Model of total skin electron treatment using the 'six-dual-field' technique

During implementation of the total skin electron treatment, using six-dual-field technique, at radiotherapy department a large number of measurements are needed. To assess depth dose curve required by clinicians and dose uniformity over a whole treatment plane, combinations of different irradiation parameters are used (electron energy, beam angle, scatterers). Measurements for each combination must be performed. One possible way to reduce number of measurements is to model the treatment using the Monte Carlo simulation of electron transport. We made a simplified multiple-source Monte Carlo model of electron beam and tested it by comparing calculations and experimental results. Calculated data differs less than 5 percent from measurements in the treatment plane. During the treatment patient can be approximated using cylinders with different diameters and orientations. We tried to model the depth dose variations in the total skin electron treatment not just around the body cross-section (simplified to cylinders of different diameters), but also along the body to account for the variations in body curvature longitudinally. This effect comes down to the problem of modeling distribution in different cylinders, but varying the longitudinal orientation of those cylinders. We compared Monte Carlo calculations and film measurements of depth dose curves for two orientations of the cylindrical phantom, which were the simplest for experimental arrangement. Comparison of the results proved accuracy of the model and we used it to calculate depth dose curves for a number of other cylinder orientations.     

Influence of the incoming solar radiation on the bone mineral density in the female adult population in Croatia

The relationship between the bone mineral density (BMD) in Croatian female adults and the average incoming solar radiation at the ground was investigated. The study included 387 volunteers of average age of 60 years from three different towns: Pula (n = 128, age from 35 to 76), Krapina (n = 141, age from 43 to 77), and Zagreb (n = 118, age from 32 to 79). Apart from the different lifestyle, each of above towns is characterized by different incoming solar radiation, where values of 503.3 kJ cm-2, 471.2 kJ cm-2 and 436.3 kJ cm-2 correspond to average annual radiation at the ground for Pula, Krapina and Zagreb, respectively. Heel BMD was measured by clinical bone sonometer (Sahara). On the average the BMD was highest for Pula (0.469 g cm-2) and the lowest for Zagreb (0.433 g cm-2). Similarly, the percentage of normal bones was the highest for Pula (46.1%) and the lowest for Zagreb (32.2%). Osteopenic bones were the most frequent for Zagreb (61.0%), while corresponding figures for Pula and Krapina were 46.9% and 43.6%, respectively. Osteoporosis varied from 6.8% in Zagreb to 11.4% in Krapina. A test of independence by contingency table confirmed at the significance level alpha = 0.05 that probability of normal bone occurrence increases with the increase of incoming solar radiation. Results of the multiple regression analysis suggest the dependence of BMD on woman's age and weight, and incoming solar radiation at the place of habitation.     

Chronic tension-type headache in school-aged children--personality traits and behavior

Basic personality traits and specific behavior characteristics were assess in 39 patients (12 to 15 years old) having chronic tension-type headache. Patients were referred for clinical examination to the Neural-pediatrics Ward of the Department of Pediatrics, Osijek, Croatia. Eysenck Personality Questionnaire--Juniors (EPQ-J), a new Croatian personality Questionnaire of domination, aggression, introversion and ambition (DAIA), were applied for the testing. The scores obtained by patients in personality questionnaires were compared with averages scores normal sample of healthy pupil same ages. Our patients were found to have no signs of emotional instability. Their behavior is prosocial, nonaggressive, and ambitious, aimed at the achievement of superior results at school and life although already quite successful in their studies. Tensions arising from the school setting seem to be important factors triggering tension-type headaches.     

Social phobia

Social anxiety disorder (social phobia) is an irrational fear of being observed and judged by other people in various social settings. The individual is afraid that he or she will act in a way that will be humiliating or embarrassing. It is often a chronic, disabling condition that is characterized by a phobic avoidance of most social situations. Social anxiety disorder is the most frequent anxiety disorder (10-15%) that occurs in two subtypes--generalized and specific. It is a disorder that occurs during the adolescence and reflects negatively to the quality of life of an individual. Neurobiological basis of this disorder has not been explored yet. The disorder is frequently burdened with comorbidity with other anxiety disorders, depression and substance-related disorders. Only cognitive-behavioral techniques are desirable in the psychotherapeutic treatment of the disorder and the best results are achieved in combination with pharmacotherapy. The medicaments of choice in the treatment of social anxiety disorder are selective serotonin reuptake inhibitors. Anxiolytics should be used only as a supplementary in the acute phase. Treatment of social anxiety disorder should last at least 3 months up to one year.     

