PubMed Health⌕ Search

Biomedical subjects

L Vlachos

Publications and source records attributed to L Vlachos.

At least 37 records · Page 2Linked to original sources

Dose rate calculations around 192Ir brachytherapy sources using a Sievert integration model.

The classical Sievert integral method is a valuable tool for dose rate calculations around brachytherapy sources, combining simplicity with reasonable computational times. However, its accuracy in predicting dose rate anisotropy around 192Ir brachytherapy sources has been repeatedly put into question. In this work, we used a primary and scatter separation technique to improve an existing modification of the Sievert integral (Williamson's isotropic scatter model) that determines dose rate anisotropy around commercially available 192Ir brachytherapy sources. The proposed Sievert formalism provides increased accuracy while maintaining the simplicity and computational time efficiency of the Sievert integral method. To describe transmission within the materials encountered, the formalism makes use of narrow beam attenuation coefficients which can be directly and easily calculated from the initially emitted 192Ir spectrum. The other numerical parameters required for its implementation, once calculated with the aid of our home-made Monte Carlo simulation code, can be used for any 192Ir source design. Calculations of dose rate and anisotropy functions with the proposed Sievert expression, around commonly used 192Ir high dose rate sources and other 192Ir elongated source designs, are in good agreement with corresponding accurate Monte Carlo results which have been reported by our group and other authors.

Anisotropy↗

Superselective microcoil embolization of a traumatic pseudoaneurysm of the cavernosal artery.

According to the literature, straddle injuries of the perineum may result in arteriosinusoidal fistula and secondary high-flow priapism. We report a case of a 23-year-old man who developed a traumatic pseudoaneurysm of the cavernosal artery, secondary to straddle injury, and presented with painless priapism. It was treated successfully with superselective microcoil embolization and the priapism resolved.

Adult↗

Embolization of a segmental renal artery pseudoaneurysm after partial nephrectomy in a solitary kidney.

Renal pseudoaneurysms are a well-documented complication following trauma or after percutaneous biopsy. When symptomatic, patients present with hematuria and deteriorating renal function. We present the case of a 62-year-old man who, due to development of a pseudoaneurysm, presented with gross hematuria 10 days after partial nephrectomy for a renal cell carcinoma in a single kidney. A segmental artery was embolized with stainless steel coils without significant loss of the limited renal vascularization.

Aneurysm, False↗

A new polymer gel for magnetic resonance imaging (MRI) radiation dosimetry.

New composition polymer gels, the N-vinylpyrrolidone argon (VIPAR) gels, were developed and investigated as MRI dosimeters. VIPAR gels were irradiated in the dose range of 0-12 Gy by a 6 MV x-ray linear accelerator and MR-scanned in a 1.5 T magnetic resonance imager. A linear relationship was found between absorbed dose and spin spin relaxation rate R2. The dose sensitivity was found to be approximately 0.1 s(-1) Gy(-1) for a gel composition of 4% w/w in N-vinylpyrrolidone, 4% w/w in N,N'-methylene-bisacrylamide, 5% w/w in gelatine type A and 87% w/w in water. This dose sensitivity was stable with time and did not deteriorate even when a boost radiation dose of 2.5 Gy was applied 15 days after the first irradiation. Good reproducibility of these results was observed when a new batch of gels was produced and used for corresponding measurements and analysis.

Gels↗

A Monte Carlo investigation of the dosimetric characteristics of the VariSource 192Ir high dose rate brachytherapy source.

An analytical Monte Carlo simulation code, incorporating in detail source construction and dimensions, was used to investigate the dosimetric characteristics of the VariSource 192Ir high dose rate brachytherapy source. Dose-rate constant, radial dose functions, and anisotropy functions, utilized in the AAPM Task Group 43 dose estimation formalism, were calculated with the source centered in a spherical water phantom of 30 cm in diameter. The results, which are in agreement with the corresponding data available in the literature, are compared to those obtained in our previous study for the widely used microSelectron 192Ir high dose-rate brachytherapy source. The dose-rate constant was found to be equal to 1.043 +/- 0.005 cGy h(-1) U(-1) for the VariSource, compared to a value of 1.116 +/- 0.006 cGy h(-1) U(-1) calculated for the microSelectron. Significant differences in the anisotropy of the two sources are observed only for polar angles close to their long axis and are due to their different dimensions.

Anisotropy↗

The real incidence of extracapsular (satellite) cysts of liver echinococcus.

BACKGROUND: The presence of extracapsular (Satellite) cysts in liver echinococcus granulosus is known for many years. In one of our previous studies of radiological (CT) material they were found to be present in 16% of cases. METHODS: In the present study the operative findings, in cases of total capsectomy (cystopericystectomy) or partial lobectomy are presented. RESULTS: The real incidence of these cysts in operative specimens was as high as 29,5%. They were present in 15 out of 51 totally excised cysts. CONCLUSIONS: We conclude that satellite cysts are present more often than they are radiologically detected. As they can be incriminated as a cause of recurrence of the disease they must be excised en block with the main parasitic cysts, by means of more radical procedures such as cystopericystectomy or partial hepatectomy, whenever it is feasible.

