow transplantation is a therapy for acute leukemia. We show that a 10 MV linear accelerator is a suitable source of radiation for these procedures. Dosimetric and clinical results are presented for 25 patients who were treated between 5/76 and 12/78

  17. Iodine I 131 Monoclonal Antibody BC8, Fludarabine Phosphate, Total Body Irradiation, and Donor Stem Cell Transplant Followed by Cyclosporine and Mycophenolate Mofetil in Treating Patients With Advanced Acute Myeloid Leukemia or Myelodysplastic Syndrome

    2015-11-16

    Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Childhood Myelodysplastic Syndromes; Chronic Myelomonocytic Leukemia; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Myeloid Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Refractory Anemia With Excess Blasts; Refractory Anemia With Excess Blasts in Transformation; Refractory Anemia With Ringed Sideroblasts; Refractory Cytopenia With Multilineage Dysplasia; Secondary Acute Myeloid Leukemia; Secondary Myelodysplastic Syndromes

  18. Radiolabeled Monoclonal Antibody Therapy, Fludarabine Phosphate, and Low-Dose Total-Body Irradiation Followed by Donor Stem Cell Transplant and Immunosuppression Therapy in Treating Older Patients With Advanced Acute Myeloid Leukemia or High-Risk Myelodysplastic Syndromes

    2015-11-16

    Adult Acute Myeloid Leukemia in Remission; Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Chronic Myelomonocytic Leukemia; de Novo Myelodysplastic Syndromes; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Myeloid Leukemia; Refractory Anemia With Excess Blasts; Refractory Anemia With Excess Blasts in Transformation; Refractory Anemia With Ringed Sideroblasts; Refractory Cytopenia With Multilineage Dysplasia; Secondary Myelodysplastic Syndromes; Untreated Adult Acute Myeloid Leukemia

  19. Total body irradiation in non-Hodgkin's lymphoma

    Between October 1972 and August 1977, low-dose fractionated total body irradiation (TBI), 150 to 300 rad,, was selected for 48 patients with previously untreated non-Hodgkin's lumphoma staged II, III, and IV. In 63% of the patients the disease had a nodular pattern; there were no patients with diffuse histiocytic lymphoma. All but 2 patients responded to TBI. The 4-year acutarial survival was 71% for the nodular group and 57% for the diffuse group. There were no acute symptoms during the course of treatment and no mortality associated with the treatment. Seventeen per cent of the patients developed transient platelet counts less than 30,000/mm3. Four required hospitilization for correction of thrombocytopenia and/or infection. The majority of patients who failed more than 3 months after initial complete remission were placed back in remission with either chemotherapy, TBI, or local irradiation. Patients with persistent disease after TBI showed a less favorable response with chemotherapy. A selected group of 15 patients in relapse after chemotherapy or localized radiotherapy were treated with TBI. Eleven responded to treatment, while 4 showed no useful response. The median survival for this group was slightly over 2 years. Twenty percent developed transient platelet counts less than 30,000/mm3

  20. Total body irradiation for myasthenia gravis with thymoma: case report

    Kang, Ki Mun; Choi, Ihl Bohng; Kim, In Ah [College of Medicine, Catholic Univ., Seoul (Korea, Republic of)

    1999-06-01

    Myasthenia Gravis (MG) is relatively rare occuring as one of important autoimmune disease to affect neuromuscular junction. This study was clinically to evaluate total body irradiation (TBI) against two patients including 33-year and 39-year females for chronic MG with thymoma who hospitalized in the St. Mary's Hospital, Catholic University since 1994 as well as who showed no response by thymectomy, immunotherapy and hormonal therapy. TBI designed by the dose of 150-180 cGy consisting of 10 cGy per fraction, three times a week, for 5-6 weeks using linear accelerator of 6 MV. During the treatment of TBI, they did complain acute side effect such as vomiting and also appear improved physical condition from 4-6 weeks after TBI. Through the follow-up period of 18 or 42 months after TBI, they did not have any symptomatic recurrence. Consequently, the results suggest that TBI can be used as an alternative tool for the patients concurrently for MG with thymoma who had been refractory to various conventional therapies like thymectomy, immunotherapy and hormonal therapy.

  1. Total body irradiation for myasthenia gravis with thymoma: case report

    Myasthenia Gravis (MG) is relatively rare occuring as one of important autoimmune disease to affect neuromuscular junction. This study was clinically to evaluate total body irradiation (TBI) against two patients including 33-year and 39-year females for chronic MG with thymoma who hospitalized in the St. Mary's Hospital, Catholic University since 1994 as well as who showed no response by thymectomy, immunotherapy and hormonal therapy. TBI designed by the dose of 150-180 cGy consisting of 10 cGy per fraction, three times a week, for 5-6 weeks using linear accelerator of 6 MV. During the treatment of TBI, they did complain acute side effect such as vomiting and also appear improved physical condition from 4-6 weeks after TBI. Through the follow-up period of 18 or 42 months after TBI, they did not have any symptomatic recurrence. Consequently, the results suggest that TBI can be used as an alternative tool for the patients concurrently for MG with thymoma who had been refractory to various conventional therapies like thymectomy, immunotherapy and hormonal therapy

  2. Total body irradiation - review of treatment techniques in Europe

    In treatment of acute leukaemia and other disseminated diseases, high dose total body irradiation (TBI) combined with intensive chemotherapy and bone marrow transplantation (BMT) is use more and more successfully. Reflecting the complex clinical, biological, physical and technical situation of TBI, a large variety of TBI treatment techniques has been developed. In order to review the techniques applied in Europe and to report about common methods as well as about new ideas in TBI, a questionnaire was prepared and mailed to medical physicists in Europe responsible for TBI. The topics of this questionnaire are general information: TBI technique (beams, fields, treatment conditions); basic TBI dosimetry; physical treatment planning (patient dosimetry, heterogeneity correction, dose modification, dose homogeneity, dose precision, confirmation measurements); TBI treatment planning (dose prescription, localization, documentation, verification, in vivo dosimetry); requirements (additional staff, time, equipment) and recommendations for improvement of TBI. Most questionnaires (34/45) were returned in time with detailed information from TBI centres in 15 European countries. These data as well as results of the 'Meeting of Leiden, 1982' of the 'Meeting of Essen, 1985' and of the 'Meeting of Toulouse, 1986' are summarized and discussed. There are many interesting methods to plan and perform exact TBI. However, anterior-posterior TBI is preferred to achieve sufficient homogeneity of dose and effective lung shielding. While the development of TBI has reached a high level of exactness, further improvement will require a better knowledge of the dose-effect relationships. (Auth.)

  3. Total body irradiation: current indications; L`irradiation corporelle totale: les indications actuelles

    Giraud, P.; Danhier, S.; Dubray, B.; Cosset, J.M. [Institut Curie, 75 - Paris (France)

    1998-05-01

    The choice of dose and fractionation for total body irradiation is made difficult by the large number of considerations to be taken into account. The outcome of bone marrow transplantation after total body irradiation can be understood in terms of tumor cell killing, engraftment, and normal tissue damage, each of these endpoints being influenced by irradiation-, disease-, transplant-, and patient- related factors. Interpretation of clinical data is further hampered by the overwhelming influence of logistic constraints, the small numbers of randomized studies, and the concomitant variations in total dose and fraction size or dose rate. So far, three cautious conclusions can be drawn in order to tentatively adapt the total body irradiation schedule to clinically-relevant situations. Firstly, the organs at risk for normal tissue damage (lung, liver, lens, kidney) are protected by delivering small doses per fraction at low dose rate. This suggests that, when toxicity is at stake (e.g. in children), fractionated irradiation should be preferred, provided that inter-fraction intervals are long enough. Secondly, fractionated irradiation should be avoided in case of T-cell depleted transplant, given the high risk of graft rejection in this setting. An alternative would be to increase total (or fractional) dose of fractionated total body irradiation, but this approach is likely to induce more normal tissue toxicity. Thirdly, clinical data have shown higher relapse rates in chronic myeloid leukemia after fractionated or low dose rate total body irradiation, suggesting that fractionated irradiation should not be recommended, unless total (or fractional) dose is increased. Total body irradiation-containing regimens, primarily cyclophosphamide / total body irradiation, are either equivalent to or better than the chemotherapy-only regimens, primarily busulfan / cyclophosphamide. Busulfan / cyclophosphamide certainly represents a reasonable alternative, especially in patients who

  4. Determination of total body water by Fourier transform infrared analysis

    A new technique for determinig body water using deuterium isotope dilution for Fourier transform infrared (FTIR) analysis is described. The advantages of the FTIR over conventional dispersion and filter infrared instruments include greater flexibility through computer controlled operations and availability of 'on-line' analytical software. The technique was further improved by the development of a simple procedure for determining D2O concentration in untreated serum samples. A validation study of six normal adults showed that the fat-free-mass determined from the deuterium-space (total body water) correlated well with the results obtained by total body nitrogen (r = 0.997), total body potassium (r = 0.99f6) and anthropometric (r = 0.995) measurements. 17 refs., 4 tabs., 4 figs

  5. Fractionated homogenous total-body irradiation prior to bone marrow transplantation

    At the University of Kiel, myeloid and acute lymphatic leukemia is treated since 1983 by total-body irradiation applied prior to bone marrow transplantation. Dose deviations in the midplane caused by the irregular surface and tissue inhomogeneities of the patient are reduced down to +- 3.5% compared to the central ray, with the help of CT-based individual compensators. This method prevents above all an excessive dose to the lungs. The radiobiologic advantages of fractionated irradiation have been employed for all patients treated hitherto (n = 9). At present, a total body dose of 12 Gy in six fractions is applied within three days. There were no undesired acute radiogenic reactions except a mild acute mucositis found in all patients. Chronic side effects, especially in the lungs, were not demonstrated, too. However, the average follow-up time of 149 days has been rather short. One patient died from relapse of leukemia after a total dose of 10 Gy, another patient died because the transplanted bone marrow was rejected, and a third died from catheter sepsis. Six out of nine patients are in complete remission with a maximum index of Karnofsky. The limited experiences gained hitherto show that the homogeneous accelerated-fractionated total-body irradiation offers essential advantages compared to non-compensated single dose irradiation with respect to the prevention of undesired radiogenic effects in sound tissues and that its therapeutic efficacy is at least the same. (orig.)

  6. Moderate Intensity Resistance Training Significantly Elevates Testosterone following Upper Body and Lower Body Bouts When Total Volume is Held Constant

    Robert Rietjens

    2015-10-01

    Full Text Available Introduction: It is unknown whether resistance training intensity or total volume of work affects the acute testosterone response to a greater extent. Purpose: Therefore, the circulating testosterone response was investigated following four resistance training protocols where total volume of work was held constant: moderate intensity (70% 1RM upper body (bench press, bent barbell row, and military press, moderate intensity lower body (squat and deadlift, high intensity (90% 1RM upper body, high intensity lower body. Methods: Total volume of work performed by each participant between protocols was maintained by adjusting the number of sets and or repetitions performed. Ten healthy, resistance trained men volunteered, and performed exercise protocols on separate days in a counterbalanced order. Capillary blood was obtained via finger stick at baseline (pre, immediately following the exercise session (post, and 1h post for the determination of testosterone concentration. Data were analyzed using a factorial ANOVA and significance was accepted at p≤ 0.05. Results: Both moderate intensity resistance protocols (upper and lower body significantly increased testosterone concentration (p=0.026, and p=0.024 respectively, whereas the high intensity protocols elevated testosterone but failed to achieve significance (upper p=0.272, lower p=0.658. No difference was noted in post session testosterone concentration between upper and lower body protocols for either moderate (p=0.248 or high intensity (p=0.990. Conclusion: This may be useful for novice resistance trained individuals because it provides evidence that moderate intensity is sufficient to increase testosterone compared to high intensity protocols that could be associated with a greater risk of injury.Keywords: hormone response, equal total work, high intensity protocol

  7. Evaluation of severity by whole body CT in acute pancreatitis

    Evaluation of severity in acute pancreatitis is still controversial. We studied about thirteen cases of acute pancreatitis and calculated CT score using findings of early whole body CT scanning within forty eight hours after initial symptoms. Simultaneously we calculated clinical score too. CT score was constituted by ten points (changes limitted in pancreas itself, extension of inflammation and extrapancreatic fluid collection etc.). And clinical score was constituted by eight clinical symptoms and fourteen laboratory findings in fatal pancreatitis reported in Japan. From these studies, we conclude that early CT scanning is more useful for objective determination of severity and therapy (surgical or medical) in acute pancreatitis than clinical findings. So we made new classification of severity in acute pancreatitis by CT score as follows: severe (6=: medical therapy). (author)

  8. Total body neutron activation analysis of calcium: calibration and normalisation

    An irradiation system has been designed, using a neutron beam from a cyclotron, which optimises the uniformity of activation of calcium. Induced activity is measured in a scanning, shadow-shield whole-body counter. Calibration has been effected and reproducibility assessed with three different types of phantom. Corrections were derived for variations in body height, depth and fat thickness. The coefficient of variation for repeated measurements of an anthropomorphic phantom was 1.8% for an absorbed dose equivalent of 13 mSv (1.3 rem). Measurements of total body calcium in 40 normal adults were used to derive normalisation factors which predict the normal calcium in a subject of given size and age. The coefficient of variation of normalised calcium was 6.2% in men and 6.6% in women, with the demonstration of an annual loss of 1.5% after the menopause. The narrow range should make single measurements useful for diagnostic purposes. (author)

  9. Hepatic, renal, and total body galactose elimination in the pig

    Winkler, K; Henriksen, Jens Henrik Sahl; Tygstrup, N

    1993-01-01

    reabsorption (Tm 178 +/- 3.0 mumol/min, Km 3.8 +/- 0.9 mmol/l, n = 20). Metabolic conversion of galactose in the kidney was not demonstrable. At all concentrations studied (0.4-5.8 mmol/l), total galactose elimination from the body exceeded the sum of hepatic and renal elimination by approximately 100 mumol....../min, independent of the concentration. At blood concentrations usually used for clinical estimation of the galactose elimination capacity (approximately 4 mmol/l), hepatic removal in the pig accounted for 55% and renal removal for 30% of total removal; 15% of removal occurred in other organs. We conclude that...... estimation of the hepatic galactose elimination capacity from whole body elimination curves requires correction for renal removal of galactose....

  10. Electronic compensation technique to deliver a total body dose

    Lakeman, Tara E.

    Purpose: Total body irradiation (TBI) uses large parallel-opposed radiation fields to suppress the patient's immune system and eradicate the residual cancer cells in preparation of recipient for bone marrow transplant. The manual placement of lead compensators has been conventionally used to compensate for the varying thickness throughout the body in large-field TBI. The goal of this study is to pursue utilizing the modern electronic compensation technique to more accurately and efficiently deliver dose to patients in need of TBI. Method: Treatment plans utilizing the electronic compensation to deliver a total body dose were created retrospectively for patients for whom CT data had been previously acquired. Each treatment plan includes two pair of parallel opposed fields. One pair of large fields is used to encompass the majority of the patient's anatomy. The other pair are very small open fields focused only on the thin bottom portion of the patient's anatomy, which requires much less radiation than the rest of the body to reach 100% of the prescribed dose. A desirable fluence pattern was manually painted within each of the larger fields for each patient to provide a more uniform distribution. Results: Dose-volume histograms (DVH) were calculated for evaluating the electronic compensation technique. In the electronically compensated plans, the maximum body doses calculated from the DVH were reduced from the conventionally-compensated plans by an average of 15%, indicating a more uniform dose. The mean body doses calculated from the electronically compensated DVH remained comparable to that of the conventionally-compensated plans, indicating an accurate delivery of the prescription dose using electronic compensation. All calculated monitor units were within clinically acceptable limits. Conclusion: Electronic compensation technique for TBI will not increase the beam on time beyond clinically acceptable limits while it can substantially reduce the compensator setup

  11. Total body irradiation in hematopoietic stem cell transplantation

    Fundagul Andic

    2014-01-01

    Total body irradiation is used in conjunction with chemotherapy as a conditioning regimen in the treatment of many disease such as leukemia, myelodysplastic syndrome, aplastic anemia, multiple myeloma and lymphoma prior to the hematopoetic stem cell transplantation. The main purposes of the hematopoetic stem cell transplantation are eradication of the recipient bone marrow and any residual cancer cells, creation of space in the receipient bone marrow for donor hematopoetic stem cells, and imm...

  12. Total energy expenditure and body composition in early infancy.

    Wells, J. C.; Cole, T.J.; Davies, P S

    1996-01-01

    In adults greater energy expenditure, primarily on physical activity, is associated with greater leanness. Such an association has proved more difficult to demonstrate in infants, partly due to the difficulty of measuring fatness and free living energy expenditure in this age group. Stable isotope techniques now make such investigations more viable. OBJECTIVE: The relationship between body composition and energy expenditure was investigated in 12 week infants. METHODS: Total energy expenditur...

  13. From Talking Heads to Communicating Bodies: Cybersemiotics and Total Communication

    Ole Nedergaard Thomsen

    2010-03-01

    Full Text Available Current linguistics is biased towards considering as object of scientific study only verbal language, i.e., ordinary language whose basic entities are words, sentences, and texts. By having this focus, the crucial non-verbal semiotic contributions from acts of bodily communication are left out of consideration. On the face of it, this is a strange situation, because, phenomenologically, when observing a communicating dyad, what appears to the senses is a multimodal semiotic display–the interactants produce acts of total communication, the linguistic part of which has in fact to be disentangled from the integral semiotic behavior. That a human being should in the first place be conceptualized as a ‘talking head’, rather than a ‘communicating body’, stems from at least four historically interrelated fountains: ancient Greek philosophy with its emphasis on logos as meaning both rational mind and verbal language/speech as well as with its rejection of rhetoric (including body language; Cartesian dualistic rationalism where the body was the animal, mechanistic part of a human being, unworthy for the Geisteswissenschaften; Saussure’s formal structuralism with its defocusing of the individual’s performance, parole, and its high focus on societal langue; and Chomskyan linguistics with its neglect of actual, also bodily, performance, and its total focus on an ideal mental grammatical computational competence. With the recent philosophy (‘in the flesh’ of the ‘embodied mind’, time has now come for integrating the (linguistic head with the (other part of the communicating body and seeing communication as total communication of the whole body. This means that the communicating mind is no longer restricted to its ‘rational’ aspects but has to be conceived full-scale as integrating also all kinds of ‘irrational’ factors, like emotions and motivations. Another, no less important, implication of the above is that an individual

  14. Feasibility study of helical tomotherapy for total body or total marrow irradiation

    Total body radiation (TBI) has been used for many years as a preconditioning agent before bone marrow transplantation. Many side effects still plague its use. We investigated the planning and delivery of total body irradiation (TBI) and selective total marrow irradiation (TMI) and a reduced radiation dose to sensitive structures using image-guided helical tomotherapy. To assess the feasibility of using helical tomotherapy (A) we studied variations in pitch, field width, and modulation factor on total body and total marrow helical tomotherapy treatments. We varied these parameters to provide a uniform dose along with a treatment times similar to conventional TBI (15-30 min). (B) We also investigated limited (head, chest, and pelvis) megavoltage CT (MVCT) scanning for the dimensional pretreatment setup verification rather than total body MVCT scanning to shorten the overall treatment time per treatment fraction. (C) We placed thermoluminescent detectors (TLDs) inside a Rando phantom to measure the dose at seven anatomical sites, including the lungs. A simulated TBI treatment showed homogeneous dose coverage (±10%) to the whole body. Doses to the sensitive organs were reduced by 35%-70% of the target dose. TLD measurements on Rando showed an accurate dose delivery (±7%) to the target and critical organs. In the TMI study, the dose was delivered conformally to the bone marrow only. The TBI and TMI treatment delivery time was reduced (by 50%) by increasing the field width from 2.5 to 5.0 cm in the inferior-superior direction. A limited MVCT reduced the target localization time 60% compared to whole body MVCT. MVCT image-guided helical tomotherapy offers a novel method to deliver a precise, homogeneous radiation dose to the whole body target while reducing the dose significantly to all critical organs. A judicious selection of pitch, modulation factor, and field size is required to produce a homogeneous dose distribution along with an acceptable treatment time. In

  15. Severe Pulmonary Toxicity After Myeloablative Conditioning Using Total Body Irradiation: An Assessment of Risk Factors

    Purpose: To assess factors associated with severe pulmonary toxicity after myeloablative conditioning using total body irradiation (TBI) followed by allogeneic stem cell transplantation. Methods and Materials: A total of 101 adult patients who underwent TBI-based myeloablative conditioning for hematologic malignancies at Duke University between 1998 and 2008 were reviewed. TBI was combined with high-dose cyclophosphamide, melphalan, fludarabine, or etoposide, depending on the underlying disease. Acute pulmonary toxicity, occurring within 90 days of transplantation, was scored using Common Terminology Criteria for Adverse Events version 3.0. Actuarial overall survival and the cumulative incidence of acute pulmonary toxicity were calculated via the Kaplan-Meier method and compared using a log-rank test. A binary logistic regression analysis was performed to assess factors independently associated with acute severe pulmonary toxicity. Results: The 90-day actuarial risk of developing severe (Grade 3-5) pulmonary toxicity was 33%. Actuarial survival at 90 days was 49% in patients with severe pulmonary toxicity vs. 94% in patients without (p < 0.001). On multivariate analysis, the number of prior chemotherapy regimens was the only factor independently associated with development of severe pulmonary toxicity (odds ratio, 2.7 per regimen). Conclusions: Severe acute pulmonary toxicity is prevalent after TBI-based myeloablative conditioning regimens, occurring in approximately 33% of patients. The number of prior chemotherapy regimens appears to be an important risk factor.

  16. Bioimpedance index for measurement of total body water in severely malnourished children

    Girma, Tsinuel; Kæstel, Pernille; Workeneh, Netsanet;

    2016-01-01

    BACKGROUND & OBJECTIVES: Restoration of body composition indicates successful management of severe acute malnutrition (SAM). Bioimpedance (BI) index (height(2)/resistance) is used to predict total body water (TBW) but its performance in SAM, especially with oedema, requires further investigation....... SUBJECTS/METHODS: Children with SAM (mid-arm circumference <11.0 cm or weight-for-height <70% of median of NCHS reference and/or nutritional oedema) admitted to Jimma University Hospital were included. Tetrapolar-whole-body impedance (Z), resistance (R) and reactance (Xc) were measured at 50 and 200 k...... children with oedematous SAM, BI index was weak in predicting TBW. Moreover, predicted TBWs at 200 kHz and 50 kHz did not differ and hence BI measurement at 50 kHz is still practical for TBW estimation....

  17. Total body irradiation in France in the past twenty years

    A review of the activity and techniques of total body irradiation (TBI) in France in the last 20 years is presented. In order to have on overall view of the activity and techniques of total body irradiation in France, the group of cancer centre radiation oncologists sent a questionnaire to all the cancer centres or public hospitals radiotherapy departments dealing with this treatment. Thirty-six questionnaires were sent and thirty-one departments answered. Three departments do not offer this treatment. Five departments did not answer. Results, therefore, concern the activity of the 28 departments that agreed to give detailed and clear answers. A total of 10 630 TBIs have been documented, 850 to 900 TBI have been done each year since 1995. Single fraction TBIs are used in only five centres and are being progressively abandoned. For Multiple-fraction TBIs, the techniques described here are the ones used in 1999, at the time the questionnaires were sent. A majority (98%) of the teams used linear accelerators. The collected data are synthesised in tables. Nowadays, single fraction TBIs are only indicated in exceptional cases, Most of the TBIs are fractionated in six twice-daily fractions with pulmonary shielding to limit the dose between 6 and 11 Gy depending on departments' protocols and pathologies. (author)

  18. Renin secretion and total body sodium: Pathways of integrative control

    Bie, Peter; Damkjaer, Mads

    2009-01-01

    Abstract 1. We review mechanisms of sodium balance operating at constant mean arterial blood pressure (MABP), i.e., conditions where MABP does not provide the primary signal to the kidney. 2. Relative constancy of body fluids requires accurate regulation of total body sodium (TBS). Normally, plenty...... of sodium is ingested, and balance achieved by control of renal excretion driven by multiple central nervous, cardiovascular, endocrine, and renal tubular mechanisms. Subtle changes in sodium balance are associated with parallel changes in extracellular volume (due to fast and precise osmoregulation......), but not necessarily in MABP. Signals different from MABP, therefore, seem to be the primary link between TBS and kidney function. 3. Renal functions involved in sodium homeostasis include (i) the rate of glomerular filtration (GFR) determined by renal hemodynamics including tubulo-glomerular feedback...

