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Background: With conformal radiotherapy techniques, acute and late toxicities can be reduced because of better dose conformity and reduced doses to normal tissue. With Intensity Modulated Radiation Therapy (IMRT) further dose escalation is possible and one of the methods is IMRT with simultaneous integrated boost (IMRT-SIB)., Aim: To evaluate feasibility, toxicity patterns and loco-regional control rates of IMRT-SIB technique in head and neck cancer patients who are not suitable candidates for concurrent chemoradiation., Study Design: Prospective study of 30 patients treated with IMRT-SIB technique and evaluation of clinical results., Method and Materials: 30 patients received definitive treatment using IMRT-SIB without concurrent chemotherapy. Patients were monitored during and after treatment for toxicity using the Radiation Therapy Oncology group (RTOG) criteria. Analysis of acute and late toxicity and early efficacy is presented., Results: The median treatment duration was 42days (range 41-43days). Overall, maximum acute Grade 3 toxicity of mucositis, skin, pharynx/esophageal toxicity and laryngeal were 56.66%, 30%, 26.67%, and 6.67% respectively at treatment completion. None of the patients had Grade 4 acute toxicity. No haematological toxicity was seen. Overall, grade 2 late toxicities were 7% (subcutaneous toxicity) and 13.3% (Xerostomia). Loco regional control rate at a median follow up of 13months was 86%., Conclusion: IMRT-SIB is a safe and acceptable treatment option for patients of head and neck squamous cell carcinoma unsuitable for definitive chemo-radiotherapy., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

A total of 36 semen ejaculates, six from each of three Holstein-Friesian bulls and three Murrah buffalo bulls, were frozen in tris citric acid-fructose-egg-yolk-glycerol diluent after 1 hour of equilibration to study the effect of various cooling rates (15, 30, 60 and 120 minutes from 10 degrees to 5 degrees C vs a control sample cooled for 120 minutes from 28 degrees to 5 degrees C) and thawing temperatures (40 degrees C 60 seconds , 60 degrees C 15 seconds and 80 degrees C 5 seconds ) on prefreeze and post-thaw sperm motility. Sperm motility differed significantly (P < 0.01) between various cooling rates in both the Holstein-Friesian bull semen and the Murrah buffalo semen at prefreezing, immediately post-thawing, and after 1 hour of post-thaw incubation at 38 degrees C. Post-thaw sperm motility and survival at 38 degrees C were significantly (P<0.01) higher in Holstein-Friesian bulls at 60 degrees C and 80 degrees C than at 40 degrees C (39.79+/-2.46% and 38.15+/-2.18% Vs 35.16+/-2.19%, and 20.22+/-2.14% and 19.05+/-2.05% vs 14.83+/-1.64%, respectively). In Murrah buffalo bulls the recovery percentage and survival rate increased significantly (P<0.01) with the increase in temperature from 40 degrees C to 80 degrees C (41.72+/-2.45%, 47.45+/-2.09% and 51.61+/-2.06%; and 9.22+/-1.47%, 11.79+/-1.63% and 12.27+/-1.53%, respectively). Prefreeze motility did not differ between cattle and buffalo bulls (64.97+/-1.08% Vs 67.11+/-0.89%, respectively) but post-thaw motility was significantly (P<0.01) higher in the buffalo (46.93+/- 1.39% Vs 37.70+/-1.32%). While incubation survival was higher in the cattle (18.04+/-1.16% Vs 10.96+/-0.89%). A fast cooling rate was found to be detrimental for cattle spermatozoa, whereas the post-thaw buffalo sperm motility deteriorated very quickly at 38 degrees C. The influence of species-by-cooling rate interaction was significant (P<0.01) for post-thaw motility and survival rate, but the species-by-thawing or cooling-by-thawing interactions were not significant. These results suggest that a cooling rate of 2 hour either at 10 degrees C or 28 degrees C is essential for cattle semen. However, buffalo semen can be frozen successfully after 30 minutes of cooling at 10 degrees C. A thawing temperature of 60 degrees C yielded a higher sperm motility rate than 40 degrees C. Thus, our findings can be applied under tropical conditions for the successful freezing-thawing of bovine semen provided conception rates are not affected adversely.

Hereditary Cushing's syndrome is an uncommon clinical entity, and most reported cases have been described in families with nodular adrenocortical dysplasia. Isolated cases of Cushing's disease (pituitary-dependent bilateral adrenal hyperplasia) have been reported in association with the multiple endocrine neoplasia syndrome, Type I (MEN I), but there are no published reports of pedigrees with more than one affected family member. Within a period of 8 months, two sisters presented with clinical findings suggestive of hypercortisolism, and Cushing's disease was confirmed by appropriate diagnostic studies. There was no evidence of any other endocrine excess syndrome in either patient. Transsphenoidal pituitary surgery confirmed the presence of an ACTH-immunostaining pituitary adenoma in each woman. The authors think this is the first report in the English literature of Cushing's disease in first-degree relatives.

Rectus abdominis myocutaneous flap has been used in four different therapeutic situations after mastectomy for breast cancer. These include (1) to obtain skin cover after radical mastectomy with liberal skin sacrifice for locally advanced cancer in 14 cases, (2) for skin cover to obtain primary wound healing in 10 cases treated by preoperative radiotherapy, (3) for delayed breast reconstruction in three patients and (4) for immediate postmastectomy breast reconstruction in 25 patients. Prosthesis was not used for breast reconstruction. The operative morbidity was minimal but 1-2 units of extra blood transfusion was required. Administration of adjuvant treatment, including chemotherapy and radiotherapy was not affected. Reconstruction was satisfactory.

A 36-year-old woman with hyperthyroidism, elevated blood thyroid-stimulating hormone (TSH) and alpha-subunit levels, amenorrhea, hyperprolactinemia and no evidence of acromegaly, was found to have a pituitary adenoma containing TSH, alpha-subunit and growth hormone by immunohistochemistry. Preoperative testing revealed elevated TSH and alpha-subunit with no response to thyrotropin-releasing hormone (TRH) but a normal response in prolactin to TRH. Culture of the pituitary cells showed release of TSH, alpha-subunit and prolactin. In vitro, TRH failed to cause TSH discharge; however, it increased prolactin concentrations in the culture medium. Triiodothyronine, added to the pituitary cell culture, resulted in no inhibition of TSH and prolactin discharge. By electron microscopy, the adenoma cells showed features of thyrotrophs. However, some adenoma cells contained fibrous bodies characteristic of some growth hormone cell tumors and acidophil stem cell adenomas, suggesting that the adenoma originated in a common progenitor cell.