The role of transbronchial lung biopsy in the diagnosis of solitary pulmonary nodule

Transbronchial lung biopsy (TBLB) is a well-recognized diagnostic technique in diffuse interstitial lung diseases, but it is not considered to be the first choice in investigation of solitary pulmonary nodules (SPN). The main idea of this study was to increase the sensitivity of bronchoscopy using multiple techniques, especially TBLB, thus to avoid more aggressive diagnostic procedures. The objective of this prospective study was to evaluate the efficacy and safety of TBLB in the diagnosis of SPN, in comparison with other bronchoscopic techniques. Fifty patients with chest x-ray finding consistent with SPN underwent bronchoscopy with bronchial washing, brushing, bronchoalveolar lavage (BAL) and TBLB were included in this study. Thirty-one patients suffered from malignant tumors, while 19 patients had nonmalignant lesions. TBLB achieved overall diagnostic sensitivity of 62%, BAL of 29%, bronchial brushing of 16% and washing of 6%. Combining all techniques together, bronchoscopy had overall sensitivity of 86%. Concerning malignant lesions, TBLB had a sensitivity of 65%, specificity of 100%, and accuracy of 82%. TBLB had a significantly better yield for lesions with a diameter > or = 25 mm than for lesions of < 25 mm (sensitivity of 82% and 53% respectively, p < 0.05). Diagnostic yield improved significantly with the increasing number of specimens (less than 3 specimens: sensitivity 59%, 3 or more specimens: sensitivity 87%, p < 0.05). Complications of TBLB occurred in 2 (4%) patients: 1 incomplete pneumothorax and 1 hemorrhage. According to the results, we conclude that TBLB is an accurate and safe technique for the diagnosis of pulmonary solitary nodule with a diameter equal or greater than 25 mm.     

Hair testing for drugs of abuse

Hair testing for drugs of abuse is a developing technology, which offers the possibility of longer detection times than is commonly obtained with urine analysis. It is the main method for evaluation of an individual's drugs of abuse history. In many countries hair analysis is routinely used to detect drug abuse in forensic cases, occupational and traffic medicine and clinical toxicology. Hair analysis in pregnant women, neonates and infants is a useful tool for the detection of drug exposure in utero. In Croatia hair testing for drugs of abuse is performed at the Institute for Medical Research and Occupational Health. Three-year experience in drugs of abuse analysis in hair is described. In 331 hair samples (270 from adolescents and 61 from adults) opiates and metabolites, cocaine, methadone, and amphetamines were analyzed by gas chromatography/mass spectrometry. Most prevalent drugs of abuse in adolescents were amphetamines, and in adults heroin. From the examples cited and samples analyzed it is evident that hair testing is emerging as a reliable biological marker for cumulative account of individual exposure to drugs of abuse.     

Diagnostic value of cytology and colposcopy for squamous and glandular cervical intraepithelial lesions

The main objective of work was to determine a diagnostic value of cytology and colposcopy as a method of screening and differential diagnosis, as well as to determine the relative value of some colposcopic features of squamous and glandular cervical intraepithelial lesions. Cytological diagnosis and colposcopy findings is compared with histological ones for 187 patients with intraepithelial lesions (142 squamous and 45 glandular ones with or without squamous components) and determined the sensitivity and positive predictive value of cytology and colposcopy, including the types of colposcopic abnormalities associated with squamous/glandular intraepithelial lesions. The sensitivity of cytology as a screening method for SIL (squamous intraepithelial lesions) is 89% and for GIL (glandular intraepithelial lesions) 98%. Positive predictive value of differential cytology for SIL is 59% and for GIL 53%. Sensitivity of colposcopy for both lesions' type is 87%. Acetowhite epithelium occurs for more often with SIL, whereas atypical vessels and unequal, dilated gland openings with GIL (p < 0.05). Cytology and colposcopy as screening methods have a high sensitivity. Nevertheless, cytology is far more accurate in determining differential diagnosis of SIL than GIL and some colposcopy abnormalities suspicious of GIL should be further tested in praxis.     

Dermatoglyphs and gastric cancer

Gastric cancer is very common malignant disease, etiology of which is still unknown. Some studies consider that it is caused by a joint activity of both genetic and environmental factors. Digito-palmar dermatoglyphs were already used to determine hereditary base of some malignant diseases (breast, lung and colorectal cancer) and it was the reason for investigations of the correlation of their quantity features at patients with gastric cancer (36 males and 32 females) and the control groups of phenotypically healthy persons (50 males and 50 females). By performing statistical data processing of the multivariate and univariate analysis, as well as of discriminant ones, it was possible to prove the existence of heterogeneity between the investigated groups. Higher incidence of gastric cancer and the blood group A could be confirmed, as well. From the obtained findings can be concluded, that the results of quantitative analysis of digitopalmar dermatoglyphs affirm the existence of genetic predisposition for development of gastric cancer.     

Efficacy and safety of propofol sedation during urgent upper gastrointestinal endoscopy--a prospective study

The aim of this study was to investigate both the efficacy and safety of sedation with propofol during urgent therapeutic gastroscopy in patients with upper gastrointestinal bleeding. This prospective study included a total of 110 patients. Propofol was administered intravenously at the starting dose of 1 mg/kg body weight and was followed by repeated doses. Oxygen saturation and heart rate were monitored by pulse oxymetry. The mean dose of propofol administered was 161 +/- 49 mg. Urgent upper GI endoscopy under propofol sedation was successful in 98% of cases. Endoscopists rated the sedation as good in 83.6%, satisfactory in 14.5%, and poor in 1.8% of patients. Potentially harmful drop in oxygen saturation below 85% was observed in 5.5% of patients, whereas a temporary drop in heart rate below 50 beats/min was observed in 11.8%, not requiring any intervention. Almost 93% of patients could not remember the beginning or the end of the intervention. This data demonstrates that sedation with propofol is suitable for use in patients with upper gastrointestinal bleeding undergoing urgent endoscopy.