  19. Body composition determination by measurement of total body activation products in expired air

    In-vivo neutron activation followed by whole body counting has become a routine method for measuring the major elements in the body, such as total body calcium. More recently a careful analysis of radioactive components in expired air after neutron activation has shown some of these components are directly related to the body content of major elements. The gaseous activation products are produced both by direct fast neutron reactions and by secondary proton reactions. The protons are produced by hydrogen atom recoil after neutron interaction with the large quantity of hydrogen in the body. The specific longer-lived radionuclides which are easily measured in expired air are 37Ar, 41Ar, 11C, and 13N. The 37Ar is expired as noble gas and is produced by the reaction 40Ca(n, α)37Ar. The accurate determination of total body calcium in animals has been demonstrated using 37Ar measurements and the determination in humans appears very feasible. The 11C, expired as 11CO and 11CO2, is produced by 14N(p, α)11C and it appears that total body nitrogen can be determined from the 11C measurements All activation products which form gases in the body after neutron irradiation are potentially useful in determining the body content of the parent element. Several radioactive gases have been recently identified in the expired air of animals or humans after low level neutron irradiation. These include 37Ar, 41Ar, 11CO, 11CO2, 13N2, 13NO or 13N2O. Other radioactive gases which can probably be measured at very low levels are 11CH3

  20. Study on Fractionated Total Body Irradiation before Hematopoietic Stem Cell Transplantation

    Tong Fang; Bo Liu; Hong Gao

    2009-01-01

    OBJECTIVE To observe the dose and the complications from total body irradiation before hematopoietic stem cell transplantation.METHODS This study involved 312 patients with total body irradiation before hematopoietic stem cell transplantation. They were entered into the treated research from May 1999 to October 2005. All patients had Received the irradiation from 60Co of an absorbed dose rate of (5.2 ± 1.13) cGy/min. The total dose of TBI was 7~12 Gy, 1 f/d × 2 d. A high-dose rate group (≥ 10 Gy) included 139 cases and a low-dose rate group (< 10 Gy) included 173 cases.RESULTS The probability of acute gastrointestinal reactions in the high-dose rate group was more compared with that in the low-dose rate group. The differences for other reactions, such as hematopoietic reconstitution and graft survival rate, between the two groups were insignificant.CONCLUSION Using fractional total body irradiation at a dose rate of 5 cGy/min, with a total dose of 7~12 Gy, 1 f/d x 2 d, with the lung receiving under 7.5 Gy is a safe and effective pretreatment for hematopoietic stem cell transplantation.

  1. A modified 60C teletherapy unit for total body irradiation

    Purpose: A modified teletherapy unit to achieve total body irradiation with a vertical beam in a conventional treatment room. Methods and Materials: A standard 60C teletherapy unit has been modified to achieve total body irradiation with a vertical beam in a conventional treatment room. Patients are treated in prone and supine positions. Removal of the adjustable collimator assembly of this standard machine provides a circular field of 196 cm in diameter at 167 cm from the source. Second, the machine has been elevated by about 50 cm on a metallic base to enlarge irradiation field to obtain 248 cm in diameter at 210 cm from the source, and to encompass tall patients under better conditions. A special lead conical beam flattening filter, 10-mm thick at the center, was designed to compensate the spatial inhomogeneity of the beam. An instantaneous dose rate of 6.10-2 Gy/min is attained at the L4 level (midplane) in an average 20-cm thick patient with a source activity of 5099 RHM (air kerma rate of 44.8 Gy·h-1·m2). Between February 2, 1984 and December 27, 1990, 244 total body irradiations were performed either by single dose (n = 69, 10 Gy were given to midplane at L4 level in about 6 to 8 h, 8 Gy to the lungs), or by fractionated dose (n = 175, 12 Gy were given in 6 fractions over 3 consecutive days to midplane at L4 level, 9 Gy to the lungs). Results: The dose distribution is similar than the ones obtained by a linear accelerator with patients lying on their sides. Conclusion: Patients were treated in a comfortable and highly reproductible position. Organ shielding was easily achievable. This could be a less expensive and reasonable alternative to linear accelerator

  2. Total Body Irradiation (TBI) using Helical Tomotherapy in children and young adults undergoing stem cell transplantation

    Establishing Total Body Irradiation (TBI) using Helical Tomotherapy (HT) to gain better control over dose distribution and homogeneity and to individually spare organs at risk. Because of their limited body length the technique seems especially eligible in juvenile patients. The cohort consisted of 10 patients, 6 female and 4 male, aged 4 - 22 y with acute lymphoblastic- (ALL) or acute myeloic leukemia (AML). All patients presented with high risk disease features. Body length in treatment position ranged from 110–180 cm. Two Gy single dose was applied BID to a total dose of 12 Gy. Dose volume constraint for the PTV was 95% dose coverage for 95% of the volume. The lungs were spared to a mean dose of [less than or equal to] 10 Gy. Patients were positioned in a vac-loc bag in supine position with a 3-point head mask. Average D95 to the PTV was 11.7 Gy corresponding to a mean coverage of the PTV of 97.5%. Dmean for the lungs was 9.14 Gy. Grade 3–4 side effects were not observed. TBI using HT is feasible and well tolerated. A benefit could be demonstrated with regard to dose distribution and homogeneity and the selective dose-reduction to organs at risk

  3. Total body irradiation in hematopoietic stem cell transplantation

    Fundagul Andic

    2014-06-01

    Full Text Available Total body irradiation is used in conjunction with chemotherapy as a conditioning regimen in the treatment of many disease such as leukemia, myelodysplastic syndrome, aplastic anemia, multiple myeloma and lymphoma prior to the hematopoetic stem cell transplantation. The main purposes of the hematopoetic stem cell transplantation are eradication of the recipient bone marrow and any residual cancer cells, creation of space in the receipient bone marrow for donor hematopoetic stem cells, and immunosuppression to prevent rejection of donor stem cells in the case of an allotransplant. [Archives Medical Review Journal 2014; 23(3.000: 398-410

  4. Cataracts following bone marrow transplantation (BMT) conditioned with total body irradiation (TBI) for acute leukemia (AL) in complete remission (CR): a study of the European group for blood and marrow transplantation

    incidence of 27 ± 2% and 50 ± 3%, respectively. Because of the heterogeneity in terms of cataract grading by different teams, the analyses were done separately for both events: diagnosis of cataract and requiring cataract surgery. In terms of cataract formation, univariate analyses revealed favorable prognostic factors such as autoBMT (p = 0.0018), duration of steroids -4), use of heparin against VOD (p = 0.042), FTBI regimen (p -4), DR ≤ 0.04 Gy/min (p -4), and total cranial dose ≤ 18 Gy (p 0.01). Moreover, when analyzing STBI and FTBI ≤ 6F groups separately, DR ≤ 0.04 Gy/min appeared again as a protective factor against cataract formation in the two groups (p -4 and p -4, respectively). For age ≤ 23 y, the limit of significance was not reached (p = 0.08), whereas sex and GvHD did not influence the cataract formation. Multivariate analysis (Cox model) revealed 5 unfavorable independent factors, age > 23 y (RR 1.34), DR > 0.04 Gy/min (RR = 3.26), STBI (RR = 2.71), long-term steroid therapy (RR = 1.36), and alloBMT (RR = 1.65). In the STBI group, the unfavorable factors were DR > 0.04 Gy/min (RR = 3.26), long-term steroid therapy (RR = 1.83), no heparin administration (RR = 2.50), and total dose > 8 Gy (RR = 1.98); in the FTBI ≤ 6F group DR > 0.04 Gy/min (RR = 4.34) and alloBMT (RR = 2.08). In 111 of the 257 (43%) pts cataract surgery was required. Multivariate analyses were performed in all pts and in the STBI group; in the FTBI group the number of events was not sufficient to construct a multivariate model. In the whole population, the unfavorable factors associated with required surgery for cataract were age > 23 y (RR = 1.70), DR > 0.04 Gy/min (RR = 2.06), STBI (RR = 7.14), no heparin administration (RR 2.32), and cGVHD (RR = 2.47). In the STBI group, total dose > 8 Gy (RR 2.48), DR > 0.04 Gy/min (RR = 2.06), and cGVHD (RR = 2.12) were risk factors; while heparin administration was a protective factor (RR = 0.26). Following cataract surgery, the

  5. Total body protein in chronic diseases and in aging.

    Hansen, R D; Raja, C; Allen, B J

    2000-05-01

    Substantial losses of total body protein (TBP) can occur in chronic diseases and in aging. Such losses impact negatively on immunity and quality of life, and on growth rates in children. Direct measurements of total body nitrogen (TBN) monitor the integrated changes in TBP over time and allow comparison with normal subjects. TBN assessment via neutron capture analysis is therefore the gold-standard method of TBP estimation, so that risk factors for protein deficit can be identified and patient management optimized. The nitrogen index (NI) can be used to predict prognostic outcome: an NI breast-cancer patients. These findings emphasize the central importance of adequate protein stores in recovery from disease or in maintaining quality of life. Aging appears to involve a gradual loss of TBP throughout adulthood. Cross-sectional data suggest that TBP declines curvilinearly with age, such that there is an accelerated decline after 65 years of age. However, longitudinal data are scarce, and little is known about the relative loss of visceral protein, as opposed to skeletal muscle protein. More clearly-defined data are essential if the effects of aging per se are to be separated from the effects of chronic disease. A further complication is the knowledge that physical activity also declines with age. Thus sarcopenia, the loss of skeletal muscle mass, could primarily result from disuse rather than aging. The economic impact of unsuccessful aging places a pressing need for multicompartment data in longitudinal study designs. PMID:10865769

  6. Secondary radiation dose during high-energy total body irradiation

    The goal of this work was to assess the additional dose from secondary neutrons and γ-rays generated during total body irradiation (TBI) using a medical linac X-ray beam. Nuclear reactions that occur in the accelerator construction during emission of high-energy beams in teleradiotherapy are the source of secondary radiation. Induced activity is dependent on the half-lives of the generated radionuclides, whereas neutron flux accompanies the treatment process only. The TBI procedure using a 18 MV beam (Clinac 2100) was considered. Lateral and anterior-posterior/posterior-anterior fractions were investigated during delivery of 2 Gy of therapeutic dose. Neutron and photon flux densities were measured using neutron activation analysis (NAA) and semiconductor spectrometry. The secondary dose was estimated applying the fluence-to-dose conversion coefficients. The main contribution to the secondary dose is associated with fast neutrons. The main sources of γ-radiation are the following: 56Mn in the stainless steel and 187W of the collimation system as well as positron emitters, activated via (n,γ) and (γ,n) processes, respectively. In addition to 12 Gy of therapeutic dose, the patient could receive 57.43 mSv in the studied conditions, including 4.63 μSv from activated radionuclides. Neutron dose is mainly influenced by the time of beam emission. However, it is moderated by long source-surface distances (SSD) and application of plexiglass plates covering the patient body during treatment. Secondary radiation gives the whole body a dose, which should be taken into consideration especially when one fraction of irradiation does not cover the whole body at once. (orig.)

  7. Changes in body chemical composition with age measured by total-body neutron activation

    Total-body levels of calcium and phosphorus (reflecting skeletal mass) and total-body levels of potassium (reflecting muscle mass) were measured by neutron activation analysis in 39 men and 40 women ages 30 to 90 yr. In order to intercompare the total body calcium (TBCa) values in a heterogeneous population, such as this, it was necessary to normalize the data for skeletal size. The normalization consisted of dividing the absolute calcium level by the predicted calcium level for each individual matched to a set of critical parameters. The parameter used in the computation of normal values were age, sex, muscle mass, i.e., total body potassium (TBK) and height. For the calcium data of the women, it was necessary to add an age correction factor after the age of 55 yr. The calcium ratio (mean ratio of the predicted to measured TBCa) in men was 1.000 +- 7.8 percent and in women 0.996 +- 7.1 percent. The TBCa of normal males and females can thus be predicted to +-13 percent (at the 90 percent confidence level). An exception to this was found in males (70 to 90 yr) who exhibited a mean calcium ratio greater than 1.13

  8. Cyclic, low-dose total body irradiation for metastatic neuroblastoma

    Total body irradiation (TBI) can be thought of as a systemic anticancer agent. It therefore might best be given like an adjuvant drug, i.e., in tolerable doses, cyclically. The therapeutic ratio between normal bone marrow stem cells and suitably sensitive cancer cells should be widened by these means. Fourteen children with advanced (Stage IV) neuroblastomas were given 100-150 rad TBI in 50 rad daily fractions along with each three-week cycle of standard triple-agent chemotherapy (vincristine, DTIC, cyclophosphamide). Two patients died of toxicity and one is still undergoing therapy. Four of the remaining 12 survive free of disease for 12+ to 31+ months. The regimen is well tolerated, but prolonged, pronounced bone marrow depression, especially thrombocytopenia, commonly occurs after doses of 300-450 rad

  9. In vivo dosimetry with silicon diodes in total body irradiation

    The aim of this work is the characterization and application of silicon diode detectors for in vivo dosimetry in total body irradiation (TBI) treatments. It was evaluated the diode response with temperature, dose rate, gantry angulations and field size. A maximum response variation of 2.2% was obtained for temperature dependence. The response variation for dose rate and angular was within 1.2%. For field size dependence, the detector response increased with field until reach a saturation region, where no more primary radiation beam contributes for dose. The calibration was performed in a TBI setup. Different lateral thicknesses from one patient were simulated and then the calibration factors were determined by means of maximum depth dose readings. Subsequent to calibration, in vivo dosimetry measurements were performed. The response difference between diode readings and the prescribed dose for all treatments was below 4%. This difference is in agreement as recommended by the International Commission on Radiation Units and Measurements (ICRU), which is ±5%. The present work to test the applicability of a silicon diode dosimetry system for performing in vivo dose measurements in TBI techniques presented good results. These measurements demonstrated the value of diode dosimetry as a treatment verification method and its applicability as a part of a quality assurance program in TBI treatments. - Highlights: ► Characterization of a silicon diode dosimetry system. ► Application of the diodes for in vivo dosimetry in total body irradiation treatments. ► Implementation of in vivo dosimetry as a part of a quality assurance program in radiotherapy

  10. [Clinical results and problems of total-body hyperthermia].

    Maeta, M; Koga, S; Shimizu, N; Hamazoe, R; Murakami, A; Inoue, Y; Ikeda, Y

    1986-04-01

    The clinical results and problems of extracorporeally-induced total-body hyperthermia (TBHT) for recurrent cancer were presented. A total of 105 hyperthermic treatments were performed in 38 patients who had had unsuccessful conventional systemic anticancer chemotherapy. Partial response was observed in 10 of 29 evaluable patients (37%). In analysing the anticancer effects of TBHT according to cancer site, a high efficacy was observed in patients with their main tumor in the lung, liver and lymph nodes. The anticancer effects were most enhanced when TBHT was performed in combination with cis-diamminedichloroplatinum (II) and 5-fluorouracil. In order to augment the anticancer effects of TBHT, the choice of combined agent(s) and administration timing are important. A useful method for determining the thermochemosensitivity of individual cancer cells to agents selected for drug treatment is the human tumor stem cell assay. Further, the usefulness of angiotensin II-induced hypertensive chemotherapy during TBHT for augmenting selective drug delivery to cancer tissues is stressed. PMID:3729457

  11. Biochemical and hematological indicators in model of total body irradiation

    With the purpose of evaluating the applicability of several biological indicators in accidental overexposures a study was carried out in 20 patients undergoing therapeutical total body irradiation (TBI). The following parameters were evaluated: a) Oxidative stress indicators: erythrocyte superoxide dismutase (SOD) and catalase activity (CAT), lipo peroxyde levels (TBARS) and total plasma antioxidant activity (TAA). b) Haematological indicators: reticulocyte maturity index (RMI) and charges in lymphocyte subpopulations. Non significant changes in SOD and CAT activity were observed. Significant higher TBARS levels were found in patients with unfavorable post-BTM course without any significant correlation with TAA. RMI decreased early and dropped to zero in most of the patients and rose several days prior to reticulocyte, neutrophils and platelets counts. A significant decrease in absolute counts of all lymphocyte subpopulations was observed during TBI, particularly for B lymphocytes. A subpopulation of natural killer (NK) cells (CD16+/ CD 56 +) showed a relative higher radioresistance. Cytotoxic activity was significantly decreased after TBI. These data suggest that TBARS could provide an useful evolutive indicator in accidental over exposure d patients and RMI is an early indicator of bone marrow recovery after radioinduced aplasia. The implications of the different radiosensitivities within the NK subsets remains unanswered. (author)

  12. Interstitial pneumonitis after allogeneic bone marrow transplantation following total body irradiation

    The records of 40 patients who received allogeneic bone marrow transplantation (BMT) at Hyogo College of Medicine under the same conditioning regimen using cyclophosphamide and total body irradiation (TBI) from January 1984 to August 1989 were analyzed. The dose rate of TBI was 10 cGy per minute, and the total dose was 10 Gy (2.5 Gy daily for 4 days). Interstitial pneumonitis (IP) occurred in 13 of 40 patients, and was fatal in five patients. The probability of developing IP during the first year was 31%. We performed univariate analysis on the following factors but did not find any significant risk factors for IP: age and sex of patient, sex mismatch, ABO mismatch, grade of acute graft-versus-host disease, post immunosuppression regimen, and number of marrow cells transfused. (author)

  13. The ratio total body potassium/total body water as a measure of the mean intracellular potassium concentration

    The ratios total body potassium (TBK)/total body water (TBW) and TBK/(TBW-82Br-R) are compared as a measure of the mean intracellular potassium concentration. TBK (40K), THO-distribution volume (TBW) and 82Br space (82Br-R) were measured in 28 controls, in 15 patients with cirrhosis of the liver, and in 37 rsp. 42 mechanically ventilated patients of the intensive care unit. Effects of dehydration, hyperhydration and increased membraneous permeability concerning the ratios 82Br-R/TBW, TBK/TBW and TBK/(TBW-82Br-R) are discussed and evaluated by a theoretical model. In cirrhosis of the liver we found a significantly lowered TBK and simultaneously increased values of TBW and 82Br-R. In critically ill patients TBK was lowered whereas the TBW was normal and the bromide space was increased. We believe that this was due to an increased bromide penetration into cells and to a potassium depletion. It is concluded that: a) In homeostasis of water and electrolytes TBK/TBW is a better measure of the mean intracellular potassium concentration; this is because of a lower standard error and a lower radiation dose. b) In the case of isotonic hyperhydration TBK/(TBW-82Br-R) is a better measure of the mean intracellular potassium concentration than TBK/TBW; within the next 2 weeks it is not possible to make a TBK follow-up. c) In a pathophysiological state with an increased permeability of cells to tracers of the extracellular space TBK/TBW is the better measure for the mean intracellular potassium concentration in patients with normal TBW values. (orig.)

  14. Ratio total body potassium/total body water as a measure of the mean intracellular potassium concentration

    Schober, O.; Ollech, J.; Lehr, L.; Hundeshagen, H.

    1981-10-01

    The ratios total body potassium (TBK)/total body water (TBW) and TBK/(TBW-/sup 82/Br-R) are compared as a measure of the mean intracellular potassium concentration. TBK (/sup 40/K), THO-distribution volume (TBW) and /sup 82/Br space (/sup 82/Br-R) were measured in 28 controls, in 15 patients with cirrhosis of the liver, and in 37 rsp. 42 mechanically ventilated patients of the intensive care unit. Effects of dehydration, hyperhydration and increased membraneous permeability concerning the ratios /sup 82/Br-R/TBW, TBK/TBW and TBK/(TBW-/sup 82/Br-R) are discussed and evaluated by a theoretical model. In cirrhosis of the liver we found a significantly lowered TBK and simultaneously increased values of TBW and /sup 82/Br-R. In critically ill patients TBK was lowered whereas the TBW was normal and the bromide space was increased. We believe that this was due to an increased bromide penetration into cells and to a potassium depletion. It is concluded that: a) In homeostasis of water and electrolytes TBK/TBW is a better measure of the mean intracellular potassium concentration; this is because of a lower standard error and a lower radiation dose. b) In the case of isotonic hyperhydration TBK/(TBW-/sup 82/Br-R) is a better measure of the mean intracellular potassium concentration than TBK/TBW; within the next 2 weeks it is not possible to make a TBK follow-up. c) In a pathophysiological state with an increased permeability of cells to tracers of the extracellular space TBK/TBW is the better measure for the mean intracellular potassium concentration in patients with normal TBW values.

  15. Patterns of patient specific dosimetry in total body irradiation

    Akino, Yuichi [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana 46202 (United States); Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871 (Japan); McMullen, Kevin P.; Das, Indra J. [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana 46202 (United States)

    2013-04-15

    Purpose: Total body irradiation (TBI) has been used for bone marrow transplant for hematologic and immune deficiency conditions. The goal of TBI is to deliver a homogeneous dose to the entire body, with a generally accepted range of dose uniformity being within {+-}10% of the prescribed dose. The moving table technique for TBI could make dose uniform in whole body by adjusting couch speed. However, it is difficult to accurately estimate the actual dose by calculation and hence in vivo dosimetry (IVD) is routinely performed. Here, the authors present patterns of patient-specific IVD in 161 TBI patients treated at our institution. Methods: Cobalt-60 teletherapy unit (Model C9 Cobalt-60 teletherapy unit, Picker X-ray Corporation) with customized moving bed (SITI Industrial Products, Inc., Fishers, IN) were used for TBI treatment. During treatment, OneDose{sup TM} (Sicel Technology, NC) Metal Oxide-silicon Semiconductor Field Effect Transistor detectors were placed at patient body surface; both entrance and exit side of the beam at patient head, neck, mediastinum, umbilicus, and knee to estimate midplane dose. When large differences (>10%) between the prescribed and measured dose were observed, dose delivery was corrected for subsequent fractions by the adjustment of couch speed and/or bolus placement. Under IRB exempt status, the authors retrospectively analyzed the treatment records of 161 patients who received TBI treatment between 2006 and 2011. Results: Across the entire cohort, the median {+-} SD (range) percent variance between calculated and measured dose for head, neck, mediastinum, umbilicus, and knee was -2.3 {+-} 10.2% (-66.2 to +35.3), 1.1 {+-} 11.5% (-62.2 to +40.3), -1.9 {+-} 9.5% (-66.4 to +46.6), -1.1 {+-} 7.2% (-35.2 to +42.9), and 3.4 {+-} 12.2% (-47.9 to +108.5), respectively. More than half of treatments were within {+-}10% of the prescribed dose for all anatomical regions. For 80% of treatments (10%-90%), dose at the umbilicus was within {+-}10

  16. INVESTIGATING THE RELATIONSHIP BETWEEN ACUTE FLUID LOSS AND BODY FAT PERCENTAGE BY USING BIA METHOD TO DETERMİNE BODY COMPOSİTİON

    Mehmet; VAN, Ali; Yücel

    2015-01-01

    Bioelectric impedance analysis (BIA) is so popular technique to analysis body fat mass (BFM), free fat mass (FFM), lean body mass (LBM) and total body fluid (TBF) in both healthy and patient subjects. The aim of this study is to investigate the effect of the acute weight(fluid) loss on body fat mass and percentage by using BIA method. In this study 43 soccer players (age: 21.90; length: 179.62and weight: 73.90) who playing in college league in Afyonkarahisar province has been participated....