Adolescent↗

Comparison of the efficacy and safety of tropisetron, metoclopramide, and chlorpromazine in the treatment of emesis associated with far advanced cancer.

BACKGROUND: A single institution, prospective, randomized trial was performed in terminal cancer patients to compare tropisetron (TRO), metoclopramide (MET), and chlorpromazine (CHL) in the management of nausea and emesis. Patients had far advanced cancer, were far removed from chemotherapy or radiotherapy, and their nausea and emesis was not due to bowel obstruction, drug intake, or cranial, electrolytic, or metabolic causes. The effects of antiemetic treatments were evaluated from Days 1-15. METHODS: Two hundred and eighty patients were randomized to receive 1) MET+ dexamethasone (DEX) (10 mg*4 and 2 mg*1, respectively, orally), 2) TRO (5 mg*1, orally), 3) TRO + MET (5 mg*1 and 10 mg*2, respectively, orally), 4) TRO + MET + DEX (5 mg*1, 10 mg*2, and 2 mg*1, respectively, orally), 5) CHL + DEX (25 mg*2 and 2 mg*1, respectively, orally), 6) TRO + CHL (5 mg*1 and 12.5 mg*2, respectively, orally), or 7) TRO + CHL + DEX (5 mg*1, 12.5 mg*2, and 2 mg*1, respectively, orally). Total control was defined as no nausea or emesis. RESULTS: By the end of the 15th day, total control of emesis was obtained in 23.6% (9 of 38) of MET + DEX patients, 78.9% (30 of 38) of TRO patients, 84.2% (32 of 38) of TRO + MET patients, 92.3% (36 of 39) of TRO + MET + DEX patients, 33.3 (13 of 39) of CHL + DEX patients, 84.6% (33 of 39) of TRO + CHL patients, and 92.5% (37 of 40) of TRO + CHL + DEX patients. Total control of nausea was achieved in 18.4% (7 of 38) of MET + DEX patients, 65.7% (25 of 38) of TRO patients, 73.6% (28 of 38) of TRO + MET patients, 87.1% (34 of 39) of TRO + MET + DEX patients, 17.9% (7 of 39) of CHL + DEX patients, 74.3% (29 of 39) of TRO + CHL patients, and 85% (34 of 40) of TRO + CHL + DEX patients. When comparing MET + DEX versus TRO; MET + DEX versus TRO + MET; MET + DEX versus TRO + MET + DEX; MET + DEX versus TRO + CHL; MET + DEX versus TRO + CHL + DEX; CHL + DEX versus TRO; CHL + DEX versus TRO + MET; CHL + DEX versus TRO + MET + DEX; CHL + DEX versus TRO + CHL; and CHL + DEX versus TRO + CHL + DEX, significant differences were noted. All antiemetic drugs were well tolerated with no severe side effects observed in any treatment arm. CONCLUSIONS: These data suggest that 5-HT3 receptor antagonists such as tropisetron clinically are more effective in the control of emesis of patients with far advanced cancer than previously used agents. This study raises important issues when attempting to decide which antiemetic therapy to choose for an individual patient with far advanced disease.

Adult↗

Comparison of tropisetron and chlorpromazine combinations in the control of nausea and vomiting of patients with advanced cancer.

The single-institution, prospective, randomized trial was performed to evaluate the efficacy of tropisetron and chlorpromazine in the management of nausea and vomiting of terminal cancer patients. Patients had no recent chemotherapy or radiotherapy, and emesis was not due to bowel obstruction, electrolytic or metabolic disturbances, drug intake, or intracranial disease. One hundred and sixty patients randomly received either (a) chlorpromazine (CLO) (50 mg/day) plus dexamethasone (DEX) (2 mg/day), (b) chlorpromazine (25 mg/day) plus tropisetron (TRO) (5 mg/day), (c) chlorpromazine (25 mg/day plus tropisetron (5 mg/day) plus dexamethasone (2 mg/day), or (d) tropisetron (TRO) (5 mg/day). Patients were monitored from day 1 to day 15. No nausea or vomiting was defined as "total" control. On day 15, total vomiting control was achieved in 33.3% of the patients receiving CLO + DEX, 84.6% of the patients receiving CLO + TRO, 92.5% of the patients receiving CLO + TRO + DEX, and 78.9% of the patients receiving TRO. Total control of nausea was achieved in 18.0% of the patients receiving CLO + DEX, 74.4% of the patients receiving (CLO + TRO), 85.0% of the patients receiving CLO + TRO + DEX, and 65.8% of the patients receiving TRO. Tropisetron-containing combinations produced significant control of nausea and vomiting from the third day onward. All antiemetic drugs were well tolerated. These data suggest that tropisetron-containing combinations or tropisetron as a single agent are much more effective in the control of emesis in patients with advanced cancer than the conventional antiemetic combination of chlorpromazine plus dexamethasone. Tropisetron is well tolerated and may be the best choice for controlling persistent nausea and vomiting in terminal cancer patients.

