PubMed · 11627308
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G Silló-Seidl. 1976. [Not Available].. https://pubmed.ncbi.nlm.nih.gov/11627308/
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PURPOSE: To describe the frequency and magnitude of late GI and GU morbidity in prostate cancer patients treated to high dose levels with a simple three-dimensional conformal technique. METHODS AND MATERIALS: A total of 156 intermediate- and high-risk patients were treated between January 1, 1992 and February 28, 1999 with a simple four-field three-dimensional conformal technique to 79-84 Gy. All patients were treated with a four-field conformal technique; the prostate received 82 Gy and the seminal vesicles and periprostatic tissue 46 Gy. GI and GU toxicity was scored according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Morbidity Grading Scale and compared using Kaplan-Meier estimates. RESULTS: The late Grade 2 GI complication rate was 9% and 38% at 3 years for patients treated with and without rectal blocking, respectively (p = 0.0004). No Grade 3 late GI complications developed. The rate of Grade 2 late GU complications was 5%, 8%, and 12% at 12, 24, and 36 months, respectively. The Grade 3 late GU complication rate was 2% at 36 months. These differences were not statistically significant. CONCLUSION: The treatment method described is a simple four-field conformal technique that can be easily implemented in the general radiation community. A dose of 79-84 Gy can be safely delivered to the prostate, with a 9% rate of late Grade 2 GI, 12% rate of late Grade 2 GU, and 2% rate of late Grade 3 GU complications.
Care of critically ill, preterm infants is a major challenge. Because of their small size and complex health problems, preterm infants require long-term hospitalization in the intensive care unit where they are exposed to serious microorganisms and other antigens that can overwhelm their immature immune systems. As smaller and more fragile preterm infants are surviving NICU care, these infants are at increased risk for nosocomial infections. Although modern antimicrobial agents are invaluable in the management of infection, they can result in biologic stress to the immature physiology of the preterm infant. Nonpharmacologic strategies to enhance the immunocompetence of the preterm immune systems provide another alternative in the management of these infants. Because the gastrointestinal tract is one of the largest immune organs within the body, strategies to maximize its immune functions can improve the outcome of these infants and help prevent or minimize the risk of infection. One such strategy is the early introduction of enteral feedings designed to stimulate or prime the gut. Early introduction of enteral feedings in the acutely ill preterm infant appears to be well tolerated in a variety of small clinical studies. Although the studies vary considerably in design and variables measured, collectively they show a solid trend toward improved outcomes. By preventing the negative consequences of a prolonged period of NPO, early enteral feedings promote the normal processes of the gut as a physical, mechanical, physiologic, and immunologic barrier. A solid understanding of the pathophysiology of prolonged NPO status and the physiology of the gut's immune properties enables critical care nurses to improve care of these vulnerable NICU patients.
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