  17. Anticarcinogenic effect of tetrachlorodecaoxide after total-body gamma irradiation in rats

    Tetrachlorodecaoxygen (TCDO) therapy of acute radiation syndrome was tested for a possible influence on the development of X-ray-induced malignancies. BD IX rats were exposed to total-body irradiation (TBI, γ rays, 9 or 11 Gy) and received daily intravenous injections of either TCDO or physiological saline solution from days 4 through 11 after TBI. The short-term TCDO therapy reduced the acute death rate markedly, but survival rates after 4 months were similar with and without TCDO. The first malignancy after TBI occurred on day 103, and over the lifetime of the animals the tumor incidence in the group given TBI (11 Gy) without TCDO treatment was 73% vs 20% in animals with short-term TCDO therapy after TBI. In particular, there was a highly significant prevention of radiation-induced leukemia [P (one-sided) < 0.001] by TCDO, and a significantly reduced incidence of malignant epithelial tumors [P (one-sided) < 0.05]. The development of sarcomas was not affected by TCDO. Long-term survival was not enhanced by TCDO due to the occurrence of bronchopneumonial infections about 1 year after TBI. In conclusion, TCDO is not only a potent therapeutic agent in acute radiation syndrome, but it also significantly reduced the carcinogenic risk in rats after exposure to ionizing radiation. 18 refs., 3 figs., 4 tabs

  18. Total body irradiation for treatment of haematological diseases

    The present status of total body irradiation (TBI) as a part of the treatment of haematological diseases was discussed during a separate symposium at the 5th Annual ESTRO meeting at Baden-Baden. The experimental techniques applied in Europe, the dosimetry for TBI, the radiobiological aspects and the late effects after TBI have been reviewed. For specific geometries, precautions have to be taken to avoid increased dose contributions at the skin due to electrons scattered from the wall behind the patient. CT data can be useful for the individualisation of the exposure regimen of patients with extreme variations in lung anatomy or lung density. An appreciable number of centres apply in vivo dosimetry, however, special care is needed for the correct interpretation of the dosimeter readings. A number of late effects, including induction of cataract and secondary tumours has been observed after TBI. The techniques applied for TBI at the various centres and the temporal administration of the dose show wide variations. At present, the patient material is too heterogeneous to draw any conclusion about an optimum schedule for a TBI regimen. Further cooperation between clinicians, radiobiologists and radiation physicists has to be established to achieve consistency and further improvement of the results after TBI. (Auth.)

  19. Lean body mass and total body fat by dual-photon (153Gd) absorptiometry

    The authors describe a method for measuring the lean body mass (LBM) and total body fat (FAT) by dual-photon (153Gd) absorptiometry (DPA). Lean percent determination on limb phantoms, revealed precision and accuracy errors below 2.0%. The in vivo precision of the LBM of duplicate measurements on five healthy subjects was 2.2%. The accuracy error in vivo of measuring the total mass of soft tissues was 1.4%, thus yielding an overall accuracy error of the LBM of about 2.5%. Measurements on 100 healthy subjects revealed high correlations between FAT, FAT% or LBM by DPA versus FAT, FAT% or LBM calculated from anthropometric measurements. From DPA measurements of 228 normal adults, multiple regression equations of LBM and FAT based on age, height, and weight were computed. They conclude that DPA measurements of LBM and FAT in vivo is a reliable estimation of the gross body composition, and that LBM and FAT in normal adults can be calculated solely from age, height, and weight with reasonable accuracy for many purposes

  20. Evaluation of body composition and nitrogen content of renal patients on chronic dialysis as determined by total body neutron activation

    Total body protein (nitrogen), body cell mass (potassium), fat, and water were measured in 15 renal patients on maintenance hemodialysis (MHD). Total body nitrogen was measured by means of prompt γ neutron activation analysis; total body water was determined with tritium labeled water; total body potassium was measured by whole body counting. The extracellular water was determined by a technique utilizing the measurement of total body chloride and plasma chloride. When compared with corresponding values of a control group of the same age, sex, and height, the protein content, body cell mass, and total body fat of the MHD patients were within the normal range. The only significant change was an increase in the extracellular water/body cell mass ratio in the male MHD patients compared to the control. The lack of significant difference of the nitrogen values of the MHD patients compared to matched controls suggests that dialysis minimizes any residual effects of uremic toxicity or protein-calorie malnutrition. These findings further suggest that there is a need to reevaluate the traditional anthropometric and biochemical standards of nutritional status for MHD patients. It was concluded that it is particularly important to measure protein stores of MHD patients with low protein intake to ascertain nutritional status. Finally, in vivo measurement of total body nitrogen and potassium for determination of body composition provides a simple, direct, and accurate assessment of the nutritional status of MHD patients

  1. Acute effects of whole body gamma irradiation on exocrine pancreatic secretion in the pig

    Reports on radiation damage to the pancreas deal essentially with long-term morphological changes with few data on pancreatic exocrine function. The aim of this work was to study the acute effects of whole body irradiation on volume and enzyme activities in the pancreatic juice. A whole body gamma irradiation (6 Gy) was investigated in pigs with continuous sampling of pancreatic juice before and after exposure via an indwelling catheter in the pancreatic duct. For each sample collected, total protein concentration and enzyme activities of trypsin, chymotrypsin, elastase, lipase and amylase were determined. Pancreatic juice volume was monitored during all periods of collection. The volume of pancreatic juice secreted daily decreased one day after irradiation and remained lower than the control values over the experimental period. Total proteins secreted in the pancreatic juice and total activities of pancreatic enzymes were reduced similarly. On the other hand, only specific activities of elastase and lipase were affected by irradiation. Whole body gamma irradiation resulted in a rapid and marked decrease of exocrine pancreatic secretion, in terms of volume as well as secreted enzymes. This may contribute in part to the intestinal manifestations of the acute and/or late radiation syndrome. (author)

  2. Total lymphoid irradiation and total body irradiation for allogeneic bone marrow transplantation in aplastic anemia

    Between April 1980 and June 1989, 15 patients with severe aplastic anemia (SAA) were treated at Hyogo College of Medicine with bone marrow transplantation (BMT) after preparation consisting of cyclophosphamide (CY) and total lymphoid irradiation (TLI) or total body irradiation (TBI) for the purpose of reducing the incidence of graft rejection. All patients had initial evidence of engraftment after the first transplantation except for one patient who died of heart failure due to CY on the third day after transplantation and could not be evaluated for engraftment. Rejection later occurred in four of these 14 patients, who then underwent successful regrafting. One of these four patients, who was conditioned with CY alone at the first grafting, underwent successful regrafting after a conditioning regimen of CY and TBI. In the other three patients, irradiation was performed twice as the conditioning regimen. Thus, 14 of 15 patients underwent successful BMT and are alive with restored hematopoietic function. From the above results, the combination of TLI or TBI and CY was considered to be very useful as a conditioning regimen for BMT in patients with SAA. (author)

  3. Measurement of total body potassium in premature infants by means of a whole-body counter

    This paper describes a whole-body counter (WBC) specially designed to measured total body potassium (TBK) infants under 4500 g. The counter is a ''shadow shield'' design and consists of a single 10 cm X 10 cm X 45 cm NaI(Tl) crystal, positioned lengthwise and shielded from environmental background radiation by a minimum of 10 cm of lead. The standard error of counting for a 2000-s counting period is 19.9% for a 1000-g infant and 11.9% for a 2000-g infant. TBK of stillborn pigs, measured by the WBC, agreed to an average of 3% of TBK determined by carcass analysis in the same animals. A total of 118 measurements of TBK have been made in 50 premature infants ranging in weight between 1100 and 3600 g and in age between 2 and 75 days. The observed relationship of TBK with weight is described by the equation: TBK (mEq) = 0.0433Wt (g + 1.57 r = 0.92. Potassium retention per gram weight gain is estimated to be 0.043 mEq. The obtained TBK values agree well with values published by other workers but extend the range of measurement to 1100 g

  4. Cytogenetic studies on recipients of allogeneic bone marrow transplants after fractionated total body irradiation

    Cytogenetic findings from the bone marrow (BM) and the peripheral blood (PB) of nine consecutive patients after allogeneic bone marrow transplantation (BMT) for acute or chronic myelogenous leukaemia are reported. After a conditioning regimen consisting of cyclophosphamide and fractionated total body irradiation (TBI) given in five or six fractions of 2 Gy, persistence of host cells was detected in four out of seven cases with permanent engraftment. While one of these patients relapsed 4 months after host cells had been found in BM and PB, the other patients stayed relapse-free 124, 257 and 347 d after grafting. Before transplantation, the leukaemic cells in all three cases carried unique cytogenetic abnormalities giving the opportunity to distinguish the leukaemic population from chromosomally non-aberrant cells thought to represent residual normal host cells. As the persisting host cells after BMT lacked any cytogenetic abnormalities, it is suggested that they were members of residual normal clones not involved in the leukaemic process. (author)

  5. Cobalt-60 total body irradiation dosimetry at 220 cm source-axis distance

    Adults with acute leukemia are treated with cyclophosphamide and total body irradiation (TBI) followed by autologous marrow transplants. For TBI, patients seated in a stand angled 450 above the floor are treated for about 2 hours at 220 cm source-axis distance (SAD) with sequential right and left lateral 87 cm x 87 cm fields to a 900 rad mid-pelvic dose at about 8 rad/min using a 5000 Ci cobalt unit. Maximum (lateral) to minimum (mid-plane) dose ratios are: hips--1.15, shoulders--1.30, and head--1.05, which is shielded by a compensator filter. Organ doses are small intestine, liver and kidneys--1100 rad, lung--1100 to 1200 rad, and heart--1300 rad. Verification dosimetry reveals the prescribed dose is delivered to within +-5%. Details of the dosimetry of this treatment are presented

  6. Relative effect of radiation dose rate on hemopoietic and nonhemopoietic lethality of total-body irradiation

    Experiments were undertaken to determine the influence of dose rate on the toxicity of total-body irrdiation (TBI) with and without syngeneic bone-marrow rescue in mice. The results showed a much greater dose-rate dependence for death from nonhemopoietic toxicity than from bone-marrow ablation, with the ratio of LD50's increasing from 1.73 at 25 cGy/min to 2.80 at 1 cGy/min. At the higher dose rates, dose-limiting nonhemopoietic toxicity resulted from late organ injury, affecting the lungs, kidneys, and liver. At 1 cGy/min the major dose-limiting nonhemopoietic toxicity was acute gastrointestinal injury. The implications of these results in the context of TBI in preparation for bone-marrow transplantation are discussed. 15 refs., 4 figs

  7. Study on Dosimetry Used TLD Dosimeter and Body Mass Index at Total Body Irradiation

    The aim of study is to expose a more uniform dose depending on the relationship between a body mass index in patients who underwent radiation therapy and an acquired dosimetric information by using a thermoluminescent dosimeter. Since 2006 to August 2011 we investigated 28 people who underwent radiation therapy were enrolled in AMC. Each patient was measured on the head, neck, chest, abdomen, pelvis, thigh, knee joint, and ankle joint using the thermoluminescent dosimeter. The measurement value of each points compared with the prescribed center point, abdominal point, and dose measurements of points on which to base the abdomen and the patient's body mass index (BMI) were compared with reference point, abdomen dose. 28 patients on prescribed dose in the abdomen by which the center point, an average dose was 100.6±5.5, and the other seven measuring points with the average maximum difference among the head, neck, chest, pelvic, thigh, knee, and ankle were 92.8±4.2%, 97.6±6.2%, 96.4±5.5%, 102.6±5.3%, 103.4±7.9%, 95.8±5.9%, 96.1±5.5%. The relationship of abdominal point dose and the patient's body mass index (BMI) was analyzed a scatter plot, and the result of linear relationship analysis by regression method, the regression of the dose (y) was -1.009 BMI (x) plus 123.3 and coefficient of determination (R2) was represented 0.697. The total body irradiation treatment process was evaluated the dose deviation and then the prescribed dose by which the average abdominal dose was satisfied with 100.6±5.5%. Results of the relationship analysis between BMI and dose, if we apply the correction value for each patients, it can be achieved more uniform dose delivery.

  8. In-vivo determination of total body water and lean body mass in subjects by deuterium dilution

    Total body water (TBW) estimation is one of a number of basic techniques required for the determination of body composition in normal and malnourished subjects. When combined with total body nitrogen (TBN) analysis by prompt gamma neutron activation, an accurate compartmental model of in vivo body composition can be formed, providing valuable nutritional and other data. This study examines the role of TBW on its own in evaluating lean body mass. Total body water was studied in six male and five female subjects using deuterium oxide and a Fourier transform infrared spectrometer. The lean body mass calculated from the results was compared with the lean body mass deduced from established total body nitrogen measurements. A four-compartment model was also used to calculate lean body mass. Excellent agreement was shown between lean body mass derived from TBW, the four-compartment model and TBN. Hence, TBW can provide a fast, cost-efficient method for evaluating normal subjects. However, for disease-induced malnutrition, or highly developed athletes, both TBN and TBW measurements are essential to establish an accurate picture of their body composition. TBW measurements alone can monitor the hydration state of patients and as such have a useful diagnostic value

  9. Increase of Total Body Water with Decrease of Body Mass while Running 100 km Nonstop--Formation of Edema?

    Knechtle, Beat; Wirth, Andrea; Knechtle, Patrizia; Rosemann, Thomas

    2009-01-01

    We investigated whether ultraendurance runners in a 100-km run suffer a decrease of body mass and whether this loss consists of fat mass, skeletal muscle mass, or total body water. Male ultrarunners were measured pre- and postrace to determine body mass, fat mass, and skeletal muscle mass by using the anthropometric method. In addition,…

  10. A simple calibration of a whole-body counter for the measurement of total body potassium in humans

    A simple calibration procedure for the Inshas whole body counter for evaluating total body potassium has been adopted. More than 120 Egyptian employees in the Nuclear Research Center (N.R.C.) were studied for their total body potassium (TBK). The potassium values were found to have an average of 2.85±0.57 g K kg-1 body weight for males and 2.62±0.52 g K kg-1 for females, which are higher than the recommended value given for reference man by ICRP. The TBK varied directly with body build index and is slightly sex dependent (Author)

  11. Marrow transplantation for leukemia following fractionated total body irradiation. A comparative trial of methotrexate and cyclosporine

    Fifty-six patients, 30-47 yr of age, with leukemia in relapse received allogeneic marrow transplants from HLA-identical siblings. All patients were treated with cyclophosphamide (120 mg/kg) and 7 daily fractions of 2.25 Gy of total body irradiation (TBI) for seven consecutive days. Nine patients (16%) are currently alive, free of disease, 324-845 days from transplantation. Actuarial relapse and survival rates at 2 yr were 56% and 9.5% respectively. These data were not remarkably different from those in previous studies using 10 Gy of TBI administered as a single dose. Thirty patients were randomized to receive methotrexate (MTX) and 26 to receive cyclosporine (CSP) as postgrafting prophylaxis for acute graft-versus-host disease (GVHD). Probability of developing significant acute GVHD by day 100 post-transplant was 71% for patients in the MTX group and 45% for patients in the CSP group (p<0.05). Probability of relapse was 37% for patients in the MTX group and 70% for patients in the CSP group (p<0.05). Transplant-related deaths were more frequent in the MTX group and leukemic deaths more frequent in the CSP group although this may have been related to an uneven distribution of high-risk patients. Long term disease-free survival was comparable. (author)

  12. Total body composition by dual-photon (153Gd) absorptiometry

    The lean-fat composition (%FATR) of soft tissue and the mineral mass of the skeleton were determined in vivo using dual-photon (153Gd) absorptiometry (dose under 2 mrem). A rectilinear raster scan was made over the entire body in 18 subjects (14 female, 4 male). Single-photon absorptiometry (125I) measured bone mineral content on the radius. Percentage fat (%FATD) was determined in the same subjects using body density (from underwater weighing with correction for residual lung volume). Lean body mass (LBM) was determined using both %FATR and %FATD. Percentage fat from absorptiometry and from underwater density were correlated (r . 0.87). The deviation of %FATD from %FATR was due to the amount of skeletal mineral as a percentage of the LBM (r . 0.90). Therefore, skeletal variability, even in normal subjects, where mineral ranges only from 4 to 8% of the LBM, essentially precludes use of body density as a composition indicator unless skeletal mass is measured. Anthropometry (fatfolds and weight) predicted %FATR and LBM at least as well as did underwater density. The predictive error of %FATR from fatfolds was 5% while the predictive error in predicting LBM from anthropometry was 2 to 3 kg (3%)

  13. Total body composition by dual-photon (153Gd) absorptiometry

    Mazess, R.B.; Peppler, W.W.; Gibbons, M.

    1984-10-01

    The lean-fat composition (%FATR) of soft tissue and the mineral mass of the skeleton were determined in vivo using dual-photon (153Gd) absorptiometry (dose under 2 mrem). A rectilinear raster scan was made over the entire body in 18 subjects (14 female, 4 male). Single-photon absorptiometry (125I) measured bone mineral content on the radius. Percentage fat (%FATD) was determined in the same subjects using body density (from underwater weighing with correction for residual lung volume). Lean body mass (LBM) was determined using both %FATR and %FATD. Percentage fat from absorptiometry and from underwater density were correlated (r . 0.87). The deviation of %FATD from %FATR was due to the amount of skeletal mineral as a percentage of the LBM (r . 0.90). Therefore, skeletal variability, even in normal subjects, where mineral ranges only from 4 to 8% of the LBM, essentially precludes use of body density as a composition indicator unless skeletal mass is measured. Anthropometry (fatfolds and weight) predicted %FATR and LBM at least as well as did underwater density. The predictive error of %FATR from fatfolds was 5% while the predictive error in predicting LBM from anthropometry was 2 to 3 kg (3%).

  14. Toxicities of total-body irradiation for pediatric bone marrow transplantation

    Purpose: To determine the acute and late effects, including cognitive function, of total body irradiation (TBI) and chemotherapy for bone marrow transplant (BMT) in children with immunodeficiency or hematologic disorders. Methods and Materials: At UCSF, 15 children with immunodeficiency disorders and 58 children with leukemia received chemoradiotherapy between July 1982 and November 1993 and were evaluated for toxicity. Patients with severe combined immunodeficiency disorder (SCID) received 7 Gy TBI while leukemia patients received 12 Gy TBI. Results: Eight immunodeficient patients (53%) are alive at 4 months to 11 years posttransplant. Acute toxicity was limited and treatment well tolerated. Most patients developed mild nausea and vomiting, skin rash, or erythema. Transient fever/chills, oral mucositis, and alopecia were noted in approximately 50% of patients. Seventy-three percent of patients demonstrated acute liver dysfunction, but only four (27%) developed veno-occlusive disease. All children had decreased growth velocity but normal growth hormone levels. Other endocrinologic evaluations including adrenocorticotropic hormone (ACTH), cortisol, and thyroid hormones were normal. Only one evaluable girl had delayed puberty with late onset of secondary sexual characteristics. Neuropsychological testing demonstrated an intelligence quotient (IQ) reduction between the baseline and 1 year post-BMT, with some recovery at 3 years. Only one patient developed a clinically significant cataract. Thirteen percent of patients had chronic interstitial lung disease. Four children developed exostosis. Only 1 of the 15 children developed a second malignancy (acute myelogenous leukemia) at age 5, 51 months posttransplant for SCID. For patients with leukemia, similar toxicities were observed. Twenty-nine percent disease-free survival was noted with a mean follow-up of 4.7 years. Twenty-two percent had chronic interstitial lung disease and two patients were diagnosed with cataracts

  15. Inhaled /sup 147/Pm and/or total-body gamma radiation: Early mortality and morbidity in rats

    Filipy, R.E.; Lauhala, K.E.; McGee, D.R.; Cannon, W.C.; Buschbom, R.L.; Decker, J.R.; Kuffel, E.G.; Park, J.F.; Ragan, H.A.; Yaniv, S.S.; Scott, B.R.

    1989-05-01

    Rats were given doses of /sup 60/Co gamma radiation and/or lung burdens of /sup 147/Pm (in fused aluminosilicate particles) within lethal ranges in an experiment to determine and compare morbidity and mortality responses for the radiation insults within 1 year after exposure. Radiation-induced morbidity was assessed by measuring changes in body weights, hematologic parameters, and pulmonary-function parameters. Acute mortality and morbidity from inhaled promethium were caused primarily by radiation pneumonitis and pulmonary fibrosis that occurred more than 53 days after exposure. Acute mortality and morbidity from total-body gamma irradiation occurred within 30 days of exposure and resulted from the bone-marrow radiation syndrome. Gamma radiation caused transient morbidity, reflected by immediately depressed blood cell levels and by reduced body weight gain in animals that survived the acute gamma radiation syndrome. Inhaled promethium caused a loss of body weight and diminished pulmonary function, but its only effect on blood cell levels was lymphocytopenia. Combined gamma irradiation and promethium lung burdens were synergistic, in that animals receiving both radiation insults had higher morbidity and mortality rates than would be predicted based on the effect of either kind of radiation alone. Promethium lung burdens enhanced the effect of gamma radiation in rats within the first 30 days of exposure, and gamma radiation enhanced the later effect of promethium lung burdens. 70 refs., 68 figs., 21 tabs.

  16. Clinical tolerance of total body irradiation and allogeneic bone marrow transplantation

    Total body irradiation (TBI) followed by bone marrow transplantation (BMT) is well established as a part of the conditioning regimen in high dose therapy. The objective is to report the organ toxicity investigated prospectively in patients who had conditioning regimes including fractionated TBI (FTBI) and chemotherapy. From October 2002 to December 2007 18 patients received FTBI in our institution. There were 11 males and; 7 females with median age of 20 years (range 8-50). The present study includes 11 patients with initial diagnoses; acute lymphoid leukemia (ALL), 4 - acute myeloid leukemia (AML) and 3 - chronic myeloid leukemia (GML). At the time of BMT 11 patients were in complete response, 4 in progression and 3 in chronic phase. TBI was performed on a 60Co unit in alternate prone and supine position. Three patients received nonmyeloablative regimen including 'mini' TBI of 2 Gy followed by allogeneic BMT and 15 received myeloablative regimen of 10-12 Gy FTBI. The dose rate requirement was met for TBI 5-10 cGy/min. A standardized supportive therapy was administered. During the transplantation period on day 0 and +1 of the clinical protocol the realized transplantation of the donor cells pool passed without complications in 16 of the patients and was accompanied by allergic reactions in 2 patients. Induced bone-marrow aplasia was observed in all patients during the post-transplantation period. On day +14 to +24 'entgraftment' was established in 16 patients. In 2 patients till the 35th day after the transplantation no symptoms of the grafting were observed, which imposed reinfusion of donor cells pool. Seven patients developed acute GvHD, 2 patients developed idiopathic pneumonia syndrome, 1 patient developed liver toxicity, 1 - neurological and 1 - cardiovascular toxicity. FTBI is a well tolerated therapeutic regimen in high dose therapy. The observed organ toxicity in the 18 patients in similar to that cited in reference literature. (authors)

  17. Acute and subchronic toxicological evaluation of Echinophora platyloba DC (Apiaceae total extract in Wistar rats

    Sayid Mahdi Mirghazanfari

    2012-01-01

    Full Text Available OBJECTIVE: Echinophora platyloba DC is a widely used herbal medicine and food seasoning in Iran. It is claimed to exert antimicrobial, antifungal, and antispasmodic effects. Despite the prevalent use of this plant as a food and medicine, there are no reports on its possible toxic effects. To evaluate the safety of E. platyloba, we tested its acute and sub-chronic toxicity in male and female Wistar rats. METHODS: Rats were orally treated with four different single doses of E. platyloba total extract and screened for signs of toxicity two weeks after administration. In the sub-chronic toxicity study, E. platyloba was administered for 45 days. Mortality, clinical signs, body weight changes, hematological and biochemical parameters, gross findings, organ weights, and histological markers were monitored during the study. RESULTS: We found no mortality and no abnormality in clinical signs, body weight, or necropsy findings in any of the animals in the acute study. The results of the subchronic study showed no significant difference in hematological parameters in either sex. There was a significant increase in lactate dehydrogenase in the female groups. A significant increase in the relative lung weight of female rats was noted at 500 mg/kg. Histopathological examinations revealed intra-alveolar hemorrhage in the male rats (500 mg/kg. In the females, congestion of the alveolar capillaries (at 500 mg/kg and liver bridging necrosis (at 200 mg/kg were significantly increased. CONCLUSION: The no observed adverse effect level of E. platyloba was determined to be 200 and 50 mg/kg for male and female rats, respectively.

  18. INVESTIGATING THE RELATIONSHIP BETWEEN ACUTE FLUID LOSS AND BODY FAT PERCENTAGE BY USING BIA METHOD TO DETERMİNE BODY COMPOSİTİON

    Mehmet

    2015-01-01

    Full Text Available Bioelectric impedance analysis (BIA is so popular technique to analysis body fat mass (BFM, free fat mass (FFM, lean body mass (LBM and total body fluid (TBF in both healthy and patient subjects. The aim of this study is to investigate the effect of the acute weight(fluid loss on body fat mass and percentage by using BIA method. In this study 43 soccer players (age: 21.90; length: 179.62and weight: 73.90 who playing in college league in Afyonkarahisar province has been participated. Body weight, total body fluid, body fat percentage and fat mass of soccer players were measured by using BIA(Tanita method before and after the matches. Paired t test has been used to compare pretest and posttest values. Pearson's correlation analysis has been used to determine relationship between tests values. Statistically differences has been determined between pre-post body weight and body fat TBF (p<0,01. Also, highly negative correlation has been determined between pre-post body fluide loss percentage differences and pre-post body fat mass percentage differences (r=-,766; p<0,001. Theoretically, body fat loss is expected following weight loss after computation, anything but rising rate of body fat was observed. So it is speculated that bio-electric facing more resistance in the body due to fluid loss. Therefore more body fat calculated. Dehydration should be taken into account for the measurements made by the BIA method, because of changes in body fat percentages. It is suggested that fluid intake of the subjects should be under control before the measurementin the studies.