Adult↗

Monte Carlo and TLD dosimetry of an 192Ir high dose-rate brachytherapy source.

An analytical Monte Carlo simulation code has been used to perform dosimetry calculations around an 192Ir high dose-rate brachytherapy source utilized in the widely used microSelectron afterloaded system. Radial dose functions, dose rate constant and anisotropy functions, utilized in the AAPM Task Group 43 dose estimation formalism, have been calculated. In addition, measurements of anisotropy functions using LiF TLD-100 rods have been performed in a polystyrene phantom to support our Monte Carlo calculations. The energy dependence of LiF TLD response was investigated over the whole range of measurement distances and angles. TLD measurements and Monte Carlo calculations are in agreement to each other and agree with published data. The influence of phantom dimensions on calculations was also investigated. Radial dose functions were found to depend significantly on phantom dimensions at radial distances near phantom edges. Deviations of up to 25% are observed at these distances due to the lack of full scattering conditions, indicating that body dimensions should be taken into account in treatment planning when the absorbed dose is calculated near body edges. On the other hand, anisotropy functions do not demonstrate a strong dependence on phantom dimensions. However, these functions depend on radial distance at angles close to the longitudinal axis of the source, where deviations of up to 20% are observed.

Anisotropy↗

Disclosure of diagnostic information to cancer patients in Greece.

Truth-telling to cancer patients is controversial. The aim of the present study was to investigate oncologists', radiotherapists', and palliative care specialists' attitudes and truth-telling practices in Greece. A postal survey of a representative sample of 300 oncologists, radiotherapists, and palliative care specialists was made in February 1993. A total of 228 doctors completed and returned the questionnaires. It appears that withholding the truth from cancer patients remains very common in Greece.

Adult↗

Coronary-subclavian steal syndrome. Report of a case treated with subclavian angioplasty.

We describe the case of a man aged 42 who, five years before, had undergone aortocoronary bypass surgery using the internal mammary artery for the anterior and saphenous vein graft for the posterior descending arteries. Over the last one and a half years he had started to present angina pectoris as well as symptoms of vertebrobasilar insufficiency during exertion of the left upper extremity (recently during simple writing), whereas a full treadmill test was normal. Clinically, obstruction of the left subclavian artery was suspected with both coronary and subclavian steals. This suspicion was confirmed with triplex of the vessels of the aortic arch, coronary arteriography and carotid arteriography which demonstrated severe obstruction of the left subclavian artery at its origin and reversal of blood flow through the ipsilateral vertebral artery and the internal mammary artery graft. Angina subsided after balloon angioplasty of the subclavian artery. This combined steal, termed coronary-subclavian syndrome, is rare (our case is probably the 20th reported), but an increase of its incidence is anticipated due to the widespread use of internal mammary artery grafts. The prevention and treatment of this syndrome are discussed.

Adult↗

Correlation between spinal cord MRI and clinical features in patients with demyelinating disease.

Localisation of spinal cord lesions by MRI was correlated with neurological symptoms and signs in 16 patients with clinical and laboratory evidence of multiple sclerosis. There was good correspondence between spinal cord lesions and motor tract signs. On the other hand, superficial or deep sensory disturbances correlated with spinal cord lesions in only about a quarter of the patients. MRI of the spinal cord appeared to explain the myelopathy in 11 patients, while in 3 there was strong clinical evidence of more extensive demyelinating lesions. In 7 of the 16 patients MRI of the brain was normal.

Adolescent↗

Extracapsular (satellite) hydatid cysts.

Sixteen percent of hydatid cysts in the liver in 185 patients examined by computed tomography (CT) showed daughter cysts located exterior to the fibrinous membrane of the main hydatid cysts. We call these extracapsular or satellite cysts. Extracapsular cysts have the same appearance as endogenous daughter cysts. Preoperative demonstration of these cysts is useful for planning an appropriate surgical treatment and reduction of the recurrence rate.

Adult↗

Contrast media nephrotoxicity: comparison of diatrizoate, ioxaglate, and iohexol after intravenous and renal arterial administration.

In several studies in humans and animals it has been suggested that high osmolality and ionicity of contrast media are responsible for higher nephrotoxicity. To examine this suggestion, we evaluated the renal effects of three different contrast media--an ionic high osmolar, an ionic low osmolar, and a nonionic--following intravenous and renal arterial administration, in a population of 84 unselected, nondiabetic patients with adequate renal function. The results showed that the nephrotoxicity is minimal and equal for all three contrast media and for both routes of their administration, and it is concluded that in this category of patients the far higher cost of the newer low osmolar ionics and nonionics should be considered seriously in regard to nephrotoxicity.

Biomarkers↗