Biomedical subjects
P Cornish
Publications and source records attributed to P Cornish.
Minimal toxicity with 3-FAT radiotherapy of prostate cancer.
Beam radiation with three-dimensional conformal planning appears to decrease morbidity of prostate cancer therapy. The 3-field, arc technique (3-FAT) technique was designed by computer modeling to improve radiation dose to the target and minimize dispersion to nearby organs. Toxicity was studied in patients with prostate cancer. We performed a retrospective study of 168 consecutive men with prostate cancer after 3-FAT radiotherapy with a median follow-up of 24 months. All patients, treated from 1996 through 1999 at the University of Colorado had a pathological diagnosis of cancer before irradiation. Therapy was designed with a urethrogram and planning computed tomography scan. The 3-FAT was employed using noncoplanar, rotational beams, and nonuniform blocking of portals. Patients were treated to a minimal tumor dose of 74 Gy in 37 fractions. Adverse effects were investigated. Definitive radiotherapy was given to 80% of the group, and 58% received total androgen blockade. 3-FAT produced favorable dose distributions for the rectum, bladder, femoral heads, and base of the penis. Patients routinely report minimal dysuria and frequency during treatment. There were minimal urinary complaints after irradiation and no proctitis, diarrhea, incontinence, or change in potency as a result of radiotherapy. The 3-FAT represents a technical improvement in the treatment of prostate cancer by minimizing radiation delivered to adjacent critical structures. There were minimal side effects to the rectum, bladder, and penis base despite high doses to the prostate and seminal vesicles. The large percentage of patients with preliminary prostate-specific antigen values below 1.0 portends efficacy.
Family conferences as forums for decision making in hospital settings.
Social workers in hospitals are often involved in family conferences where patient, family members and hospital personnel meet together to exchange information about the patient's condition and to plan for the future. In this paper the complexities of these meetings as decision making arenas are discussed and an outline of the three phases of family conferences--preparation, the conference meeting and follow up--is presented. The final section reports on an exploratory review of recent conferences as perceived by social workers from an acute and rehabilitation teaching hospital. The social workers' comments indicate that the conferences achieve the desired outcomes, especially for hospital staff. In this hospital the conferences are more often used for providing family members with information, and for collective decision making about the patient's future care, than for providing information to the patients about their illness and treatment.
Controlled evaluation of thermal biofeedback in treatment of elevated blood pressure in unmedicated mild hypertension.
In the first of two studies, 42 unmedicated mild hypertensives completed either 16 sessions of thermal biofeedback (TBF) training for hand (7 sessions) and foot (9 sessions) warming or 8 weeks of monitoring BPs at home. There was a trend (p < .10) for more of those treated (57.1%) to have DBPs lower than 90 mm Hg than for those only monitoring BPs at home (33%). Analyses of clinic BP values from random zero sphygmomanometer measurements, from 24-hour ambulatory BP monitoring, and from home BP measurements made by the patient showed no advantage for treatment versus BP monitoring. Sixteen of the 21 patients in BP monitoring were later treated. Analyses of treatment effects across all treated subjects by gender revealed a significant (p = .02) decrease in DBP for treated female subjects (n = 13) but not for males (n = 24). In the second study the 22 initial treatment successes, that is, those whose DBP was below 90 mm Hg at posttreatment (59.4% of those who completed treatment), were randomized to an intensive follow-up (monthly visits for 6 months, then visits every two months) emphasizing regular home practice with an electronic TBF device or regular follow-up (visits every 3 months). Twelve of the 22 were still normotensive at 12 months. There were no differences at any point during the follow-up between the two conditions in success rate or BPs despite a numerical advantage in reported frequency of home practice by those in the intensive follow-up condition.
Comparison of Super Stuff and paraffin wax bolus in radiation therapy of irregular surfaces.
Irregular facial contours can make radiation therapy of head and neck tumors difficult. Isodose lines become skewed, making treatment planning complex. A traditional solution to this problem is the paraffin wax box bolus. Such a bolus is made to fit the irregular surface compensating for the topology and creating an even surface. The fabrication of a wax bolus can be a difficult and time-consuming process. A method that is simple and efficient has been devised. Super Stuff bolus can be easily molded and has approximately the same effect as a similar paraffin wax bolus. This was verified by irradiating a Rando head phantom with both a paraffin wax bolus and a Super Stuff bolus. Doses to various points of interest were measured with thermoluminescent dosimetry (TLD) chips (LiF). The particular case addressed is malignant melanoma of the nasal septum, but the technique described can be useful in the treatment of other sites as well.
Biphasic positive airway pressure for airway obstruction secondary to adenotonsillar hypertrophy.
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Regarding axillary and supraclavicular techniques of nerve block being described as approaches to brachial plexus.
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