  19. Revisiting Biomarkers of Total-Body and Partial-Body Exposure in a Baboon Model of Irradiation.

    Marco Valente

    Full Text Available In case of a mass casualty radiation event, there is a need to distinguish total-body irradiation (TBI and partial-body irradiation (PBI to concentrate overwhelmed medical resources to the individuals that would develop an acute radiation syndrome (ARS and need hematologic support (i.e., mostly TBI victims. To improve the identification and medical care of TBI versus PBI individuals, reliable biomarkers of exposure could be very useful. To investigate this issue, pairs of baboons (n = 18 were exposed to different situations of TBI and PBI corresponding to an equivalent of either 5 Gy 60Co gamma irradiation (5 Gy TBI; 7.5 Gy left hemibody/2.5 right hemibody TBI; 5.55 Gy 90% PBI; 6.25 Gy 80% PBI; 10 Gy 50% PBI, 15 Gy 30% PBI or 2.5 Gy (2.5 Gy TBI; 5 Gy 50% PBI. More than fifty parameters were evaluated before and after irradiation at several time points up to 200 days. A partial least square discriminant analysis showed a good distinction of TBI from PBI situations that were equivalent to 5 Gy. Furthermore, all the animals were pooled in two groups, TBI (n = 6 and PBI (n = 12, for comparison using a logistic regression and a non parametric statistical test. Nine plasmatic biochemical markers and most of hematological parameters turned out to discriminate between TBI and PBI animals during the prodromal phase and the manifest illness phase. The most significant biomarkers were aspartate aminotransferase, creatine kinase, lactico dehydrogenase, urea, Flt3-ligand, iron, C-reactive protein, absolute neutrophil count and neutrophil-to-lymphocyte ratio for the early period, and Flt3-ligand, iron, platelet count, hemoglobin, monocyte count, absolute neutrophil count and neutrophil-to-lymphocyte ratio for the ARS phase. These results suggest that heterogeneity could be distinguished within a range of 2.5 to 5 Gy TBI.

  20. Acute Diffuse and Total Alopecia of the Female Scalp Associated with Borrelia-Infection

    Bhardwaj, Ekta K; Trüeb, Ralph Michel

    2015-01-01

    A case of acute diffuse and total alopecia of the female scalp associated with Borrelia-infection (acrodermatitis chronica atrophicans) is presented. Today, acute diffuse and total alopecia of the female scalp is recognized as a distinct variant of alopecia areata (AA) predominantly observed in women. Cases of AA have formerly been reported in association with infections. AA is understood to represent an organ-specific autoimmune disease of the hair follicle. It is conceivable that the antige...

  1. Association between body water status and acute mountain sickness.

    Hannes Gatterer

    Full Text Available PURPOSE: The present study determined the association between body fluid variation and the development of acute mountain sickness (AMS in adults. METHODS: Forty-three healthy participants (26 males and 17 females, age: 26 ± 6 yr, height: 174 ± 9 cm, weight: 68 ± 12 kg were passively exposed at a FiO2 of 12.6% (simulated altitude hypoxia of 4500 m, PiO2 = 83.9 mmHg for 12-h. AMS severity was assessed using the Lake Louise Score (LLS. Food and drink intakes were consumed ad libitum and measured; all urine was collected. Before and after the 12-h exposure, body weight and plasma osmolality were measured and whole-body bioimpedance analysis was performed. RESULTS: The overall AMS incidence was 43% (38% males, 50% females. Participants who developed AMS showed lower fluid losses (3.0 ± 0.9 vs. 4.5 ± 2.0 ml/kg/h, p = 0.002, a higher fluid retention (1.9 ± 1.5 vs. 0.6 ± 0.8 ml/kg/h, p = 0.022, greater plasma osmolality decreases (-7 ± 7 vs. -2 ± 5 mOsm/kg, p = 0.028 and a larger plasma volume expansion (11 ± 10 vs. 1 ± 15%, p = 0.041 compared to participants not developing AMS. Net water balance (fluid intake--fluid loss and the amount of fluid loss were strong predictors whether getting sick or not (Nagelkerkes r(2 = 0.532. The LLS score was related to net water balance (r = 0.358, p = 0.018, changes in plasma osmolality (r = -0.325, p = 0.033 and sodium concentration (r = -0.305, p = 0.047. Changes in the impedance vector length were related to weight changes (r = -0.550, p<0.001, fluid intake (r = -0.533, p<0.001 and net water balance (r = -0.590, p<0.001. CONCLUSIONS: Participants developing AMS within 12 hours showed a positive net water balance due to low fluid loss. Thus measures to avoid excess fluid retention are likely to reduce AMS symptoms.

  2. Establishment of Early Endpoints in Mouse Total-Body Irradiation Model.

    Koch, Amory; Gulani, Jatinder; King, Gregory; Hieber, Kevin; Chappell, Mark; Ossetrova, Natalia

    2016-01-01

    Acute radiation sickness (ARS) following exposure to ionizing irradiation is characterized by radiation-induced multiorgan dysfunction/failure that refers to progressive dysfunction of two or more organ systems, the etiological agent being radiation damage to cells and tissues over time. Radiation sensitivity data on humans and animals has made it possible to describe the signs associated with ARS. A mouse model of total-body irradiation (TBI) has previously been developed that represents the likely scenario of exposure in the human population. Herein, we present the Mouse Intervention Scoring System (MISS) developed at the Veterinary Sciences Department (VSD) of the Armed Forces Radiobiology Research Institute (AFRRI) to identify moribund mice and decrease the numbers of mice found dead, which is therefore a more humane refinement to death as the endpoint. Survival rates were compared to changes in body weights and temperatures in the mouse (CD2F1 male) TBI model (6-14 Gy, 60Co γ-rays at 0.6 Gy min-1), which informed improvements to the Scoring System. Individual tracking of animals via implanted microchips allowed for assessment of criteria based on individuals rather than by group averages. From a total of 132 mice (92 irradiated), 51 mice were euthanized versus only four mice that were found dead (7% of non-survivors). In this case, all four mice were found dead after overnight periods between observations. Weight loss alone was indicative of imminent succumbing to radiation injury, however mice did not always become moribund within 24 hours while having weight loss >30%. Only one survivor had a weight loss of greater than 30%. Temperature significantly dropped only 2-4 days before death/euthanasia in 10 and 14 Gy animals. The score system demonstrates a significant refinement as compared to using subjective assessment of morbidity or death as the endpoint for these survival studies. PMID:27579862

  3. Prognostic value of serum total bilirubin in patients with acute coronary syndrome after percutaneous coronary intervention

    孙同文

    2013-01-01

    Objective To investigate the predictive value of serum total bilirubin (STB) level in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) .Methods A total of 1273 consecutive patients treated with PCI in cardiology department,First Affiliated Hospital of Zhengzhou University from June

  4. Total body irradiation and allogeneic bone marrow transplantation - Sofia University Hospital experience

    Aim of the study: To report the long-term outcome in patients with leukaemias, who had conditioning regimens including total body irradiation (TBI) prior to bone marrow transplantation (BMT), and to establish independent factors correlated with treatment outcome. Material and methods: Between January 2002 and December 2007, 18 patients, 11 males and 7 females with median age of 12 years (range 8-50), received TBI. Initial diagnoses were acute lymphoblastic leukaemia (ALL) 11 (61%), acute myeloid leukaemia (AML) 4 (22%), and chronic myeloid leukaemia (CML) 3 (17%). Pre-transplantation disease status was defined as remission 11 (61%), progression 4 (22%), and chronic phase 3 (17%). All the patients were conditioned with a high-dose chemoradiotherapy regimen including fractionated TBI delivering 10 to 12 Gy in 15 (73%) and a single fraction of 2 Gy in 3 (17%) of the cases. TBI was performed in alternate prone and supine positions with a 60 Co machine. In 13 (72%) patients transplantation was carried out from an HLA-identical related donor and in 5 (28%) from an unrelated donor. Seventeen allogeneic transplantations were of peripheral blood stem cells and 1 was of bone marrow stem cells. Post- transplantation clinical, biological, and functional evaluations were performed on days 30, 100, 180, at 1 year, and annually thereafter. Each evaluation included an assessment of the study end points: marrow chimerism, disease status (complete remission or relapse), survival status (alive or dead), treatment-related toxicity (TRT), treatment-related mortality (TRM) and graft-versus-host-disease (GvHD). Results: Median follow-up from BMT was 27 months (range 3-52). Sixteen patients achieved engraftment, 2 patients had primary graft failure. Seven of 18 (39%) evaluable patients developed acute GvHD, 6 (35%) patients developed chronic GvHD. At the time of reporting 9 of 18 patients remain alive and in remission. Nine patients died, 4 (22%) because of relapse and 5 (28%) because of

  5. A Triple Iron Triathlon Leads to a Decrease in Total Body Mass but Not to Dehydration

    Knechtle, Beat; Knechtle, Patrizia; Rosemann, Thomas; Oliver, Senn

    2010-01-01

    A loss in total body mass during an ultraendurance performance is usually attributed to dehydration. We identified the changes in total body mass, fat mass, skeletal muscle mass, and selected markers of hydration status in 31 male nonprofessional ultratriathletes participating in a Triple Iron triathlon involving 11.4 km swimming, 540 km cycling…

  6. A Meta-Analysis of Enteral Nutrition and Total Parenteral Nutrition in Patients with Acute Pancreatitis

    Heming Quan; Xingpeng Wang; Chuanyong Guo

    2011-01-01

    Objective. To analyze the effect of total parenteral nutrition (TPN) and enteral nutrition (EN) in patients with acute pancreatitis. Methods. Randomized controlled trials of TPN and EN in patients with acute pancreatitis were searched in NCBI and CBM databases and The Cochrane Controlled Trials Register. Six studies were enrolled into the analysis, and the details about the trial designs, characters of the subjects, results of the studies were reviewed by two independent authors and analyzed ...

  7. Case of severe acute pancreatitis with near total pancreatic necrosis diagnosed by dynamic CT scanning

    Takeda, Kazunori; Kakugawa, Yoichiro; Amikura, Katsumi; Miyagawa, Kikuo; Matsuno, Seiki; Sato, Toshio

    1987-09-01

    A 42 year-old woman with severe acute pancreatitis had drainage of the pancreatic bed, cholecystostomy and jejunostomy on admission, but symptoms were not improved. Fourteen days after admission, clinical sepsis and septisemia were recognized. Dynamic CT scanning of the pancreas showed near total pancreatic necrosis. Symptoms were improved after necrosectomy of the pancreas and debridement of the peripancreatic necrotic tissue were performed. Our experience suggests the usefulness of dynamic CT scanning for detection of pancreatic necrosis in severe acute pancreatitis.

  8. Total Flavonoids from Mimosa Pudica Protects Carbon Tetrachloride -Induced Acute Liver Injury in Mice

    Zhen-qin QIU

    2015-03-01

    Full Text Available Objective: To observe the protective effect of total flavonoids from Mimosa pudica on carbon tetrachloride (CCl4-induced acute liver injury in mice. Methods: CCl4-induced acute liver injury model in mice was established. The activity of ALT and AST, the content of serum albumin (Alb and total antioxidant capacity (T-AOC were determined. The content of malondiadehyde (MDA was measured and the activity of superoxide dismutase (SOD was determined. The histopathological changes of liver were observed.Results: Compared with CCl4 modle group, each dose group of total flavonouida from Mimosa pudica couldreduced the activity of ALT and AST in mice obviously (P<0.01, indicating they had remarkably protective effect on CCl4-induced acute liver injury in mice. high and middle dose groups of total flavonouida from Mimosa pudica couldincrease the content of Alb in mice (P<0.01. Each dose group of total flavonouida from Mimosa pudica could enhance the level of T-AOC (P<0.01. each dose group of total flavonouida from Mimosa pudica could lower the content of liver homogenate MDA but enhance the activity of SOD in a dose-depended manner (P<0.01. Conclusion: Total flavones from Mimosa Pudica have obvious protective effect on CCl4-induced acute liver injury in mice.

  9. Therapeutic application of IL-4 on total body irradiated mice with lethal doses

    In the present study, we determined the consequences of IL-4 treatment on survival hematopoietic recovery as well as acute inflammatory response of irradiated mice. Mice were total body irradiated with lethal doses of γ-rays and treated with IL-4 30 min or 2 h after exposure. Our data show an enhancement of the 30-day survival after 8 Gy irradiation, from 20% for placebo-treated mice to 75% with IL-4. It is generally admitted that the death of animals occurring in this dose range is due to hematopoietic syndrome. Therefore, we determined the efficacy of IL-4 on promoting the recovery of blood cell counts and progenitors in bone marrow. The hematopoietic status of animals is the same whether or not treated with IL-4. Given the anti-inflammatory properties of IL-4, we studied the consequences of IL-4 treatment on the inflammatory response within 24 h after 8 Gy exposure. We have shown that IL-4 treatment led to a limitation of the release of inflammatory mediators, such as IL-1β or KC, in the plasma or tissues of irradiated mice. On the other hand, IL-4 improved the ratio-induced metabolic and functional damages in the central nervous system. In conclusion, our results have shown an enhanced survival of IL-4 treated irradiated mice without improvement of hematopoietic reconstitution. Therapeutic potential of IL-4 could result, at least in part, from the limitation of the radio-induced inflammatory response. (author)

  10. Estimation of the total parasite biomass in acute falciparum malaria from plasma PfHRP2.

    2005-08-01

    Full Text Available BACKGROUND: In falciparum malaria sequestration of erythrocytes containing mature forms of Plasmodium falciparum in the microvasculature of vital organs is central to pathology, but quantitation of this hidden sequestered parasite load in vivo has not previously been possible. The peripheral blood parasite count measures only the circulating, relatively non-pathogenic parasite numbers. P. falciparum releases a specific histidine-rich protein (PfHRP2 into plasma. Quantitative measurement of plasma PfHRP2 concentrations may reflect the total parasite biomass in falciparum malaria. METHODS AND FINDINGS: We measured plasma concentrations of PfHRP2, using a quantitative antigen-capture enzyme-linked immunosorbent assay, in 337 adult patients with falciparum malaria of varying severity hospitalised on the Thai-Burmese border. Based on in vitro production rates, we constructed a model to link this measure to the total parasite burden in the patient. The estimated geometric mean parasite burden was 7 x 10(11 (95% confidence interval [CI] 5.8 x 10(11 to 8.5 x 10(11 parasites per body, and was over six times higher in severe malaria (geometric mean 1.7 x 10(12, 95% CI 1.3 x 10(12 to 2.3 x 10(12 than in patients hospitalised without signs of severity (geometric mean 2.8 x 10(11, 95% CI 2.3 x 10(11 to 3.5 x 10(11; p < 0.001. Parasite burden was highest in patients who died (geometric mean 3.4 x 10(12, 95% CI 1.9 x 10(12 to 6.3 x 10(12; p = 0.03. The calculated number of sequestered parasites increased with disease severity and was higher in patients with late developmental stages of P. falciparum present on peripheral blood smears. Comparing model and laboratory estimates of the time of sequestration suggested that admission to hospital with uncomplicated malaria often follows schizogony-but in severe malaria is unrelated to stage of parasite development. CONCLUSION: Plasma PfHRP2 concentrations may be used to estimate the total body parasite biomass in

  11. Evaluation of morphological indices and total body electrical conductivity to assess body composition in big brown bats

    Pearce, R.D.; O'Shea, T.J.; Wunder, B.A.

    2008-01-01

    Bat researchers have used both morphological indices and total body electric conductivity (TOBEC) as proxies for body condition in a variety of studies, but have typically not validated these indices against direct measurement of body composition. We quantified body composition (total carcass lipids) to determine if morphological indices were useful predictors of body condition in big brown bats (Eptesicus fuscus). We also evaluated body composition indirectly by TOBEC using EM-SCAN?? technology. The most important predictors of body composition in multiple regression analysis were body mass-to-forearm ratio (partial r2 = 0.82, P < 0.001) followed by TOBEC measurement (partial r2 = 0.08, P < 0.001) and to a minor extent head length (partial r2 = 0.02, P < 0.05). Morphological condition indices alone may be adequate for some studies because of lower cost and effort. Marking bats with passive integrated transponder (PIT) tags affected TOBEC measurements. ?? Museum and Institute of Zoology PAS.

  12. Morphological changes of carotid bodies in acute respiratory distress syndrome: a morphometric study in humans

    E.N.G. Vinhaes; Dolhnikoff, M; Saldiva, P. H. N.

    2002-01-01

    Carotid bodies are chemoreceptors sensitive to a fall of partial oxygen pressure in blood (hypoxia). The morphological alterations of these organs in patients with chronic obstructive pulmonary disease (COPD) and in people living at high altitude are well known. However, it is not known whether the histological profile of human carotid bodies is changed in acute clinical conditions such as acute respiratory distress syndrome (ARDS). The objective of the present study was to perform a quantita...

  13. Combined total body X-ray irradiation and total skin electron beam radiotherapy with an improved technique for mycosis fungoides

    Twelve consecutive patients with advanced stage mycosis fungoides (MF) were treated with combined total body X ray irradiation (TBI) and total skin electron beam radiotherapy (EBRT). Six had generalized plaque disease and dermatopathic nodes, three had tumor stage disease and node biopsy positive for mycosis fungoides, and three had erythroderma/Sezary syndrome. The treatment regimen consisted of split course total body X ray irradiation, given in twice weekly 15 cGy fractions to 75 cGy, then total skin electron beam radiation therapy given in once weekly 400 cGy fractions to a total dose of 2400 cGy. Underdosed areas and areas of greatest initial involvement were boosted 400 cGy twice weekly for an additional 1200 cGy. This was followed by a second course of total body X ray irradiation, to a total dose of 150 cGy. The total skin electron beam radiotherapy technique is a modification of an established six position EBRT technique for mycosis fungoides. Measurements to characterize the beam with and without a lexan scattering plate, demonstrated that the combination of no-plate beams produced better dose uniformity with a much higher dose rate. This improved technique is particularly advantageous for elderly and/or frail patients. Nine (75%) of the 12 patients achieved complete response (CR). The other three had significant improvement with greater than 80% clearing of their disease and resolution of symptoms. All six patients with generalized plaque disease achieved complete response and remained free of disease from 2 to 16 months. Two of three node positive patients also achieved complete response; one, with massive biopsy-documented mycosis fungoides nodal disease and deep open tumors, remained relapse-free over 2 years. Only one of the three patients with erythroderma/Sezary syndrome achieved a complete response, which was short lived

  14. The Effects of Total Colectomy on Bacterial Translocation in a Model of Acute Pancreatitis.

    Şenocak, Rahman; Yigit, Taner; Kılbaş, Zafer; Coşkun, Ali Kağan; Harlak, Ali; Menteş, Mustafa Öner; Kılıç, Abdullah; Günal, Armağan; Kozak, Orhan

    2015-12-01

    Prevention of secondary infection is currently the main goal of treatment for acute necrotizing pancreatitis. Colon was considered as the main origin of secondary infection. Our aim was to investigate whether prophylactic total colectomy would reduce the rate of bacterial translocation and infection of pancreatic necrosis. Forty-two Sprague-Dawley rats were used. Pancreatitis was created by ductal infusion of sodium taurocholate. Rats were divided into four groups: group-1, laparotomy + pancreatic ductal infusion of saline; group-2, laparotomy + pancreatic ductal infusion of sodium taurocholate; group-3, total colectomy + pancreatic ductal infusion of saline; and group-4, total colectomy + pancreatic ductal infusion of sodium taurocholate. Forty-eight hours later, tissue and blood samples were collected for microbiological and histopathological analysis. Total colectomy caused small bowel bacterial overgrowth with gram-negative and gram-positive microorganisms. Bacterial count of gram-negative rods in the small intestine and pancreatic tissue in rats with colectomy and acute pancreatitis were significantly higher than in rats with acute pancreatitis only (group-2 versus group-4; small bowel, p = bacterial overgrowth and pancreatic infection (r = 0,836, p = 0.001). In acute pancreatitis, prophylactic total colectomy (which can mimic colonic cleansing and reduction of colonic flora) induces small bowel bacterial overgrowth, which is associated with increased bacterial translocation to the pancreas. PMID:26730036

  15. Acute effect of whole-body vibration combined with stretching on bridge performance in artistic gymnasts

    DALLAS GEORGE

    2012-01-01

    Full Text Available The purpose of this study was to examine the acute effect of Whole-Body Vibration combined with stretching (WBVS on flexibility of shoulder’s joint in relation to bridge performance. Twelve artistic gymnasts that where dropped out from their competition duties (23,00 ± 2,29 years, 56,91 ± 6,23 kg, 164,08 ± 4,83 cm composed the WBVS, and 12 female students of Department of Physical Education composed the control group (non vibration-stretching group: NVS (20,33 ± 0,78, 58,91 ± 5,18 kg, 165,50 ±4,01 cm. Both groups performed an 1-minute intervention program on a Whole Body Vibration platform that was turn on for WBVS, whereas NVG performed the same intervention program with the device was turn off. The total sample was assessed on bridge performance. Vibration (30Hz, 2mm displacement was applied to two sites, four times for 10 seconds, with 10 sec of rest between times and one minute rest between sites. According to the results both groups improved “bridge performance” after the end of intervention program and remain this improvement for at least 60 minutes. Whoever, WBVS had significant increase flexibility than NVS. Conclusively, Whole-Body Vibration combined with stretching on shoulders joint may greatly influence flexibility in bridge performance.

  16. The carcinogenic risk of high dose total body irradiation in non-human primates

    High dose total body irradiation (TBI) in combination with chemotherapy, followed by rescue with bone marrow transplantation (BMT), is increasingly used for the treatment of haematological malignancies. With the increasing success of this treatment and its current introduction for treating refractory autoimmune diseases the risk of radiation carcinogenesis is of growing concern. Studies on turnout induction in non-human primates are of relevance in this context since the response of this species to radiation does not differ much from that in man. Since the early sixties, studies have been performed on acute effects in Rhesus monkeys and the protective action of bone marrow transplantation after irradiation with X-rays (average total body dose 6.8 Gy) and fission neutrons (average dose 3.4 Gy). Of those monkeys, which were irradiated and reconstituted with autologous bone marrow, 20 animals in the X-irradiated group and nine animals in the neutron group survived more than 3 years. A group of 21 non-irradiated Rhesus monkeys of a comparable age distribution served as controls. All animals were regularly screened for the occurrence of neoplasms. Complete necropsies were performed after natural death or euthanasia. At post-irradiation intervals of 4-21 years an appreciable number of tumours was observed. In the neutron irradiated group eight out of nine animals died with one or more malignant tumours. In the X-irradiated group this fraction was 10 out of 20. The tumours in the control group, in seven out of the 21 animals, appeared at much older a-e compared with those in the irradiated cohorts. The histogenesis of the tumours was diverse with a preponderance of renal carcinoma, sarcomas among which osteosarcormas, and malignant glomus tumours in the irradiated groups. When corrected for competing risks, the carcinogenic risk of TBI in the Rhesus monkeys is similar to that derived from the studies of the Japanese atomic bomb survivors. The increase of the risk by a

  17. Total-body irradiation and bone-marrow transplantation - first observations on clinical tolerance

    complications in 5 of the cases. The transplantation was accompanied by allergic reactions in two patients. Acute GvHD was developed in only one patient. No pneumonitis was developed and we attribute this to the fact that the planned dose in the lungs was not exceeded - it was verified to be 8 Gy by in vivo measurements. Powerful antibiotic, antifungal, antiviral, substituting and symptomatic therapy was accomplished in all patients. No clinically displayed infections were observed in 6 of them despite of the presence of positive uro- and coprocultures. Six patients were discharged in good general condition within the interval of 16 to 30 days after the transplantation with compensated hematological parameters and stable transplant effect.The aspiration for widening the scope of indications for TBI treatment with subsequent allogeneic PSCT continues to be in the bases of the routine practice in the country and the clinical observations proceed in this context. Key words: total-body irradiation. bone-marrow transplantation. clinical tolerance

  18. Total body irradiation as a form of preparation for bone marrow transplantation

    The history of total body irradiation and bone marrow transplantation is surprisingly old. Following the success of Thomas et al. in the 1970s, bone marrow transplantation appeared to be the sole curative treatment modality for high-risk leukemia. A supralethal dose of total body irradiation was widely accepted as a form of preparation for bone marrow transplantation. In this paper, I described the present status of bone marrow transplantation for leukemia patients in Japan based on the IVth national survey. Since interstitial pneumonitis was one of the most life threatening complications after bone marrow transplantation, I mentioned the dose, dose-rate and fraction of total body irradiation in more detail. In addition, I dealt with some problems of the total body irradiation, such as dose prescription, compensating contour as well as inhomogeneity, and shielding for the highrisk organs. (author) 82 refs

  19. THE METHODS OF TOTAL BODY BIOIMPEDANCE SPECTROSCOPY IN ANALYSIS THE FUNCTIONAL CLASS OF CONGESTIVE HEART FAILURE

    Ivanov, G.; Dvornicov, V.; Niculina, L.; Kotlarova, L.; Bernshtein, Ju; Pavlovich, A.

