PubMed · 5359433
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C M Godfrey. 1969. Cerebral dysfunction in children.. https://pubmed.ncbi.nlm.nih.gov/5359433/
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PURPOSE: To compare different treatment techniques for unilateral treatment of parotid gland tumors. METHODS AND MATERIALS: The CT-scans of a representative parotid patient were used. The field size was 9 x 11 cm, the separation was 15.5 cm, and the prescription depth was 4.5 cm. Using 3D dose distributions, tissue inhomogeneity corrections, scatter integration (for photons) and pencil beam (for electrons) algorithms and dose-volume histogram (DVH), nine treatment techniques were compared. [1] unilateral 6 MV photons [2] unilateral 12 MeV electrons [3] unilateral 16 MeV electrons [4] an ipsilateral wedge pair technique using 6 MV photons [5] a 3-field AP (wedged), PA (wedged) and lateral portal technique using 6 MV photons [6] a mixed beam technique using 6 MV photons and 12 MeV electrons (1:4 weighting) [7] a mixed beam technique using 6 MV photons and 16 MeV electrons (1:4 weighting) [8] a mixed beam technique using 18 MV photons and 20 MeV electrons (2:3 weighting) [9] a mixed beam technique using 18 MV photons and 20 MeV electrons (1:1 weighting). RESULTS: Using dose-volume histograms to evaluate the dose to the contralateral parotid gland, the percentage of contralateral parotid volume receiving > or = 30% of the prescribed dose was 100% for techniques [1], [8] and [9], and < 5% for techniques [2] through [7]. Evaluating the "hottest" 5 cc of the ipsilateral mandible and temporal lobes, the hot spots were: 152% and 150% for technique [2], 132% and 130% for technique [6]. Comparing the exit doses, techniques [1], [8] and [9] contributed to > or = 50% of the prescribed dose to the contralateral mandible and the temporal lobes. Only techniques [2] and [6] kept the highest point doses to both the brain stem and the spinal cord below 50% of the prescribed dose. CONCLUSION: The single photon lateral field [1] and the mixed electron-photon beams [8] and [9] are not recommended treatment techniques for unilateral parotid irradiation because of high doses delivered to the contralateral parotid gland and high exit doses which are associated with Xerostomia. The en face electron beam technique [2] and the mixed electron-photon beam technique [6] are unacceptable due to the excessive dose heterogeneity to the contiguous normal structures. In spite of optimal dose fall-off achieved using the en face technique [3], most patients cannot tolerate the resulting high skin doses. We conclude that the ipsilateral wedge pair [4], the 3-field [5], and the mixed electron-photon beam [7] techniques are optimal techniques in providing relatively homogeneous dose distributions within the target area and for minimizing dose to the relevant normal structures.
Neurologic illness relating to health care delivery has been increasingly described since the 1960's, primarily in the general medical literature. Iatrogenic neurologic complications have either been defined generically in terms of consequences of particular therapeutic or diagnostic approaches, or have been delineated with reference to more specific and serious complications such as intracerebral hemorrhage. In these reports, little attempt has been made to situate iatrogenic neurologic complications, either historically or conceptually, within the larger framework of medically related harms. Moreover, in this literature, few suggestions have been provided with regard to strategies to reduce such complications. The objective of the present review is to place the problem of iatrogenic neurologic complications within a larger historical and conceptual framework, as well as to provide suggestions for limiting such injuries.
Organ transplantation is a marvel of 20th century medicine. However, it is not without costs. Complications of transplant procedures, particularly neurologic complications, are a significant cause of morbidity and mortality. Neurologic complications in the transplant population may be divided into three groups: those occurring prior to transplantation, those in the perioperative period, and those arising weeks to months after the procedure. This review discusses neurologic complications associated with organ failure and transplantation in the perioperative period.