    2004-01-01

    The article presented result of studies, which determined signs an studies of total body bioimpedance spectros-copy analysis in evaluate of functional class of chronic heart failure. Key words: biompedance, congestive heart failure.

  20. Validity of total and segmental impedance measurements for prediction of body composition across ethnic population groups

    Deurenberg, P.R.M.; Deurenberg-Yap, M.; Schouten, F.J.M.

    2002-01-01

    Methods: Anthropometric parameters were measured in addition to impedance (100 kHz) of the total body, arms and legs. Impedance indexes were calculated as height2/impedance. Arm length (span) and leg length (sitting height), wrist and knee width were measured from which body build indices were calcu

  1. Report of the work party: comparison of total body irradiation techniques for bone marrow transplantation

    The report presents a survey of total body irradiation techniques for bone marrow transplantation in nine institutions in North America and England. The survey compares their nominal dose, dose rate, point of dose prescription, type of machine used, patient's position during treatment, and use of compensators. This experience has emphasized the need for a system of uniform dose reporting and for uniform dose prescription in total body irradiation

  2. Total body topical 5-fluorouracil for extensive non-melanoma skin cancer

    van Ruth, Serge; Jansman, Frank G.A.; Sanders, Cornelis J.

    2006-01-01

    Background Topical 5-fluorouracil 5% cream is one of␣the treatment modalities for non-melanoma skin cancer (NMSC). There is a lack of suitable therapies to treat patients with extensive NMSC. In this paper we report two patients with extensive NMSC treated by total body application of topical 5-fluorouracil 5% cream. Observations Topical 5-fluorouracil 5% cream was applied twice daily to the total body, including normal appearing skin. During the treatment, weekly blood samples were taken for...

  3. Measurements of the total-body potassium contents. Application of reference value with the whole-body counter

    Yamamoto, Tetsuo [Chiba Univ. (Japan). Inst. for Training Radiological Technicians; Saegusa, Kenji; Arimizu, Noboru; Kuniyasu, Yoshio; Itoh, Hisao

    2001-08-01

    The total-body potassium contents were measured in 405 healthy volunteers and 186 patients with whole body counter in Chiba University Hospital. The total-body potassium contents was expressed by the reference value (R value). The R value was calculated as measured potassium contents (g) divided by the body surface area (m{sup 2}) and adjusted by age and sex of healthy persons. The R value was 100.65{+-}9.22% in 405 healthy volunteers. Those of each disease were as follows: liver cirrhosis; 94.24{+-}11.22%, chronic hepatitis; 95.74{+-}11.24%, hyperthyroidism; 99.37{+-}10.8%, periodic paralysis; 82.0{+-}9.01%, Barter's syndrome; 93.99{+-}9.86%, myasthenia gravis; 97.34{+-}6.42% and hypo-potassemia; 90.64{+-}11.76%, respectively. The R values of other diseases such as uterine cancer, breast cancer, anemia, hypertension were 97.78{+-}11.5%, 99.22{+-}8.88%, 96.64{+-}12.73%, 98.5{+-}9.63% respectively. Fourteen patients showed especially lower R values under 75%. These were 1 liver cirrhosis, 3 hypertension, 1 diabetes mellitus, 3 hypo-potassemia, 1 periodic paralysis, 2 Barter's syndrome, 2 chemical poisoning, and 1 breast cancer. Follow-up study was performed in some patients with the lower R values. The result of follow-up study showed that there was a relationship between improvement of symptoms and increase of total body potassium contents. (author)

  4. Investigation into the relationship between body surface area and total body potassium using Monte Carlo and measurement

    Rogers, J. A.; Blake-James, M.; Green, S.; Beddoe, A. H.

    2002-03-01

    The use of body surface area (BSA) as a means of indexing chemotherapy doses is widespread even though the value of this practice is uncertain. In principle, the body cell mass (BCM) more closely represents the body's metabolic size and this is investigated here as an alternative to BSA; since 98% of body potassium is intracellular the derivation of total body potassium (TBK) via the measurement of 40K in a whole body counter (WBC) will provide a useful normalizing index for metabolic size, potentially avoiding toxicity and underdosing. The Queen Elizabeth Hospital WBC has been used in this study, initially involving single geometrical phantoms and then combinations of these to simulate human body habitus. Monte Carlo N-particle (MCNP) codes were constructed to model the phantoms and simulate the measurements made in the WBC. Efficiency corrections were derived by comparing measurement and modelled data for each detector separately. A method of modelling a person in the WBC as a series of ellipsoids was developed. Twenty-four normal males and 24 females were measured for their 40K emissions. Individual MCNP codes were constructed for each volunteer and the results used in conjunction with the measurements to derive TBK, correcting for body habitus effects and detector efficiencies. An estimate of the component of error arising from sources other than counting statistics was included by analysing data from the measurement of phantoms. The total residual errors (expressed as coefficients of variation) for males and females were 10.1% and 8.5% respectively. The measurement components were determined to be 2.4% and 2.5%, implying that the biological components were 9.8% and 8.1% respectively. These results suggest that the use of BSA for indexing chemotherapy doses is likely to give rise to clinically significant under- or overdosing.

  5. Investigation into the relationship between body surface area and total body potassium using Monte Carlo and measurement

    The use of body surface area (BSA) as a means of indexing chemotherapy doses is widespread even though the value of this practice is uncertain. In principle, the body cell mass (BCM) more closely represents the body's metabolic size and this is investigated here as an alternative to BSA; since 98% of body potassium is intracellular the derivation of total body potassium (TBK) via the measurement of 40K in a whole body counter (WBC) will provide a useful normalizing index for metabolic size, potentially avoiding toxicity and underdosing. The Queen Elizabeth Hospital WBC has been used in this study, initially involving single geometrical phantoms and then combinations of these to simulate human body habitus. Monte Carlo N-particle (MCNP) codes were constructed to model the phantoms and simulate the measurements made in the WBC. Efficiency corrections were derived by comparing measurement and modelled data for each detector separately. A method of modelling a person in the WBC as a series of ellipsoids was developed. Twenty-four normal males and 24 females were measured for their 40K emissions. Individual MCNP codes were constructed for each volunteer and the results used in conjunction with the measurements to derive TBK, correcting for body habitus effects and detector efficiencies. An estimate of the component of error arising from sources other than counting statistics was included by analysing data from the measurement of phantoms. The total residual errors (expressed as coefficients of variation) for males and females were 10.1% and 8.5% respectively. The measurement components were determined to be 2.4% and 2.5%, implying that the biological components were 9.8% and 8.1% respectively. These results suggest that the use of BSA for indexing chemotherapy doses is likely to give rise to clinically significant under- or overdosing. (author)

  6. Energy absorption, lean body mass, and total body fat changes during 5 weeks of continuous bed rest

    Krebs, Jean M.; Evans, Harlan; Kuo, Mike C.; Schneider, Victor S.; Leblanc, Adrian D.

    1990-01-01

    The nature of the body composition changes due to inactivity was examined together with the question of whether these changes are secondary to changes in energy absorption. Volunteers were 15 healthy males who lived on a metabolic research ward under close staff supervision for 11 weeks. Subjects were ambulatory during the first six weeks and remained in continuous bed rest for the last five weeks of the study. Six male volunteers (age 24-61 years) were selected for body composition measurements. Nine different male volunteers (age 21-50 years) were selected for energy absorption measurements. The volunteers were fed weighed conventional foods on a constant 7-d rotation menu. The average daily caloric content was 2,592 kcal. Comparing the five weeks of continuous bed rest with the previous six weeks of ambulation, it was observed that there was no change in energy absorption or total body weight during bed rest, but a significant decrease in lean body mass and a significant increase in total body fat (p less than 0.05).

  7. Total body irradiation with a four-field technique using a 10 MV linear accelerator

    Recently, total body irradiation (TBI) is being used as a method of preparation for bone marrow transplantation (BMT). However, many variations exist in the TBI procedure, such as the irradiation technique, total dose, dose rate and dose fractionation. In TBI treatment, it is important to apply a homogeneous dose to the total body, and avoid interstitial pneumonitis and cataracta. Therefore, we applied a four-field technique using 10 MV X-rays with a shield for lungs and eyeballs, and employed tissue compensators and bolus to obtain a homogeneous dose distribution. The midpoint doses in 12 positions of the total body have been achieved within ±10% of that of the pelvis with the use of this technique. Also, this TBI technique is capable of accurately controlling absorbed doses to the lungs and eyes. (author)

  8. Leukemia cutis with lymphoglandular bodies: a clue to acute lymphoblastic leukemia cutis

    Obiozor, Cynthia; Ganguly, Siddhartha; Fraga, Garth R.

    2015-01-01

    Leukemia cutis describes cutaneous lesions produced by infiltrates of leukemic cells. It usually manifests contemporaneously with the initial diagnosis of systemic leukemia, but may also precede or follow systemic leukemia. Most cases are associated with acute myeloid leukemia. Adult B-cell lymphoblastic leukemia cutis is very rare. We report a 59-year-old woman with a history of B-cell acute lymphoblastic leukemia who relapsed with aleukemic lymphoblastic leukemia cutis. Lymphoglandular bodi...

  9. Chronic activation of plasma renin is log-linearly related to dietary sodium and eliminates natriuresis in response to a pulse change in total body sodium

    Kjolby, Mads; Bie, Peter

    2008-01-01

    Responses to acute sodium loading depend on the load and on the level of chronic sodium intake. To test the hypothesis that an acute step increase in total body sodium (TBS) elicits a natriuretic response, which is dependent on the chronic level of TBS, we measured the effects of a bolus of Na......Cl administration increased PV (+6.3-8.9%) and plasma sodium concentration (~2%) and decreased plasma protein concentration (-6.4-8.1%). Plasma ANG II and aldosterone concentrations decreased transiently. Potassium excretion increased substantially. Sodium excretion, arterial blood pressure, glomerular filtration...

  10. Acute and subchronic toxicological evaluation of Echinophora platyloba DC (Apiaceae) total extract in Wistar rats

    Sayid Mahdi Mirghazanfari; Leila Hosseinzadeh; Yalda Shokoohinia; Majid Aslany; Mohammad Kamali-Nejad

    2012-01-01

    OBJECTIVE: Echinophora platyloba DC is a widely used herbal medicine and food seasoning in Iran. It is claimed to exert antimicrobial, antifungal, and antispasmodic effects. Despite the prevalent use of this plant as a food and medicine, there are no reports on its possible toxic effects. To evaluate the safety of E. platyloba, we tested its acute and sub-chronic toxicity in male and female Wistar rats. METHODS: Rats were orally treated with four different single doses of E. platyloba total e...

  11. Measurements of the total-body potassium contents. Application of reference value with the whole-body counter

    The total-body potassium contents were measured in 405 healthy volunteers and 186 patients with whole body counter in Chiba University Hospital. The total-body potassium contents was expressed by the reference value (R value). The R value was calculated as measured potassium contents (g) divided by the body surface area (m2) and adjusted by age and sex of healthy persons. The R value was 100.65±9.22% in 405 healthy volunteers. Those of each disease were as follows: liver cirrhosis; 94.24±11.22%, chronic hepatitis; 95.74±11.24%, hyperthyroidism; 99.37±10.8%, periodic paralysis; 82.0±9.01%, Barter's syndrome; 93.99±9.86%, myasthenia gravis; 97.34±6.42% and hypo-potassemia; 90.64±11.76%, respectively. The R values of other diseases such as uterine cancer, breast cancer, anemia, hypertension were 97.78±11.5%, 99.22±8.88%, 96.64±12.73%, 98.5±9.63% respectively. Fourteen patients showed especially lower R values under 75%. These were 1 liver cirrhosis, 3 hypertension, 1 diabetes mellitus, 3 hypo-potassemia, 1 periodic paralysis, 2 Barter's syndrome, 2 chemical poisoning, and 1 breast cancer. Follow-up study was performed in some patients with the lower R values. The result of follow-up study showed that there was a relationship between improvement of symptoms and increase of total body potassium contents. (author)

  12. Patient dose analysis in total body irradiation through in vivo dosimetry

    Ganapathy, K.; Kurup, P. G. G.; Murali, V.; M. Muthukumaran; Bhuvaneshwari, N.; Velmurugan, J.

    2012-01-01

    Total body irradiation (TBI) is a special radiotherapy technique, administered prior to bone marrow transplantation. Due to the complex nature of the treatment setup, in vivo dosimetry for TBI is mandatory to ensure proper delivery of the intended radiation dose throughout the body. Lithium fluoride (LiF) TLD-100 chips are used for the TBI in vivo dosimetry. Results obtained from the in vivo dosimetry of 20 patients are analyzed. Results obtained from forehead, abdomen, pelvis, and mediastinu...

  13. The clinical experience and results of total body irradiation for the cases of refractory leukemia

    Five patients suffering from refractory leukemia were treated by Cyclophosphamide and total body irradiation followed by bone marrow transplantation. Total body irradiation with 10 MV Linac x-ray (1000 - 1280 rad, peak absorbed dose) followed by bone marrow transplantation is considered to be a relatively safe procedure. The dose distribution of the total body irradiation shows clinically suitable homogeniety. Although there is no long-term survivor in this study, no relapse sign of leukemia was found at autopsy. Therefore, some possibility of cure can be expected from this experience. There are many problems such as Graft-versus-host disease, susceptability to infection, etc., but this combination therapy will be able to contribute to improve the clinical course of refractory leukemia. (author)

  14. Total Body Photography as an Aid to Skin Self-examination: A Patient's Perspective.

    Secker, Lisanne J; Bergman, Wilma; Kukutsch, Nicole A

    2016-03-01

    Skin self-examination can help patients who are at high risk for developing melanoma to become more involved in their own surveillance and treatment. This study examined the use of total body photography as an aid to skin self-examination from the patients' perspective. A total of 179 individuals at high risk for developing melanoma who had undergone total body photography (60.5% response rate) completed a self-reported questionnaire assessing the frequency of skin self-examination, perceived usefulness of total body photography, and a variety of potential demographic, clinical and psychological factors. Only approximately half of the participants indicated skin self-examination as useful and 78.9% preferred clinical skin examination by a specialist. Finding total body photography useful was associated with having received instructions on how to perform skin self-examination, the use of a (hand)mirror, and confidence to detect changing moles. These findings allow us to develop strategies to further improve patients' self-screening behaviours. PMID:26315708

  15. EXPLORER: Changing the molecular imaging paradigm with total-body PET/CT (Conference Presentation)

    Cherry, Simon R.; Badawi, Ramsey D.; Jones, Terry

    2016-04-01

    Positron emission tomography (PET) is the highest sensitivity technique for human whole-body imaging studies. However, current clinical PET scanners do not make full use of the available signal, as they only permit imaging of a 15-25 cm segment of the body at one time. Given the limited sensitive region, whole-body imaging with clinical PET scanners requires relatively long scan times and subjects the patient to higher than necessary radiation doses. The EXPLORER initiative aims to build a 2-meter axial length PET scanner to allow imaging the entire subject at once, capturing nearly the entire available PET signal. EXPLORER will acquire data with ~40-fold greater sensitivity leading to a six-fold increase in reconstructed signal-to-noise ratio for imaging the total body. Alternatively, total-body images with the EXPLORER scanner will be able to be acquired in ~30 seconds or with ~0.15 mSv injected dose, while maintaining current PET image quality. The superior sensitivity will open many new avenues for biomedical research. Specifically for cancer applications, high sensitivity PET will enable detection of smaller lesions. Additionally, greater sensitivity will allow imaging out to 10 half-lives of positron emitting radiotracers. This will enable 1) metabolic ultra-staging with FDG by extending the uptake and clearance time to 3-5 hours to significantly improve contrast and 2) improved kinetic imaging with short-lived radioisotopes such as C-11, crucial for drug development studies. Frequent imaging studies of the same subject to study disease progression or to track response to therapy will be possible with the low dose capabilities of the EXPLORER scanner. The low dose capabilities will also open up new imaging possibilities in pediatrics and adolescents to better study developmental disorders. This talk will review the basis for developing total-body PET, potential applications, and review progress to date in developing EXPLORER, the first total-body PET scanner.

  16. Total body irradiation and bone marrow transplantation in some malignant tumors

    Available data and proper results of high-dose total body irradiation combined with chemotherapy and bone marrow transplantation in patients with leukemia and other disseminated malignant diseases are analyzed. It is shown that the therapeutic effect is determined by the total dose, dose per fraction, dose rate, and disease stage. Moderate fractionation is preferable; its efficacy is no leas than that of hyperfractionation, it is convenient for patients, and causes less complications than a single exposure

  17. Association between serum total testosterone and Body Mass Index in middle aged healthy men

    Shamim, Muhammad Omar; Ali Khan, Farooq Munfaet; Arshad, Rabia

    2015-01-01

    Objective: To determine correlation of serum total testosterone with body mass index (BMI) and waist hip ratio (WHR) in healthy adult males. Methods: A cross sectional study was conducted on 200 nonsmoker healthy males (aged 30-50 years) university employees. They were selected by convenience sampling technique after a detailed medical history and clinical examination including BMI and Waist Hip Ratio (WHR) calculation. Blood sampling was carried out to measure serum total testosterone (TT) u...

  18. Can tritiated water-dilution space accurately predict total body water in chukar partridges

    Total body water (TBW) volumes determined from the dilution space of injected tritiated water have consistently overestimated actual water volumes (determined by desiccation to constant mass) in reptiles and mammals, but results for birds are controversial. We investigated potential errors in both the dilution method and the desiccation method in an attempt to resolve this controversy. Tritiated water dilution yielded an accurate measurement of water mass in vitro. However, in vivo, this method yielded a 4.6% overestimate of the amount of water (3.1% of live body mass) in chukar partridges, apparently largely because of loss of tritium from body water to sites of dissociable hydrogens on body solids. An additional source of overestimation (approximately 2% of body mass) was loss of tritium to the solids in blood samples during distillation of blood to obtain pure water for tritium analysis. Measuring tritium activity in plasma samples avoided this problem but required measurement of, and correction for, the dry matter content in plasma. Desiccation to constant mass by lyophilization or oven-drying also overestimated the amount of water actually in the bodies of chukar partridges by 1.4% of body mass, because these values included water adsorbed onto the outside of feathers. When desiccating defeathered carcasses, oven-drying at 70 degrees C yielded TBW values identical to those obtained from lyophilization, but TBW was overestimated (0.5% of body mass) by drying at 100 degrees C due to loss of organic substances as well as water

  19. Monte Carlo efficiency calibration of a neutron generator-based total-body irradiator

    Many body composition measurement systems are calibrated against a single-sized reference phantom. Prompt-gamma neutron activation (PGNA) provides the only direct measure of total body nitrogen (TBN), an index of the body's lean tissue mass. In PGNA systems, body size influences neutron flux attenuation, induced gamma signal distribution, and counting efficiency. Thus, calibration based on a single-sized phantom could result in inaccurate TBN values. We used Monte Carlo simulations (MCNP-5; Los Alamos National Laboratory) in order to map a system's response to the range of body weights (65-160 kg) and body fat distributions (25-60%) in obese humans. Calibration curves were constructed to derive body-size correction factors relative to a standard reference phantom, providing customized adjustments to account for differences in body habitus of obese adults. The use of MCNP-generated calibration curves should allow for a better estimate of the true changes in lean tissue mass that many occur during intervention programs focused only on weight loss. (author)

  20. Pulmonary complications of bone marrow transplantation: a comparison of total body irradiation and cyclophosphamide to busulfan and cyclophosphamide

    Purpose: To retrospectively compare the acute and long-term pulmonary toxicities of total body irradiation and busulfan in bone marrow transplantation. Methods and Materials: From March 1984 through February 1991, 144 patients received high-dose therapy with cyclophosphamide plus either total body irradiation (TBI-CY) or busulfan (BU-CY) followed by bone marrow rescue. Treatment protocols were based on disease type. Cyclophosphamide dose was 120-200 mg/kg, given in 2-4 days. Total body irradiation was given as 12 Gy in four fractions over 4 days, or 14.4 Gy in eight fractions over 4 days. Busulfan dose was 16 mg/kg given over 4 days. Results: Seventy-nine patients were treated with TBI-CY and 65 patients with BU-CY. More patients in the TBI group had allogeneic transplants (40 vs. 18). Pulmonary events occurred in 48 patients, 19 in BU-CY and 29 in TBI-CY. Of the 58 patients with allogeneic transplants, 21 (36%) developed chronic graft-vs.-host disease (GVHD), and 10 of those patients developed pulmonary complications (including 2 with obliterative bronchitis and 1 with asthma). Interstitial pneumonitis (IP) occurred in 14 patients, 12 in the TBI-CY group and 2 in the BU-CY group. Cytomegalovirus and pneumocystis infections were associated with IP in 11 of those patients. Fatal idiopathic IP occurred in one patient in each of the TBI-CY and BU-CY groups. Multivariate analysis showed that only chronic GVHD and prior bleomycin use were significant predictors of interstitial pneumonitis; no difference was seen between TBI-CY and BU-CY. Conclusions: Pulmonary complications were most commonly associated with GVHD and prior bleomycin use. The incidence of cytomegalovirus or pneumocystis carinii pneumonitis was greater in the patients receiving the TBI regimen; fatal pulmonary complications were not significantly different between TBI and nonTBI regimens

  1. Total leucocyte count, C-reactive protein and neutrophil count: Diagnostic Aid in acute appendicitis

    Shafi Sheikh

    2009-01-01

    Full Text Available Background/Aim: Acute appendicitis is one of the most common acute intraabdominal affections seen in surgical departments, which can be treated easily if an accurate diagnosis is made in time. Otherwise, delay in diagnosis and treatment can lead to diffuse peritonitis. Materials and Methods: A study was conducted on 110 patients who were operated for acute appendicitis to determine the role and predictive value of the total leucocyte count (TLC, C-reactive protein (CRP and percentage of neutrophil count in the diagnosis of acute appendicitis. Preoperative TLC, CRP and percentage of neutrophil count were determined and were compared with the results of the histopathology of the removed appendix. Results: Of all the patients studied, 92 had histopathologically positive appendicitis. The TLC was found to be significantly high in 90 patients who proved to have acute appendicitis, whereas CRP was high in only 88 patients and neutrophil percentage was raised in 91; four had a normal CRP level. Thus, TLC had a sensitivity, specificity and positive predictive value of 97.82%, 55.55% and 91.8%, respectively. CRP had a sensitivity, specificity and positive predictive value of 95.6%, 77.77% and 95.6% respectively. Percentage of neutrophil count had a sensitivity, specificity and positive predictive value of 98.9%, 38.88% and 89.21%, respectively. When used in combination, there was a marked improvement in the specificity and the positive predictive value to 88.04% and 98.7%, respectively. Conclusion: The inflammatory markers, i.e., TLC, CRP and neutrophil count can be helpful in the diagnosis when measured together as this increases their specificity and positive predictive value.

  2. Differentiation of acute total occlusion of coronary artery from chronic total occlusion in coronary computed tomography angiography

    Kwag, Hyon Joo [Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of)

    2012-08-15

    To compare the features of coronary computed tomography angiography (CCTA) imaging of the patients with acute total occlusion (ATO) of coronary artery with those of chronic total occlusion (CTO). CCTA of 26 patients with complete interruption of the coronary artery in CCTA and occlusion in conventional coronary angiography, were retrospectively analyzed. Discrimination between the ATO group (n = 11, patients with non ST elevation myocardial infarction or unstable angina) and the CTO group (n = 15, patients with stable angina or nonspecific symptom) was arbitrarily determined by clinical diagnosis. Lesion length, remodeling index (RI), plaque density measured by Hounsfield units (HU), plaque composition, percentage attenuation drop across the lesion, and presence of myocardial thinning were evaluated. Comparisons between the ATO and CTO groups revealed significantly shorter lesion length in the ATO group (0.40 cm vs. 1.87 cm, respectively; p = 0.001), and significantly higher RI (1.56 vs. 1.10, respectively; p = 0.004). Plaque density of the ATO group was lower (37.0 HU vs. 104.7 HU, respectively; p < 0.001) and non calcified plaque was frequently seen in the ATO group (72.7% vs. 26.7%, respectively; p = 0.02). Percentage attenuation drop across the lesion was lower for the ATO group (10.92% vs. 25.44%, respectively; p = 0.005). Myocardial thinning was exclusively observed in the CTO group (seven of 15 patients, p = 0.01). CCTA shows various statistically significant differences between the ATO and CTO groups.

  3. Differentiation of acute total occlusion of coronary artery from chronic total occlusion in coronary computed tomography angiography

    To compare the features of coronary computed tomography angiography (CCTA) imaging of the patients with acute total occlusion (ATO) of coronary artery with those of chronic total occlusion (CTO). CCTA of 26 patients with complete interruption of the coronary artery in CCTA and occlusion in conventional coronary angiography, were retrospectively analyzed. Discrimination between the ATO group (n = 11, patients with non ST elevation myocardial infarction or unstable angina) and the CTO group (n = 15, patients with stable angina or nonspecific symptom) was arbitrarily determined by clinical diagnosis. Lesion length, remodeling index (RI), plaque density measured by Hounsfield units (HU), plaque composition, percentage attenuation drop across the lesion, and presence of myocardial thinning were evaluated. Comparisons between the ATO and CTO groups revealed significantly shorter lesion length in the ATO group (0.40 cm vs. 1.87 cm, respectively; p = 0.001), and significantly higher RI (1.56 vs. 1.10, respectively; p = 0.004). Plaque density of the ATO group was lower (37.0 HU vs. 104.7 HU, respectively; p < 0.001) and non calcified plaque was frequently seen in the ATO group (72.7% vs. 26.7%, respectively; p = 0.02). Percentage attenuation drop across the lesion was lower for the ATO group (10.92% vs. 25.44%, respectively; p = 0.005). Myocardial thinning was exclusively observed in the CTO group (seven of 15 patients, p = 0.01). CCTA shows various statistically significant differences between the ATO and CTO groups

  4. Modelling and validation for total body irradiation using a 3D planning system

    Pinnacle treatment planning system has been successfully commissioned for total body irradiation and will be used for patient treatments in near future. The actual dose delivered to patients will be monitored with TLDs and diode array and the agreement with the prescribed dose will be further investigated

  5. Blood volume, blood pressure and total body sodium: internal signalling and output control

    Bie, P

    2009-01-01

    . Plasma renin is log-linearly related to salt intake, and normally, decreases in renin secretion are a precondition of natriuresis after increases in total body sodium. Renin secretion is controlled by renal ABP, renal nerve activity and the tubular chloride concentrations at the macula densa (MD). Renal...

  6. Total-body CT scanning in trauma patients: Benefits and boundaries

    J.C. Sierink

    2015-01-01

    Computed tomography (CT) scanning has become essential in the early diagnostic phase of trauma care. It is a fast and highly accurate modality for the identification of various injuries and it enables a rapid response to life-threatening problems. Especially total-body CT (TBCT) scanning is increasi

  7. A SIMPLIFIED IN VIVO DOSLMETRY FOR TOTAL BODY IRRADIATION PRIOR TO BONE MARROW TRANSPLANTATION

    肖泽久

    1994-01-01

    For TBI (total body irradiation) prior to BMT (bone marrow transplantation) and in order to guarantee exact treatment, it is necessary to perfect is vivo dosimetry to detect any deviation of the treatment and to verify the dose dis-tribution. A simplified and convenient transmission type in vivo dosimetry and problems are introduced and discussed.

  8. Post-laryngectomy localization of I-131 at tracheostomy site on a total body scan

    Kirk, G.A.; Schulz, E.E.

    1984-07-01

    A post-thyroidectomy, post-I-131-therapy patient had a laryngectomy and neck dissection for recurrent papillary thyroid carcinoma. A subsequent I-131 total body scan revealed persistent anterior neck activity, which disappeared upon removal of the tracheostomy tube and dressings.

  9. Whole-body irradiation technique: physical aspects; Tecnica de irradiacion corporal total: aspectos fisicos

    Venencia, D.; Bustos, S.; Zunino, S. [Instituto Privado de Radioterapia. Obispo Oro 425. Cordoba 5000 (Argentina)

    1998-12-31

    The objective of this work has been to implement a Total body irradiation technique that fulfill the following conditions: simplicity, repeatability, fast and comfortable positioning for the patient, homogeneity of the dose between 10-15 %, short times of treatments and In vivo dosimetric verifications. (Author)

  10. Body composition and phase angle in Russian children in remission from acute lymphoblastic leukemia

    Tseytlin, G. Ja; Khomyakova, I. A.; Nikolaev, D. V.; Konovalova, M. V.; Vashura, A. Yu; Tretyak, A. V.; Godina, E. Z.; Rudnev, S. G.

    2010-04-01

    Elevated degree of body fatness and changes in other body composition parameters are known to be common effects of treatment for acute lymphoblastic leukemia (ALL) in children. In order to study peculiarities of somatic growth and development in ALL survivors, we describe the results of BIA body composition analysis of 112 boys and 108 girls aged 5-18 years in remission from ALL (remission time range 1-13 years) compared to data from the same number of age- and sex-matched healthy controls (n=220). Detrimental effect on height in ALL boys was observed, whereas girls experienced additional weight gain compared to healthy subjects. In ALL patients, resistance, body fat, and percent body fat were significantly increased. The reactance, phase angle, absolute and relative values of skeletal muscle and body cell mass were significantly decreased. Principal component analysis revealed an early prevalence of adiposity traits in the somatic growth and development of ALL girls compared to healthy controls.

  11. Acute and Chronic Whole-Body Vibration Exercise does not Induce Health-Promoting Effects on The Blood Profile

    Theodorou Anastasios A.

    2015-06-01

    Full Text Available Whole-body vibration (WBV exercise is an alternative, popular and easy exercise that can be followed by general public. Therefore, the aim of the present study was to investigate the influence of acute and chronic WBV exercise on health-related parameters. Twenty-eight women were allocated into a control group (n=11, mean ±SEM: age, 43.5 ±1.5 yr; body mass, 66.1 ±3.1 kg; height, 160.6 ±1.5 cm and a vibration group (n=17, mean ±SEM: age, 44.0 ±1.0 yr; body mass, 67.1 ±2.2 kg; height, 162.5 ±1.5 cm. After baseline assessments, participants of the experimental group performed WBV training 3 times/week for 8 weeks. Before and after the chronic WBV exercise, the participants of the vibration group performed one session of acute WBV exercise. Blood chemistry measurements (hematology, creatine kinase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, glucose, insulin, triacylglycerols, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein A1, apolipoprotein B and lipoprotein, thiobarbituric-acid reactive substances, protein carbonyls, total antioxidant capacity, uric acid, albumin and bilirubin were assessed pre-exercise and post-exercise at the first and eighth week of WBV exercise in both control and vibration groups. The results failed to support any effect of both acute and chronic WBV exercise on biochemical health-related parameters. However, it seems that WBV exercise is a safe way of training without a negative impact on muscle and liver functionality.

  12. Effects of Hypergravity and Adrenalectomy on Total Body Bone Mineral Content in Male Rats

    Girten, Beverly; Moran, Megan; Baer, Lisa; Pruitt, Sean; O'Brien, Cheryl; Arnaud, Sara; Wade, Charles; Bowley, Susan M. (Technical Monitor)

    2000-01-01

    The effects of 14 days of increased gravitational load, and the absence of adrenal stress hormones on total body bone mineral content (BMC) were examined in male Sprague-Dawley rats. Centrifugation at 2 Gs (2G) was used to increase the gravitational load, and bilateral adrenalectomy (ADX) was used to eliminate the production of adrenal stress hormones. Stationary groups at 1 G (1G) and sham operated (SHAM) animals served as controls. Thirty rats (n=6 or 8) made up the four experimental groups (1G SHAM, 1G ADX, 2G SHAM and 2G ADX). BMC was assessed by dual energy X-ray absorptiometry (DXA) and activity was determined through biotelemetry. Body mass and food intake were also measured. Multi-factorial analysis of variance (MANCOVA) and Newman Keuls post hoc tests were used to analyze significant effects (p less than 0.05) for the primary variables. Results indicated that BMC decreased significantly with increased G for both the SHAM and ADX groups. The BMC for the 1 G ADX group was also significantly lower than the 1G SHAM group, however the 2G SHAM and ADX groups were not significantly different. There was a significant decrease in body mass with increased G and there was no ADX effect on body mass. When BMC was normalized for body mass changes, there were no significant group differences. Activity level decreased with body mass, and food intake data showed there was significant hypophagia during the first few days of centrifugation. These results suggest that the decrease in total body BMC seen with hypergravity may be based to a large extent on the differences in body mass induced by the 2 G load.

  13. Kidney and lung injury in irradiated rats protected from acute death by partial-body shielding

    Ninety-six CD-1 male rats were exposed to gamma-ray doses (0-25 Gy) in increments of 5 Gy. One femur, the surgically exteriorized GI tract, and the oral cavity were shielded during irradiation to protect against acute mortality from injury to the hematopoietic system, small intestine, and oral cavity. In addition, the thoraxes of half of the animals from each dose group were shielded. At approximately monthly intervals from 2 to 10 months after irradiation the hematocrit, plasma urea nitrogen (PUN), and 51Cr-EDTA clearance were measured. During the study 20 thorax-shielded and 19 thorax-irradiated animals died. All rats whose thoraxes received 25 Gy irradiation and three out of seven rats whose thoraxes received 20 Gy died 1 to 3 months postirradiation with massive pleural fluid accumulation. Shielding the thoraxes prevented this mode of death at these doses. Kidney injury was judged to be the primary cause of death of all thorax-shielded animals and 15- and 20-Gy thorax-irradiated animals. Animals with kidney damage had elevated PUN and reduced 51Cr-EDTA clearance and hematocrits. The relative merits of each of these end points in assessing radiation-induced kidney injury after total-body exposure are discussed

  14. Attenuation of Acute Lung Inflammation and Injury by Whole Body Cooling in a Rat Heatstroke Model

    Hsi-Hsing Yang

    2009-01-01

    Full Text Available Whole body cooling is the current therapy of choice for heatstroke because the therapeutic agents are not available. In this study, we assessed the effects of whole body cooling on several indices of acute lung inflammation and injury which might occur during heatstroke. Anesthetized rats were randomized into the following groups and given (a no treatment or (b whole body cooling immediately after onset of heatstroke. As compared with the normothermic controls, the untreated heatstroke rats had higher levels of pleural exudates volume and polymorphonuclear cell numbers, lung myloperoxidase activity and inducible nitric oxide synthase expression, histologic lung injury score, and bronchoalveolar proinflammatory cytokines and glutamate, and PaCO2. In contrast, the values of mean arterial pressure, heart rate, PaO2, pH, and blood HCO3− were all significantly lower during heatstroke. The acute lung inflammation and injury and electrolyte imbalance that occurred during heatstroke were significantly reduced by whole body cooling. In conclusion, we identified heat-induced acute lung inflammation and injury and electrolyte imbalance could be ameliorated by whole body cooling.

  15. The acute effects of conventional, complex, and contrast protocols on lower-body power.

    Talpey, Scott W; Young, Warren B; Saunders, Natalie

    2014-02-01

    This study compared conventional, complex, and contrast protocols on peak power (PP) output. Static vs. dynamic contractions were also manipulated to determine the effect of these confounding variables. Eighteen recreationally trained men [age, 21.1 ± 3.3 years; body mass, 81.7 ± 15.9 kg; height, 182.8 ± 6.2 cm; 5 repetition maximum (5RM) half back squat, 119.2 ± 25.4 kg; 5RM/BW, 1.5 ± 0.2 kg] involved in sports including Australian Rules football, basketball, soccer, and rugby participated in this investigation. Five protocols were executed in a randomized order, a conventional protocol in which 3 sets of 4 countermovement jumps (CMJs) were performed 2 minutes apart. Contrast protocols using a heavy resistance conditioning action of either 4 repetitions with a 5RM load or a 5-second static back squat were alternated with sets of 4 CMJs. Complex conditions with 3 sets of 4 repetitions of a 5RM back squat or a 5-second static back squat were performed before the 3 sets of CMJs. In all conditions, 4 minutes of rest followed sets of heavy resistance exercises and 2 minutes of rest followed each set of CMJs. Individual set means and a total session mean were calculated from each CMJ performed during the session. Results showed that the conventional protocol produced significantly greater PP than all conditions except for the dynamic complex and the static contrast. Results suggest that the use of the complex and contrast protocols used in this investigation should not be used for acute increases in lower-body PP in recreationally trained individuals. PMID:23689340

  16. ACUTE EFFECTS OF SELF-SELECTED REGIMEN OF RAPID BODY MASS LOSS IN COMBAT SPORTS ATHLETES

    Jaan Ereline

    2008-06-01

    Full Text Available The purpose of the study was to assess the acute effects of the self-selected regimen of rapid body mass loss (RBML on muscle performance and metabolic response to exercise in combat sports athletes. Seventeen male athletes (20.8 ± 1.0 years; mean ± SD reduced their body mass by 5.1 ± 1.1% within 3 days. The RBML was achieved by a gradual reduction of energy and fluid intake and mild sauna procedures. A battery of tests was performed before (Test 1 and immediately after (Test 2 RBML. The test battery included the measurement of the peak torque of knee extensors for three different speeds, assessment of total work (Wtot performed during a 3-min intermittent intensity knee extension exercise and measurements of blood metabolites (ammonia, lactate, glucose and urea. Absolute peak torque was lower in Test 2 compared with Test 1 at angular velocities of 1.57 rad·s-1 (218.6 ± 40.9 vs. 234.4 ± 42.2 N·m; p = 0.013 and 3.14 rad·s-1 (100.3 ± 27.8 vs. 111.7 ± 26.2 N·m; p = 0.008. The peak torque in relation to body mass remained unchanged for any speed. Absolute Wtot was lower in Test 2 compared with Test 1 (6359 ± 2326 vs. 7452 ± 3080 J; p = 0.003 as well as Wtot in relation to body mass (89.1 ± 29.9 vs. 98.6 ± 36.4 J·kg-1; p = 0.034, respectively. As a result of RBML, plasma urea concentration increased from 4.9 to 5.9 mmol·l-1 (p = 0.003. The concentration of ammonia in a post-test sample in Test 2 tended to be higher in comparison with Test 1 (80.9 ± 29.1 vs. 67.6 ± 26.5 mmol·l-1; p = 0.082. The plasma lactate and glucose responses to exercise were similar in Test 1 and Test 2. We conclude that the self-selected regimen of RBML impairs muscle performance in 3-min intermittent intensity exercise and induces an increase in blood urea concentration in experienced male combat sports athletes

  17. RELATIVE TOTAL BODY FAT AND SKINFOLD PATTERNING IN FILIPINO NATIONAL COMBAT SPORT ATHLETES

    Luigi T. Bercades

    2006-07-01

    Full Text Available The purpose of this study was to assess relative total body fat and skinfold patterning in Filipino national karate and pencak silat athletes. Participants were members of the Philippine men's and women's national teams in karate (12 males, 5 females and pencak silat (17 males and 5 females. In addition to age, the following anthropometric measurements were taken: height, body mass, triceps, subscapular, supraspinale, umbilical, anterior thigh and medial calf skinfolds. Relative total body fat was expressed as sum of six skinfolds. Sum of skinfolds and each individual skinfold were also expressed relative to Phantom height. A two-way (Sport*Gender ANOVA was used to determine the differences between men and women in total body fat and skinfold patterning. A Bonferroni-adjusted alpha was employed for all analyses. The women had a higher proportional sum of skinfols (80.19 ± 25.31 mm vs. 51.77 ± 21.13 mm, p = 0. 001, eta2 = 0.275. The men had a lower proportional triceps skinfolds (-1.72 ± 0.71 versus - 0.35 ± 0.75, p < 0.001. Collapsed over gender, the karate athletes (-2.18 ± 0.66 had a lower proportional anterior thigh skinfold than their pencak silat colleagues (-1.71 ± 0.74, p = 0.001. Differences in competition requirements between sports may account for some of the disparity in anthropometric measurements

  18. The measurement of total body water (TBW) by GC/MS

    Equlibrium speeds of D2O administered orally in 5 normal adults were measured with the technique of self-chemical ionization on GC/MS. The variations of D2O in serum, urine and saliva were compared too. The total body water (TBW) in 6 normal Chinese adults were determined according to the average dilution in the saliva at 2.5, 3 and 3.5 hours after D2O intake at the dosage of 0.6 g/kg body weight

  19. Technical modifications in hyperfractionated total body irradiation for T-lymphocyte deplete bone marrow transplant

    The Medical College of Wisconsin implemented a major bone marrow transplant (BMT) program in July 1985. The type of transplants to be focused on were allogeneic T-lymphocyte deplete. Total body irradiation (TBI) was initially patterned after the Memorial method. Patients received total body irradiation in a sitting position at a dose rate of 20-25 cGy/minute with 50% attenuation lung blocks used both anterior/posterior and posterior/anterior. Electron boosting was utilized for the ribs beneath the lung blocks. Occasionally, lower extremity boosting was required because of the sitting position. A dose of 14 Gy was chosen since T-lymphocyte deplete bone marrow transplant data suggest the need for higher total doses to consistently obtain engraftment. This dose was given in 3 equal daily fractions over 3 days following conditioning chemotherapy. Six of 11 patients treated in this manner developed lethal pulmonary events. In response to the pulmonary toxicity, partial lung shielding was increased to 60% attenuation. In the next 107 patients receiving this program of total body irradiation there was a reduced incidence of fatal pulmonary events (10 cases of fatal idiopathic interstitial pneumonitis and 12 cases of fatal pulmonary infections) after a median follow-up of 9 months. This was an obvious improvement over the initial group. A significant level of hepato-renal toxicity was also observed with 14 Gy total body irradiation when no liver or kidney blocking was used. Of the first 20 patients treated, three cases of fatal veno-occlusive disease resulted. Subsequently, a 10% attenuation right sided liver block was added. Five of 98 patients treated with this block have developed fatal hepatic dysfunction, (median follow-up of 7.2 months)

  20. Immunologic changes after loco-regional radiotherapy and fractionated total body irradiation (TBI) in mice

    The immunologic effects of fractionated irradiation to both hind limbs and the tail of adult mice were investigated. A dose of 34 Gy given in 17 fractions of 2 Gy, 1 fraction per day, 5 days per week, was delivered with a 60Co source. A significant decrease of the total splenocyte count and of the PHA(phytohemagglutinin)-induced proliferation of T cells was found immediately after irradiation. Both parameters normalized within 30 days after irradiation. Immediately after irradiation, the MLC (mixed lymphocyte culture) was supranormal, dropped to 45% 1 week later, and normalized within 1 month after radiotherapy. The NK (natural killer) activity was significantly decreased only the first week after loco-regional irradiation, while the LAK (lymphokine activated killer) activity was not altered at all. The percentage of goat-anti-mouse+ cells (mainly B lymphocytes) was not changed immediately after loco-regional irradiation, but rose to supranormal values (175% of control level) 3 months after irradiation. A persistent decrease of the percentage and the absolute numbers of the Lyt2+ cells (= CD8+ cells, suppressor/cytotoxic phenotype) was observed up to 3 months after irradiation, while the percentage of L3T4+ cells (= CD4+ cells, helper phenotype) remained normal for the total follow-up. No differences in allogeneic skin graft survival could be demonstrated between irradiated and control animals. The observed immunological effects could not be explained by the scatter irradiation to the whole body as total body irradiation (TBI) administered in a dose and dose rate similar to the scatter dose did not result in persistent immunologic changes. No dose-rate effect could be demonstrated in a low dose fractionated total body irradiation schedule. A total body irradiation similar to the scatter dose in humans did not result in significant immunologic changes

  1. Prediction of extracellular water and total body water by multifrequency bio-electrical impedance in a Southeast Asian population

    Guricci, S.; Hatriyanti, Y.; Hautvast, J.G.A.J.; Deurenberg, P.

    1999-01-01

    Three different adult Indonesian population groups living on Sumatra (Palembang), Java (Depok) and Sulawesi (Makale) participated in a study on body composition. Body weight, body height and multifrequency bioelectrical impedance (1, 5, 50 and 100 kHz) were measured and in addition total body water

  2. Acute Colonic Pseudo-Obstruction (Ogilvie's Syndrome) Following Total Laparoscopic Hysterectomy.

    Cebola, Monique; Eddy, Eliza; Davis, Suzanne; Chin-Lenn, Laura

    2015-01-01

    Rapid identification of acute colonic pseudo-obstruction (ACPO), or Ogilvie's syndrome, is paramount in the management of this condition, which, if unresolved, can progress to bowel ischemia and perforation with significant morbidity and mortality. We present the first case report, to our knowledge, of ACPO following total laparoscopic hysterectomy. We describe the presentation and management of ACPO in a patient who underwent uncomplicated total laparoscopic hysterectomy to treat menorrhagia and dysmenorrhea after declining conservative treatment. Following initial conservative management, the patient rapidly deteriorated and required laparotomy for clinically suspected cecal ischemia. Cecal resection, colonic decompression, and end ileostomy formation were performed. A brief review of the current literature is presented with respect to the case report. PMID:26164536

  3. Optimum combination of targeted 131I and total body irradiation for treatment of disseminated cancer

    Purpose: Radiobiological modeling was used to explore optimum combination strategies for treatment of disseminated malignancies of differing radiosensitivity and differing patterns of metastatic spread. The purpose of the study was to derive robust conclusions about the design of combination strategies that incorporate a targeting component. Preliminary clinical experience of a neuroblastoma treatment strategy, which is based upon general principles obtained from modelling, is briefly described. Methods and Materials: The radiobiological analysis was based on an extended (dose-rate dependent) formulation of the linear quadratic model. Radiation dose and dose rate for targeted irradiation of tumors of differing size was in part based on microdosimetric considerations. The analysis was applied to several tumor types with postulated differences in the pattern of metastatic spread, represented by the steepness of the slope of the relationship between numbers of tumors present and tumor diameter. The clinical pilot study entailed the treatment of five children with advanced neuroblastoma using a combination of 131I metaiodobenzylguanidine (mIBG) and total body irradiation followed by bone marrow rescue. Results: The theoretical analysis shows that both intrinsic radiosensitivity and pattern of metastatic spread can influence the composition of the ideal optimum combination strategy. High intrinsic radiosensitivity generally favors a high proportion of targeting component in the combination treatment, while a strong tendency to micrometastatic spread favors a major contribution by total body irradiation. The neuroblastoma patients were treated using a combination regimen with an initially low targeting component (2 Gy whole body dose from targeting component plus 12 Gy from total body irradiation). The treatment was tolerable and resulted in remissions in excess of 9 months in each of these advanced neuroblastoma patients. Conclusions: Radiobiological analysis, which

  4. Calibration of a total body potassium monitor with an anthropomorphic phantom

    Hansen, R. D.; Allen, B. J.

    1996-11-01

    An anthropomorphic phantom was used to calibrate a supine geometry sodium iodide total body potassium monitor. Correction factors accommodating variability in subject size were empirically determined. Measurements on 12 males of weight 45 - 96 kg, height 161 - 184 cm and 18 females of weight 48 - 89 kg, height 153 - 175 cm, showed that the calibration factor was significantly correlated (r = 0.88, p , indicating comparable accuracy to -based calibration procedures. Fat-free mass determined from the potassium measurements of 16 subjects correlated significantly with fat-free mass estimated from skinfold thickness (r = 0.98, p bioimpedance analysis (r = 0.98, p -based methods of calibrating total body potassium monitors.

  5. Calibration of a total body potassium monitor with an anthropomorphic phantom

    An anthropomorphic phantom was used to calibrate a supine geometry sodium iodide total body potassium monitor. Correction factors accommodating variability in subject size were empirically determined. Measurements on 12 males of weight 45-96 kg, height 161-184 cm and 18 females of weight 48-89 kg, height 153-175 cm, showed that the 40K calibration factor (F,countss-1(gofpotassium)-1 was significantly correlated (r=0.88, p0.5, indicating comparable accuracy to 42K-based calibration procedures. Fat-free mass determined from the potassium measurements of 16 subjects correlated significantly with fat-free mass estimated from skinfold thickness (r=0.98, p42K-based methods of calibrating total body potassium monitors. (author)

  6. Calibration of a total body potassium monitor with an anthropometric phantom

    Full text: An anthropomorphic phantom was used to calibrate a supine geometry sodium iodide total body potassium monitor. Correction factors accommodating variability in subject size were empirically determined. Measurements on 10 males of weight 59-96 kg, height 161-184 cm and 12 females of weight 58-89 kg, height 153-175 cm, showed that the 40K calibration factor [F counts s-1 (g of potassium)-1] was significantly correlated (r=0.82, p0.5, indicating comparable accuracy to 42K-based calibration procedures. Fat-free mass determined from the potassium measurements of 16 subjects correlated significantly with fat-free mass estimated from skinfold thickness (r=0.98, p42K-based methods of calibrating total body potassium monitors

  7. Calibration of a total body potassium monitor with an anthropomorphic phantom.

    Hansen, R D; Allen, B J

    1996-11-01

    An anthropomorphic phantom was used to calibrate a supine geometry sodium iodide total body potassium monitor. Correction factors accommodating variability in subject size were empirically determined. Measurements on 12 males of weight 45-96 kg, height 161-184 cm and 18 females of weight 48-89 kg, height 153-175 cm, showed that the 40K calibration factor (F, counts s-1 (g of potassium)-1) was significantly correlated (r = 0.88, p bioimpedance analysis (r = 0.98, p < 0.0001). These data, together with the precision (coefficient of variation, CV = 1.5%) and accuracy (CV = 4.5%) of the system, indicate that this calibration procedure represents a relatively low-cost, non-invasive alternative to 42K-based methods of calibrating total body potassium monitors. PMID:8938038

  8. The effects of 3Gy total body irradiation on mouse intestinal intraepithelial lymphocytes' number and functions

    To explore the characteristics of intestinal mucosal immunity after radiation injury, IEL number, proliferation activity, cytotoxic activity as well as the TNF-α and TGF-β concentrations of supernatant of cultured IEL were studied using IEL freshly isolated from whole small intestine of Kunming strain mice received 3Gy total body 60Co γ-ray irradiation. The proliferation activity, cytotoxic activity as well as the number of IEL in small intestinal mucosa were significantly decreased at 8h post-irradiation, reaching lowest level at 72h. The TNF-α and TGF-β concentrations of supernatant of cultured IEL isolated from irradiated mice were elevated at 8h, reaching peak at 72h. The decrease in number and functions of IEL may play an important role in the damage intestinal mucosal immunity barrier after total body irradiation

  9. Total and regional body-composition changes in early postmenopausal women

    Wang, Q; Hassager, C; Ravn, Pernille;

    1994-01-01

    Total and regional body composition were measured in 373 early postmenopausal women aged 49-60 y by dual-energy x-ray absorptiometry to evaluate whether the changes in body composition in the early postmenopausal years are related to menopause itself or merely to age. Both fat mass and fat...... distribution correlated with age (r = 0.12-0.21, P < 0.05-P < 0.001), but not with years since menopause (YSM). Lean tissue mass, on the other hand, decreased with YSM (r = -0.17, P < 0.001) but was not related significantly to age. Total body bone mineral density decreased with both YSM (r = -0.30, P < 0.......001) and age (r = -0.21, P < 0.001). Our study suggests that postmenopausal changes in body fat and fat distribution are more dependent on age than on menopause, but we cannot exclude a separate effect of the menopause. Changes in fat-free mass, including a postmenopausal decline in both soft lean tissue...

  10. The Effect of Inflated Backrest Stiffness on Shearing Loads Estimated with Articulated Total Body

    Scurlock, Bob J; Borsa, Paul A

    2013-01-01

    In the construction of simulations of rear-end vehicle impacts, the Articulated Total Body (ATB) software package can be a useful tool. In this article we discuss the effect of using artificially inflated values for seat-backrest stiffness in ATB simulations. We will also present methods for quickly assessing the quality of simulation results. In this connection, we will discuss the perils of using the default contact-force models that are included in ATB package releases.

  11. Radiophosphate visualization of the foreign body reaction to wear debris from total knee prosthesis

    Three patients with total knee arthroplasties, in which the tibial and patellar articulating surfaces consisted of a polyethylene-carbon fiber composite, demonstrated technetium-99m methylene diphosphonate (MDP) deposition in the intraarticular space, whereas, the gallium-67 citrate images were normal. This was shown to be due to a synovial giant cell foreign body reaction to particulate carbon fiber debris in one patient who required surgical revision of the prosthesis

  12. The physiology and biochemistry of total body immobilization in animals: A compendium of research. [bibliographies

    Dorchak, K. J.; Greenleaf, J. E.

    1976-01-01

    Major studies that describe the physiological and biochemical mechanisms which operate during total body restraint (confinement in cages for example) are presented. The metabolism and behavior of various animals used in medical research (dogs, monkeys, rats, fowl) was investigated and wherever possible a detailed annotation for each study is provided under the subheadings: (a) purposes, (b) procedures and methods, (c) results, and (d) conclusions. Selected references are also included.

  13. Increased body mass index is a predisposition for treatment by total hip replacement

    Jacobsen, Steffen; Sonne-Holm, Stig

    2005-01-01

    We investigated the radiological and epidemiological data of 4,151 subjects followed up from 1976 to 2003 to determine individual risk factors for hip osteoarthritis (OA), hip pain and/or treatment by total hip replacement (THR). Pelvic radiographs recorded in 1992 were assessed for evidence of hip-joint degeneration and dysplasia. Sequential body mass index (BMI) measurements from 1976 to 1992, age, exposure to daily lifting and hip dysplasia were entered into logistic regression analyses. T...

  14. Clinical pharmacokinetics of intravenous ethanol : Relationship between the ethanol space and total body water

    Norberg, Åke

    2001-01-01

    Introduction: Total body water (TBW) is an important parameter in pathological states where the normal regulation of fluid balance is impaired (e.g., during critical illness, congestive heart failure, bum injury and renal insufficiency). Dilution of water isotopes, such as deuterium oxide (D2O), is considered die gold standard method for measuring TBW in humans. However this procedure requires skilled staff, expensive equipment and the results are seldom available in a timel...

  15. Late effects on gonadal function of cyclophosphamide, total-body irradiation, and marrow transplantation

    One hundred thirty-seven patients had gonadal function evaluated 1-11 years after marrow transplantation. All 15 women less than age 26 and three of nine older than age 26 who were treated with 200 mg/kg cyclophosphamide recovered normal gonadotropin levels and menstruation. Five have had five pregnancies resulting in three live births, one spontaneous abortion, and one elective abortion. Three of 38 women who were prepared with 120 mg/kg cyclophosphamide and 920-1200 rad total-body irradiation had normal gonadotropin levels and menstruation. Two had pregnancies resulting in one spontaneous and one elective abortion. Of 31 men prepared with 200 mg/kg cyclophosphamide, 30 had normal luteinizing hormone levels, 20 had normal follicle-stimulating hormone levels, and 10 of 15 had spermatogenesis. Four have fathered five normal children. Thirty-six of 41 men prepared with 120 mg/kg cyclophosphamide and 920-1750 rad total-body irradiation had normal luteinizing hormone levels, ten had normal follicle-stimulating hormone levels, and 2 of 32 studied had spermatogenesis. One has fathered two normal children. It was concluded that cyclophosphamide does not prevent return of normal gonadal function in younger women and in most men. Total-body irradiation prevents return of normal gonadal function in the majority of patients

  16. Estimation of total body potassium in the presence of interfering radio isotopes

    A whole body counter employing a 32 4'' x 4'' x 16'' single-crystal NaI(T1) detectors has been assembled and used to monitor total body potassium-40 (TBK-40) emissions from subjects participating in mineral bioavailability studies. The system calibration has been performed daily by counting 4 Na-22 sources and having a computer-controlled power supply set the voltage on each photomultiplier tube so that the centroid of the 1.275 MeV photopeak, observed by each detector, occurred at a designated channel in the computer-based multichannel pulse height analyzer. The total net Na-22 counts from the 32 detectors has been recorded as a stability check, and when the 1n of the daily total count was plotted as a function of time, a straight line was observed (r = 0.998) with a slope of -0.00072 d-1 +/- 0.000004 d-1. This system has been designed to estimate corrected gamma ray activity, independent of radionuclide distribution and body size, and to use matrix inversion to estimate activities from a number of isotopes having overlapping gamma ray spectra

  17. Rapid total body fat measurement by magnetic resonance imaging: quantification and topography

    Purpose: To evaluate a rapid and comprehensive MR protocol based on a T1-weighted sequence in conjunction with a rolling table platform for the quantification of total body fat. Materials and Methods: 11 healthy volunteers and 50 patients were included in the study. MR data was acquired on a 1.5-T system (Siemens Magnetom Sonata). An axial T1-weighted flash 2D sequence (TR 101, TE 4.7, FA 70, FOV 50 cm, 205 x 256 matrix, slice thickness: 10 mm, 10 mm interslice gap) was used for data acquisition. Patients were placed in a supine position on a rolling table platform capable of acquiring multiple consecutive data sets by pulling the patient through the isocenter of the magnet. Data sets extending from the upper to lower extremities were collected. The images were analyzed with respect to the amount of intraabdominal, subcutaneous and total abdominal fat by semi-automated image segmentation software that employs a contour-following algorithm. Results: The obtained MR images were able to be evaluated for all volunteers and patients. Excellent correlation was found between whole body MRI results in volunteers with DEXA (r2 = 0.95) and bioimpedance (r2 = 0.89) measurements, while the correlation coefficient was 0.66 between MRI and BMI, indicating only moderate reliability of the BMI method. Variations in patients with respect to the amount of total, subcutaneous, and intraabdominal adipose tissue was not related to standard anthropometric measurements and metabolic lipid profiles (r2 = 0,001 to 0.48). The results showed that there was a significant variation in intraabdominal adipose tissue which could not be predicted from the total body fat (r2 = 0.14) or subcutaneous adipose tissue (r2 = 0.04). Although no significant differences in BMI could be found between females and males (p = 0.26), females showed significantly higher total and subcutaneous abdominal adipose tissue (p < 0.05). Conclusion. (orig.)

  18. A Case Report: An Acute Thrombus in the Femoral Artery following Total Hip Arthroplasty

    GBS, Varun; N, Muralidhar; Bharathidasan, Kavya

    2016-01-01

    Introduction: Vascular complications post-operative to a total hip arthroplasty are a very rare phenomenon. Only a few isolated cases have been reported to date. Diagnosis of such a case in a timely manner so as to preserve the limb is also difficult due to the subtle signs with which the patient presents. We report a case of complete occlusion of the common femoral artery following total hip arthroplasty due to acute thrombus formation. Case Presentation: A 56 year old Indian male patient underwent a cemented total hip replacement. Three hours post-operatively, the patient’s left lower limb was found to be pale and pulseless. Angiography showed complete occlusion of the left common femoral artery. Thrombectomy was carried out immediately and the patient recovered well. Conclusion: Vascular injuries are highly unusual findings following a total hip arthroplasty. Careful pre-operative and immediate post-operative monitoring of the patient is essential. Signs such as limb ischemia, absence of pulses, etc. must be recognized as early as possible and the necessary investigations and procedures should be carried out without any delay. PMID:27299128

  19. Total Hg and methyl Hg distribution in sediments of selected Louisiana water bodies.

    Delaune, Ronald D; Gambrell, Robert P; Devai, Istvan; Jugsujinda, Aroon; Kongchum, Manoch

    2009-05-01

    Sediment samples (543) collected from selected Louisiana streams and lakes were analyzed for total Hg and methyl Hg content. The average total Hg content among 543 samples was 92.3 +/- 95.1 microg kg(-1). The average methyl Hg content in the samples was 0.68 +/- 0.80 microg kg(-1). Methyl Hg accounted for an average of 0.73% of the total Hg in sediment. Linear regression analysis of total Hg versus methyl Hg content of the sediment showed methyl Hg content was significantly correlated to total Hg content of sediment (P > 0.01, n = 537) and sediment organic matter content. (P > 0.01, n = 536) Methyl Hg was also positively correlated to clay (P > 0.01, n = 537) and inversely correlated to sand content of sediment (P > 0.01, n = 537). Total Hg and methyl Hg content in these sediments was within the normal range reported elsewhere indicating no significant industrial or municipal Hg contamination. A comparison of selected water bodies with fishing advisories showed no relationship to total Hg and methyl Hg in sediment. PMID:19337918

  20. Professional Soccer Player Neuromuscular Responses and Perceptions to Acute Whole Body Vibration Differ from Amateur Counterparts

    Ross Cloak, Andrew Lane, Matthew Wyon

    2016-03-01

    Full Text Available Acute whole body vibration (WBV is an increasingly popular training technique amongst athletes immediately prior to performance and during scheduled breaks in play. Despite its growing popularity, evidence to demonstrate its effectiveness on acute neuromuscular responses is unclear, and suggestions that athlete ability impacts effectiveness warrant further investigation. The purpose of this study was to compare the neuromuscular effects of acute WBV and perceptions of whether WBV is an effective intervention between amateur and professional soccer players. Participants were 44 male soccer players (22 professional and 22 amateur; age: 23.1 ± 3.7 years, body mass: 75.6 ± 8.8 kg and height: 1.77 ± 0.05 m. Participants in each group were randomly assigned to either an intervention of 3 x 60 s of WBV at 40 Hz (8mm peak-to-peak displacement or control group. Peak knee isometric force, muscle activation and post activation potentiation (PAP of the knee extensors along with self-report questionnaire of the perceived benefits of using the intervention were collected. A three-way ANOVA with repeated measures revealed professional players demonstrated a significant 10.6% increase (p < 0.01, Partial Eta2 = 0.22 in peak knee isometric force following acute WBV with no significant differences among amateur players. A significant difference (p < 0.01, Partial Eta2 = 0.16 in PAP amongst professional players following acute WBVT was also reported. No significant differences amongst amateur players were reported across measurements. Results also indicated professional players reported significantly stronger positive beliefs in the effectiveness of the WBV intervention (p < 0.01, Partial Eta2 = 0.27 compared to amateur players. Acute WBV elicited a positive neuromuscular response amongst professional players identified by PAP and improvements in knee isometric peak force as well as perceived benefits of the intervention, benefits not found among amateur players.

  1. The distribution of mesenchymal stem cells after total-body irradiation in rats

    Objective: To detect the distribution of mesenchymal stem cells(MSCs) after total-body irradiation in rats. Methods: MSCs were cultured and labeled with green fluorescent protein(GFP). Rats were exposed to total-body irradiation(TBI) or TBI plus total brain irradiation, and then MSCs were injected through the tail vein. The Fluorescent MSCs were observed by fluorescence microscope. The MSCs numbers in different organs were determined by quantitative RT-PCR method. Results: GFP-labeled MSCs were obtained. After MSCs were infused to the rats, few of them were observed in the organs of nonirradiated group except for a very low number in the lungs ,bone marrow(BM) and spleen. TBI of 6 Gy increased the engraftment of MSCs in almost all the organs, especially in early response tissues such as the small intestine and BM. TBI of 7 Gy further increased the number of MSCs. The MSCs numbers in the brain and other organs were significantly increased after 20 Gy total brain irradiation in addition to 6 Gy TBI. Conclusions: Radiation injury can induce the aggregation of MSCs. With the increase of radiation dose and severity of radiation injury, a significant increase of MSCs in different organs were observed. Local irradiation can increase the MSCs distribution in the radiation field as well as other organs. (authors)

  2. Acute Effects of Whole Body Vibration on Inhibition in Healthy Children

    Anne E den Heijer; Groen, Yvonne; Anselm B M Fuermaier; van Heuvelen, Marieke J. G.; van der Zee, Eddy A.; Tucha, Lara; Tucha, Oliver

    2015-01-01

    Objectives Whole Body Vibration (WBV) is a passive exercise method known to have beneficial effects on various physical measures. Studies on adults furthermore demonstrated beneficial effects of WBV treatment on cognition (e.g. inhibition). The present study replicated these findings in healthy children and examined acute effects of WBV treatment on inhibition. Methods Fifty-five healthy children (aged 8–13) participated in this within-subject design study. WBV treatment was applied by having...

  3. Actual versus ideal body weight for acute kidney injury diagnosis and classification in critically Ill patients

    Thongprayoon, Charat; Cheungpasitporn, Wisit; Akhoundi, Abbasali; Ahmed, Adil H.; Kashani, Kianoush B

    2014-01-01

    Background In the current acute kidney injury (AKI) definition, the urine output (UO) criterion does not specify which body weights (BW), i.e. actual (ABW) versus ideal (IBW), should be used to diagnose and stage AKI, leading to heterogeneity across research studies. Methods This is a single center, retrospective, observational study conducted at a tertiary referral hospital. All adult patients who were admitted to intensive care units (ICUs) at our institution for a minimum of 6 continuous h...

  4. Allogeneic bone marrow transplantation with conditioning regimen to total body irradiation + thiotepa + melphalan for 35 patients with high-risk leukemia

    Thirty-five children with high-risk leukemia received an allogeneic bone marrow transplantation (BMT) following a pre-conditioning regimen consisting of total body irradiation, thiotepa and melphalan. Twenty-one patients had acute lymphocytic leukemia, 6 acute nonlymphocytic leukemia, 2 acute undifferentiated leukemia, 2 acute mixed lineage leukemia, 2 myelodysplastic syndrome and 2 juvenile chronic myeloid leukemia. Sixteen patients received BMT while in complete remission (CR), but 19 were not in CR. Eighteen patients received transplants from HLA-matched related donors, 15 from unrelated donors and 2 from HLA-mismatched related donors. Cyclosporin±methotrexate was used for graft-versus-host disease (GVHD) prophylaxis in the BMTs from related donors and tacrolimus±prednisolone in the BMTs from unrelated donors. Transplant-related death occurred in 12 patients; 5 acute GVHD, 4 infections (3 fungal infections, 1 Cytomegalovirus pneumonia), 1 intracranial haemorrhage and 2 chronic GVHD. Relapses were observed in 6 patients (69, 168, 175, 222, 275 and 609 days post BMT). Event-free survival rate at 2 years is 38.1% in CR patients and 36.9% in nonCR patients. (author)

  5. Allogeneic bone marrow transplantation with conditioning regimen to total body irradiation + thiotepa + melphalan for 35 patients with high-risk leukemia

    Yumura-Yagi, Keiko; Inoue, Masami; Okamura, Takayuki [Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi (Japan)] [and others

    1997-06-01

    Thirty-five children with high-risk leukemia received an allogeneic bone marrow transplantation (BMT) following a pre-conditioning regimen consisting of total body irradiation, thiotepa and melphalan. Twenty-one patients had acute lymphocytic leukemia, 6 acute nonlymphocytic leukemia, 2 acute undifferentiated leukemia, 2 acute mixed lineage leukemia, 2 myelodysplastic syndrome and 2 juvenile chronic myeloid leukemia. Sixteen patients received BMT while in complete remission (CR), but 19 were not in CR. Eighteen patients received transplants from HLA-matched related donors, 15 from unrelated donors and 2 from HLA-mismatched related donors. Cyclosporin{+-}methotrexate was used for graft-versus-host disease (GVHD) prophylaxis in the BMTs from related donors and tacrolimus{+-}prednisolone in the BMTs from unrelated donors. Transplant-related death occurred in 12 patients; 5 acute GVHD, 4 infections (3 fungal infections, 1 Cytomegalovirus pneumonia), 1 intracranial haemorrhage and 2 chronic GVHD. Relapses were observed in 6 patients (69, 168, 175, 222, 275 and 609 days post BMT). Event-free survival rate at 2 years is 38.1% in CR patients and 36.9% in nonCR patients. (author)

  6. A technique for delivery of total body irradiation for bone marrow transplantation in adults and adolescents

    With the increasing use of bone marrow transplantation for cancer, total body irradiation is becoming a more commonplace procedure in many of the larger centers across the country. The technical difficulties in delivering homogenous doses of radiation to the whole body are significant and involve many factors such as creation of a homogeneous, flat beam of radiation, and dealing with variations in patient thickness and tissue homogeneity, particularly in the lung. In addition, techniques must be used to safely and efficiently deal with patients who are usually very ill and require long treatment times. Although there is often an advantage in terms of dosimetry to using an AP/PA treatment technique, many institutions use parallel opposed lateral beams because of equipment and facility limitations. A technique has been devised that enables total body irradation to be given by an AP/PA technique using equipment available in many radiotherapy departments. Patients are supported in an upright position during treatment by means of a modified harness attached to the ceiling of the treatment room. Lung compensators are fixed to individually fitted vests, allowing the patient moderate amounts of movement during treatment while maintaining the position of the compensator relative to the lungs. Thermoluminiscent dosimeter (TLD) dose measurements in a phantom indicate that this system can deliver accurate and homogeneous doses to lung tissue, while allowing a good degree of patient comfort and safety during the long treatment times that are required

  7. High-energy total body irradiation as preparation for bone marrow transplantation in leukemia patients: treatment technique and related complications

    Purpose: Bone marrow transplantation with conditioning regimens that include total-body irradiation (TBI) is widely used in patients with acute lymphoblastic and acute myelocytic leukemias. The major causes of death in this population are relapse of leukemia, infection, and treatment related complications. Our purpose was to achieve a homogenous radiation dose distribution and to minimize the dose to the lungs, liver, and kidneys so that the incidence of organ injury was reduced. Methods and Materials: Dose to the bone marrow, midplane, and periphery was quantified by use of thermoluminescent detectors in a bone-equivalent tissue phantom. In an effort to reduce the risk of complications, we treated relapsed or refractory leukemia patients with TBI administered in fractionated, parallel opposed large fields with 24 MV photons, using tissue compensation and partial-transmission lung shielding. Tissue toxicities were then determined. Results: Dose quantitation in bone-equivalent and tissue-equivalent phantoms demonstrated that backscatter and pair production interactions adjacent to bone increased the bone marrow dose by 6 to 11%. At an SSD of 400 cm and at patient diameters of 20 to 40 cm, the percent inhomogeneity across the phantom with 24 MV photons was 0 to 0.3%, compared to 4 to 6% for 6 MV photons. End-organ toxicities consisted of clinical interstitial pneumonitis in six patients, idiopathic interstitial pneumonitis in three patients, renal toxicity in seven patients, and veno-occlusive disease of the liver in one patient. Toxicities did not correlate with fractionation schedule. Conclusions: Total-body irradiation administered with 24 MV photons increases the dose deposition in bone marrow through pair production and backscatter interactions occurring in bone. Because percent depth dose increases with SSD, the 24 MV beam is more penetrating at a 400 cm distance than at 100 cm and dose homogeneity is improved with higher energies. Thus, the incidence of

  8. Effect of graded doses of cortisol on total body calcium in rats

    Yasumura, S.; Ellis, K.J.; Fairchild, E.; Brook, D.; Cohn, S.H.

    1976-12-01

    Male rats with an average body weight of 250 g were injected (sc) daily for 4 wk with 0.05, 0.20, 0.75, or 3.00 mg of cortisol acetate. Intact and adrenalectomized control animals were injected daily with 0.1 ml of vehicle (corn oil). Total body calcium (TB/sub Ca/) was measured weekly in each rat by in vivo neutron activation analysis. The gain in body weight of rats treated with 0.75 mg cortisol was significantly less than controls, and the animals treated with 3.00 mg cortisol lost weight. In spite of these differences in body weight, the TB/sub Ca/ of all rats increased to an equal degree from an average of 1.93 g to 2.81 g in 4 wk. In addition, there were no significant differences in tibial ash calcium. However, calcium (mg) per unit length (mm) of tibia was increased in rats treated with the higher doses of cortisol; thus bone density was increased. These results demonstrate that the TB/sub Ca/ increases even when rats are subjected to cortisol. This is explained in part by the normal rate of intestinal calcium absorption in cortisol-treated rats.

  9. Hematological Effects of Total or Partial Irradiation of the Human Body

    Many studies have been devoted to hematological effects of total body irradiation in various animal species, but there are few human data. In addition, the origin of these documents limited value. It is indeed, sometimes accidentally irradiated subjects, including irradiation was not uniform and that the dosimetry performed a posteriori, is random, sometimes irradiated patients or for the treatment of cancer or to suppress immunological reactions so that a transplant of tissue or an organ transplant, and one may wonder if the reactions such subjects are similar to those of normal subjects. Documents valid for partial irradiation of a human body by a single session even fewer and almost all relate to accidental irradiation

  10. Whole spine MRI in the assessment of acute vertebral body trauma

    To determine the incidence and types of multilevel vertebral body injury in association with acute spinal trauma as assessed by whole spine MRI. All acute admissions to a regional spinal injury unit had whole spine MRI carried out, to detect occult vertebral body injury. Two radiologists assessed 127 cases prospectively, over a period of 3 years. All cases had T2-weighted sagittal imaging of the whole spine (where possible using a T2-weighted fat-suppressed sequence), with T1-weighted imaging in both sagittal and axial planes covering the primary injury. The incidence of secondary injury (defined as either bone bruising, wedge compression fracture or burst fracture) was determined and defined by type, site and relationship to the primary injury. Seventy-seven per cent of cases had a secondary injury level. Of these, bone bruising was the commonest but often occurred in combination with secondary wedge compression fracture or burst fracture. MRI detected 27 non-contiguous wedge compression fractures and 16 non-contiguous burst fractures, giving an incidence of secondary level, non-contiguous fracture of approximately 34%. A higher frequency of secondary vertebral body injury may be defined by MRI than has been described in previous studies based on radiographic evaluation of the whole spine. Whole spine MRI in assessment for occult vertebral body fracture enables increased confidence in the conservative or surgical management of patients with severe spinal injury. (orig.)

  11. Dose-effect relationships in total body irradiation on the healing of cutaneous wounds

    冉新泽; 程天民; 林远; 屈纪富; 刘都户; 艾国平; 阎国和; 王文昌; 许汝福

    2003-01-01

    ObjectiveTo study the effects of dosages of total body irradiation on the healing process of cutaneous wounds and to observe the changes of wound area at different periods after injury.star rats. The single dosage varied from 1 to 8 Gy. Within 1 h after irradiation, two whole thickness circular cutaneduced on the back of the animals (combined injury groups). Same wounds were produced on rats with no irradiation (single wound group). Wound healing was observed at different points after injury. ResultsAfter total body irradiation with the dose of 1,2,3,4,5,6, 7 or 8 Gy, the wound healing was obviously retarded as the dosages increased. The wound area remained was larger in the large dosage groups than in the small dosage groups. Seven days after injury, there was 33.5% wound surface left unhealed in the single wound group, whereas in the combined injury groups, 35.4%, 38.1%, 41.6%, 48.8%, 53.9%, 63.7%, 69.2% and 73.9% of the wound surfaces remained unhealed, respectively. Statistical analysis showed marked correlations between the varioustimes after total body irradiation and various dosages to the percentage of unhealed wound surface. Nine dose-effect relation formulae were deduced according to the statistical results.ConclusionsIn soft tissue trauma combined with radiation injury, the delay of wound healingis related to the dose of radiation inflicted. It is also related to the time between injury and time of observation.

  12. Comparison between combination chemotherapy and total body irradiation plus combination chemotherapy in non-Hodgkin's lymphoma

    Thirty-nine untreated patients with either lymphocytic or nodular mixed/nodular histiocytic non-Hodgkin's lymphoma, stage II-IV, were randomized to treatment with total body irradiation (TBI), 100 rads in 10 fractions over 12 days, plus combination chemotherapy with either cyclophosphamide, vincristine and prednisone (CVP) or cyclophosphamide, vincristine, procarbazine and prednisone (C-MOPP) or to treatment with combination chemotherapy (CVP or C-MOPP) alone. Remission rate and duration were comparable for both treatment groups; thus the use of both treatment modalities ab initio provides no therapeutic advantage

  13. Suppression of spontaneous and artificial metastasis by low dose total body irradiation in mice

    We investigated whether low dose total body irradiation (TBI) suppresses metastasis using both artificial and spontaneous lung metastasis in WHT/Ht mice. When mice were irradiated with 15-60 cGy immediately before tumor cell injection into a tail vein in artificial lung metastasis, lung colony formation was suppressed significantly by the TBI, and 20 cGy was the most effective dose. The suppressive effect of 20 cGy TBI lasted for 6 hours. TBI with 15-20 cGy suppressed spontaneous lung metastasis significantly, and 15 cGy was the most effective dose. (author)

  14. Basal Cell Skin Cancer after Total-Body Irradiation and Hematopoietic Cell Transplantation

    Schwartz, Jeffrey L.; Kopecky, Kenneth J.; Robert W. Mathes; Leisenring, Wendy M; Friedman, Debra L.; Deeg, H. Joachim

    2009-01-01

    Previous studies identified radiation therapy as a key modifier of basal cell carcinoma (BCC) risk in survivors of hematopoietic cell transplantation (HCT). In the present analysis, risk of BCC was analyzed in relation to age at transplant, attained age, race, total-body irradiation (TBI), and radiation fractionation in 6,306 patients who received HCT at ages 0–65 years after conditioning regimens with (n = 3870) or without (n = 2436) TBI, and who were followed from 100 days to 36.2 years aft...

  15. Idiopathic interstitial pneumonia following bone marrow transplantation: the relationship with total body irradiation

    Interstitial pneumonia is a frequent and often fatal complication of allogenic bone marrow transplantation. Thirty to 40 percent of such cases are of unknown etiology and have been labelled as cases of idiopathic interstitial pneumonia. Idiopathic cases are more commonly associated with the use of total body irradiation; their occurrence appears to be independent of immunosupression or graft versus host disease. Evidence is presented from the literature suggesting that the development of idiopathic interstitial pneumonia is related to the absolute absorbed dose of radiation to lung. The similarity of idiopathic pneumonia to radiation pneumonitis seen in a different clinical setting is described

  16. Effect of total body irradiation on skeletal growth and cataract formation in rhesus monkey

    The effect of total body irradiation in single doses of 400-950 rad on skeletal growth and the development of lens cataract was investigated in 21 rhesus monkeys. The results suggest that exposure to irradiation before or during adolescent growth in children may lead to bone shortening when doses of 750 rad or higher are concerned, and that treatment of children with TBI in excess of 750 rad - as is sometimes employed in conjunction with bone marrow transplantation for the treatment of leukemia - may carry a strong risk for the subsequent development of cataract formation. (C.F.)

  17. Total energy expenditure and body composition in two free-living sympatric lemurs.

    Bruno Simmen

    Full Text Available BACKGROUND: Evolutionary theories that account for the unusual socio-ecological traits and life history features of group-living prosimians, compared with other primates, predict behavioral and physiological mechanisms to conserve energy. Low energy output and possible fattening mechanisms are expected, as either an adaptive response to drastic seasonal fluctuations of food supplies in Madagascar, or persisting traits from previously nocturnal hypometabolic ancestors. Free ranging ring-tailed lemurs (Lemur catta and brown lemurs (Eulemur sp. of southern Madagascar have different socio-ecological characteristics which allow a test of these theories: Both gregarious primates have a phytophagous diet but different circadian activity rhythms, degree of arboreality, social systems, and slightly different body size. METHODOLOGY AND RESULTS: Daily total energy expenditure and body composition were measured in the field with the doubly labeled water procedure. High body fat content was observed at the end of the rainy season, which supports the notion that individuals need to attain a sufficient physical condition prior to the long dry season. However, ring-tailed lemurs exhibited lower water flux rates and energy expenditure than brown lemurs after controlling for body mass differences. The difference was interpreted to reflect higher efficiency for coping with seasonally low quality foods and water scarcity. Daily energy expenditure of both species was much less than the field metabolic rates predicted by various scaling relationships found across mammals. DISCUSSION: We argue that low energy output in these species is mainly accounted for by low basal metabolic rate and reflects adaptation to harsh, unpredictable environments. The absence of observed sex differences in body weight, fat content, and daily energy expenditure converge with earlier investigations of physical activity levels in ring-tailed lemurs to suggest the absence of a relationship

  18. No relation between body temperature and arterial recanalization at three days in patients with acute ischaemic stroke

    M. Geurts (Marjolein); H.B. Van Der Worp (H. Bart); A.D. Horsch (Alexander D.); L.J. Kappelle (Jaap); G.J. Biessels (Geert Jan); B.K. Velthuis (Birgitta); C.B. Majoie (Charles); Y.B.W.E.M. Roos; L.E.M. Duijm (Lucien); K. Keizer (Koos); A. van der Lugt (Aad); D.W.J. Dippel (Diederik); K.E. Droogh-De Greve; H.P. Bienfait; M.A. van Walderveen (M.); M.J.H. Wermer (Marieke); G.J. Lycklama à Nijeholt (Geert); J. Boiten (Jelis); A. Duyndam (Anita); V.I.H. Kwa; F.J. Meijer (F.); E.J. van Dijk (Ewoud); A.M. Kesselring (Anouk); J. Hofmeijer; J.A. Vos (Jan Albert); W.J. Schonewille (W.); W.J. van Rooij (W.); P.L.M. de Kort (Paul); C.C. Pleiter (C.); S.L.M. Bakker (Stef); J. Bot (Joseph); M.C. Visser (Marieke); I.C. van der Schaaf (Irene); J.W. Dankbaar (Jan); W.P. Mali (Willem); T. van Seeters (Tom); A.D. Horsch (Alexander D.); J.M. Niesten (Joris); G.J. Biessels; L.J. Kappelle; J.S.K. Luitse; Y. van der Graaf (Yolanda)

    2015-01-01

    textabstractBackground: Recanalization of an occluded intracranial artery is influenced by temperature-dependent enzymes, including alteplase. We assessed the relation between body temperature on admission and recanalization. Methods: We included 278 patients with acute ischaemic stroke within nine

  19. Patient-Reported Outcomes Following Total Hip Arthroplasty Stratified by Body Mass Index.

    Wu, Eddie S; Cherian, Jeffrey J; Jauregui, Julio J; Robinson, Kristin; Harwin, Steven F; Mont, Michael A

    2016-05-01

    Obese patients undergoing total hip arthroplasty have been shown to have less functional recovery. This study prospectively compared temporal trends in patient-reported outcomes and activity levels between patients with a body mass index (BMI) of less than 30, 30 to 35, and 35 to 40 kg/m(2) after total hip arthroplasty. Patients were evaluated via the Harris Hip Score, Lower Extremity Activity Scale, and Short Form-12 physical and mental components. The results suggest that patients with BMIs of 35 to 40 kg/m(2) might have poorer functional outcomes preoperatively, with function returning more slowly or poor function being sustained and their not reaching other cohorts' levels. Surgeons must counsel these patients regarding functional expectations and the potential for slower functional returns. [Orthopedics. 2016; 39(3):e572-e577.]. PMID:27064775

  20. Determination of total body fat by tritium dilution. Methodology and relation of the results to the body-mass-index (BMI)

    The tritium dilution method primarily measures the fat-free mass of the total body by equilibration of an oral dose of tritiated water. The radioactivity is measured in a serum sample drawn four hours after tracer application. For these processes a serial precision of VC = 1.7% has been observed. The total body fat is calculated assuming the hydratation constant of the fat-free body to be 73%. 65 female and 142 male patients suffering from metabolic diseases were examined. They represent the whole scale of body composition ranging from 48 to 208 kg of body weight, 18 to 66 kg/m2 of BMI. 2.4 to 98 kg of absolute body fat, and 3.8 to 52% of relative body fat. Normal-weight (BMI from 20 to 25) women have 25% fat and standard weight men have 15% fat. Close relationships of the type F = a + b · W + c · H2 between body fat, body weight, and body height have been found. They allow to detect extreme body compositions. Scientific studies like optimizing of measures of weight reduction need direct assessment of body composition. For this purpose the tritium method is well suited due to its precision whereas the BMI is sufficient for epidemiologic and orienting statements. (author)

  1. Morphological changes of carotid bodies in acute respiratory distress syndrome: a morphometric study in humans

    Vinhaes E.N.G.

    2002-01-01

    Full Text Available Carotid bodies are chemoreceptors sensitive to a fall of partial oxygen pressure in blood (hypoxia. The morphological alterations of these organs in patients with chronic obstructive pulmonary disease (COPD and in people living at high altitude are well known. However, it is not known whether the histological profile of human carotid bodies is changed in acute clinical conditions such as acute respiratory distress syndrome (ARDS. The objective of the present study was to perform a quantitative analysis of the histology of carotid bodies collected from patients who died of ARDS. A morphometric study of carotid bodies collected during routine autopsies was carried out on three groups: patients that died of non-respiratory diseases (controls, N = 8, patients that presented COPD and died of its complications or associated diseases (N = 7, and patients that died of ARDS (N = 7. Morphometric measurements of the volume fraction of clusters of chief cells were performed in five fields on each slide at 40X magnification. The numerical proportion of the four main histological cell types (light, dark, progenitor and sustentacular cells was determined analyzing 10 fields on each slide at 400X magnification. The proportion of dark cells was 0.22 in ARDS patients, 0.12 in controls (P<0.001, and 0.08 in the COPD group. The proportion of light cells was 0.33 (ARDS, 0.44 (controls (P<0.001, and 0.36 (COPD. These findings suggest that chronic and acute hypoxia have different effects on the histology of glomic tissue.

  2. Total-body irradiation in the beginning of the 21 century

    Total-body irradiation (TBI), in combination with intensive chemotherapy, plays an important role in the preparation of patients with hematological diseases for bone-marrow transplantation (BMT). Depending of the total dose applied low- and high-dose TBI is distinguished. The present review is aimed at presenting the accumulated experience so far in the field of the high-dose total-body irradiation with an emphasis on the effect of total dose, dose rate and fractionation on the therapeutic results, the host versus graft reactions as well as some reactions and complications during TBI performance. The indications, aims and priorities of TBI over chemotherapy as a conditioning regime are discussed in detail. The radiobiological bases and the technical and dosimetric requirements for TBI realization are presented. An attempt is made for systematizing the accumulated knowledge so far with respect to effects of total dose, dose rate and fractionation on the therapeutic results, host versus graft reactions, post TBI reactions and complications. High-dose TBI, in combination with chemotherapy, has been acknowledged and widely applied conditioning regime prior to allogeneic BMT in a number of hematological diseases. During the last three decades the performance of TBI treatment varies with respect to the realized total dose (10-16 Gy) as well as to the used radiotherapeutic sources (telegamma therapeutic devices or linear accelerators), the applied techniques (latero-lateral), prone-supine or combinations of both patient positions), the radiation beam modifiers, the lung compensators used, dose rate (2.5-15 cGy/min). Heterogeneous and difficult for systematization data are available at the present stage, which concern the effect of some parameters as realized total dose, dose rate and fractionation on the prognosis for patients with serious hematological diseases subjected to BMT. There are numerous questions concerning their effect on the therapeutic results, host versus

  3. Formation of a large rice body-containing cyst following total hip arthroplasty

    Issack Paul S

    2012-06-01

    Full Text Available Abstract Background There are several well-described causes of a painful mass following total hip arthroplasty including polyethylene and metal wear debris, infection, expanding hematoma, dislocation, and synovial cysts. In addition to causing pain, these lesions, when large enough, may cause neurologic and vascular compromise. Rapid growth of the mass may clinically and radiographically resemble a sarcoma. Here, we report a case of a large painful hip mass which developed after total hip arthroplasty. The well-circumscribed mass was overlying and extending into the hip joint containing thousands of highly organized fibrin-containing “rice bodies”. To our knowledge, this is the first report of a large, highly organized (rice-body-containing cyst complicating total hip arthroplasty. Case presentation A 55-year old Caucasian woman developed a large, slowly enlarging, painful hip mass 2 1/2 years after primary total hip arthroplasty. Clinically and radiographically, the lesion resembled a soft tissue sarcoma. Surgical removal identified a well-circumscribed mass extending into the hip joint containing thousands of highly organized fibrin-containing “rice bodies”. Conclusion Identification and excision of this “pseudotumor” following hip arthroplasty is important for obtaining a definitive diagnosis, ruling out malignancy or infection and relieving any potential compression on surrounding neurovascular structures.

  4. The effect of total body irradiation and bone marrow transplantation during childhood and adolescence on growth and endocrine function

    Seventeen children with acute leukaemia and myeloproliferative disorders were investigated for growth and endocrine dysfunction. All had undergone bone marrow transplantation prepared with cyclophosphamide and single fraction total body irradiation (900-1000 cGy) between 1.5 and 3.8 (mean 2.2) years previously. The majority exhibited growth failure, of multiple aetiology. Ten patients, of whom eight had had previous prophylactic cranial irradiation, had evidence of growth hormone deficiency based on reduced growth hormone reponse to insulin induced hypoglycaemia. Three had evidence of hypothalamic damage. Gonadal failure was common. All four girls of adolescent age (10.6-14.1 years) had ovarian failure requiring sex steroid replacement. Of eight boys of adolescent age (12.3-18.3 years), two had testicular failure requiring sex steroid supplements. Both had had previous testicular irradiation. Five others had compensated gonadal failure; one had normal Leydig cell function. Abnormalities of the TSH response to TRH occurred in 10 patients but only three had overt hypothyroidism. Unlike growth hormone deficiency, gonadal and thyroid dysfunction showed no correlation with previous cranial radiotherapy. (author)

  5. In pediatric leukemia, dose evaluation according to the type of compensators in total body irradiation

    Lee, Dong Yeon [Dongnam Inst. of Radiological and Medical science, Busan (Korea, Republic of); Kim, Chang Soo; Kim, Jung Hoon [Dept. of Radiological Science, College of Health Science, Catholic University of Busan, Busan (Korea, Republic of)

    2015-04-15

    Total body irradiation (TBI) and chemotherapy are the pre-treatment method of a stem cell transplantations of the childhood leukemia. in this study, we evaluate the Quantitative human body dose prior to the treatment. The MCNPX simulation program evaluated by changing the material of the tissue compensators with imitation material of pediatric exposure in a virtual space. As a result, first, the average skin dose with the material of the tissue compensators of Plexiglass tissue compensators is 74.60 mGy/min, Al is 73.96 mGy/min, Cu is 72.26 mGy/min and Pb 67.90 mGy/min respectively. Second, regardless of the tissue compensators material that organ dose were thyroid, gentile, digestive system, brain, lungs, kidneys higher in order. Finally, the ideal distance between body compensator and the patient were 50 cm aparting each other. In conclusion, tissue compensators Al, Cu, Pb are able to replace of the currently used in Plexiglass materials.

  6. Patient dose analysis in total body irradiation through in vivo dosimetry

    K Ganapathy

    2012-01-01

    Full Text Available Total body irradiation (TBI is a special radiotherapy technique, administered prior to bone marrow transplantation. Due to the complex nature of the treatment setup, in vivo dosimetry for TBI is mandatory to ensure proper delivery of the intended radiation dose throughout the body. Lithium fluoride (LiF TLD-100 chips are used for the TBI in vivo dosimetry. Results obtained from the in vivo dosimetry of 20 patients are analyzed. Results obtained from forehead, abdomen, pelvis, and mediastinum showed a similar pattern with the average measured dose from 96 to 97% of the prescription dose. Extremities and chest received a dose greater than the prescription dose in many instances (more than 20% of measurements. Homogeneous dose delivery to the whole body is checked by calculating the mean dose with standard deviation for each fraction. Reasons for the difference between prescription dose and measured dose for each site are discussed. Dose homogeneity within ±10% is achieved using our in-house TBI protocol.

  7. Design considerations for a neutron generator-based total-body irradiator

    The prompt- and delayed-gamma neutron activation techniques have been used for the non-invasive measurement of human body composition. In recent years, neutron irradiators have used only transuranic isotopic sources (238PuBe, 241AmBe, 252Cf). However, in today's security-minded environment, the use of alternate neutron sources may provide some advantages. Several designs for an irradiator that would use a high-output, miniature D-T neutron generator (MF Physics) have been examined. The use of this type of neutron source will lessen the storage, security, and transport issues associated with continuous-output isotopic neutron sources. To determine the scientific impact of this decision, Monte Carlo simulations (MCNP-4B2; Los Alamos National Laboratory) has been performed to aid in the design of the irradiator system, evaluating shielding materials, collimation, and source-to-subject distance, for the measurement of total body nitrogen (TBN). Based on internal flux distributions within the simulated body region of a subject, several design options were identified. The final design will be selected based on the optimization of precision, dose, and exposure time. (author)

  8. Total body irradiation with volumetric modulated arc therapy: Dosimetric data and first clinical experience

    To implement total body irradiation (TBI) using volumetric modulated arc therapy (VMAT). We applied the Varian RapidArc™ software to calculate and optimize the dose distribution. Emphasis was placed on applying a homogenous dose to the PTV and on reducing the dose to the lungs. From July 2013 to July 2014 seven patients with leukaemia were planned and treated with a VMAT-based TBI-technique with photon energy of 6 MV. The overall planning target volume (PTV), comprising the whole body, had to be split into 8 segments with a subsequent multi-isocentric planning. In a first step a dose optimization of each single segment was performed. In a second step all these elements were calculated in one overall dose-plan, considering particular constraints and weighting factors, to achieve the final total body dose distribution. The quality assurance comprised the verification of the irradiation plans via ArcCheck™ (Sun Nuclear), followed by in vivo dosimetry via dosimeters (MOSFETs) on the patient. The time requirements for treatment planning were high: contouring took 5–6 h, optimization and dose calculation 25–30 h and quality assurance 6–8 h. The couch-time per fraction was 2 h on day one, decreasing to around 1.5 h for the following fractions, including patient information, time for arc positioning, patient positioning verification, mounting of the MOSFETs and irradiation. The mean lung dose was decreased to at least 80 % of the planned total body dose and in the central parts to 50 %. In two cases we additionally pursued a dose reduction of 30 to 50 % in a pre-irradiated brain and in renal insufficiency. All high dose areas were outside the lungs and other OARs. The planned dose was in line with the measured dose via MOSFETs: in the axilla the mean difference between calculated and measured dose was 3.6 % (range 1.1–6.8 %), and for the wrist/hip-inguinal region it was 4.3 % (range 1.1–8.1 %). TBI with VMAT provides the benefit of satisfactory dose

  9. Midplane dose determination and verification of calculated doses in total body irradiation

    Özlem ÖZDEMİR

    2014-06-01

    Full Text Available OBJECTIVES To compare calculated and measured doses for different regions of anthropomorphic phantom and patients using ion chamber and thermoluminescence dosimetry (TLD for total body irradiation. METHODS Measurements were done for lateral fields with 6 MV, gantry 82º, 40x40 cm2 field and 400 cm source-axis distance (SAD. Entrance-exit and midline doses were measured on anthropomorphic phantom by TLD and entrance-exit doses were measured by TLD and ion chamber on patients. RESULTS For anthropomorphic phantom measurements differences between calculated and measured entrance-exit doses of head, neck, shoulder, lung and thick pelvis were 0.8%, 2.7%, 26.4%, 4.4% and 4.9% and for midline doses were 1.6%, 1.6%, 6.3%, -1.4% and 7.4% respectively. For patients; TLD differences were within -4.13% ile 6.7%, -3.3% ile 3.9%, 5.1% ile 16.6%, -7.8% ile 2.4%, and 3.6% ile 7.1% respectively. For thick pelvis measurements with ion chamber differences were within %0.1-1.9. CONCLUSION Total body irradiation is being applied in limit values in our clinic.

  10. Effects of total body irradiation on functions of small intestinal intraepithelial lymphocytes

    Objective: To explore the characteristics of intestinal mucosal immunity after gamma irradiation. Methods: The number, proliferation activity, cytotoxic activity of small intestinal intraepithelial lymphocytes (IELs), and the TNF-α and TGF-β concentrations in supernatant of cultured IELs were studied using IELs freshly isolated from whole small intestine of Kunming strain mice after 3,8 and 12 Gy total body 60Co γ-irradiation. Results: (1) The number of IELs in small intestinal mucosa of all irradiated mice significantly decreased at 8 h, reaching the lowest level at 48-72 h post-irradiation, then began to rise, but it still did not return to its normal level on day 15. (2) The proliferation activity and cytotoxic activity of IELs isolated from irradiated mice were reduced sharply. They followed the same pattern of decreasing at 8h, reaching the lowest level at 48-72 h post-irradiation, then began to rise, but it did not return to their normal levels on day 15. (3) The TNF-α and TGF-β concentrations in supernatant of cultured IELs isolated from irradiated mice were elevated at 8h, reaching their peak at 48-72 h. Conclusion: The decrease in number and important functions of IELs is one of the factors damaging the intestinal mucosal immunity barrier after total body irradiation