Ultrasound-guided Brachytherapy for Cervix Cancer

Radiotherapy and brachytherapy are the definitive treatments for locally advanced cervix cancer. The use of soft-tissue imaging, particularly magnetic resonance imaging, has enhanced their effectiveness and improved clinical outcomes. However, the use of magnetic resonance imaging is largely restricted to well-resourced centres in both the first and developing world and remains elusive to many less advantaged centres, particularly those in areas with a high burden of cervix cancer. Ultrasound is an accessible, affordable and accurate imaging modality that can be used throughout the brachytherapy procedure. Ultrasound is primarily used to ensure safe insertion of the applicator but can also be used to guide planning. The methods used to utilise ultrasound images for planning are described. Ultrasound is particularly useful as a verification aid to confirm applicator placement after patients are moved and transferred around the radiotherapy department. It can also be used to verify the dimensions of treatment volumes over the course of brachytherapy. There is a crucial unmet need for an accessible economical soft-tissue imaging modality in cervical brachytherapy. Ultrasound has the potential to meet this need.

A preliminary evaluation of the circulating leptin/adiponectin ratio in dogs with pituitary-dependent hyperadrenocorticism and concurrent diabetes mellitus

Leptin and adiponectin are thought to modulate insulin sensitivity and pancreatic β-cell function, but there is limited information regarding the adipokine status of hyperglycemic dogs with hyperadrenocorticism. This study aimed to determine whether alterations in the leptin/adiponectin ratio, insulin sensitivity, and/or pancreatic β-cell function are associated with diabetes mellitus (DM) in dogs with pituitary-dependent hyperadrenocorticism (PDH). A total of 48 client-owned dogs were included in this prospective observational study: 20 dogs with PDH (10 normoglycemic and 10 with DM), 15 dogs with DM, and 13 healthy dogs. The serum concentrations of leptin, adiponectin, resistin, interleukin (IL)-1β, IL-6, IL-10, IL-18, and tumor necrosis factor (TNF)-α were measured, and homeostatic model assessment indices (HOMAs) were calculated and compared among the groups. Serum leptin was significantly higher in PDH dogs with and without DM than in healthy and DM dogs, and it was lower in DM dogs than in PDH dogs without DM. Serum adiponectin was significantly lower in PDH dogs with DM than in healthy and PDH dogs, and it was significantly lower in DM dogs than in healthy dogs. Serum IL-10 was significantly higher in PDH dogs with DM than in healthy and PDH dogs without DM. The leptin/adiponectin ratio was significantly higher in PDH dogs with DM than in normoglycemic PDH dogs. Serum IL-6 concentrations were significantly higher in DM dogs than in healthy dogs. Serum IL-1β concentration was significantly higher in DM dogs than in healthy dogs and PDH dogs with DM and without DM. Serum TNF-α and IL-18 concentrations were not different among groups. The HOMA_{β-cell function} was significantly lower in PDH dogs with DM than in normoglycemic PDH dogs, while HOMA_{insulin sensitivity} was significantly lower in PDH dogs with DM than in healthy dogs. These results suggest that adipokine dysregulation, a reduction in insulin sensitivity, and a further impairment in pancreatic β-cell function might predispose PDH dogs to DM. Further longitudinal study will be necessary to confirm this result.

Atlantoaxial bands in small breed dogs: influence of external pressure by the endotracheal tube tie

OBJECTIVES

To determine the prevalence of dorsal cervical spinal compression in a population of dogs susceptible to caudal occipital dysplasia. To determine whether endotracheal tube ties iatrogenically alter the dorsal compression ratio in the atlantoaxial region.

MATERIALS AND METHODS

Prospective, randomised, controlled, cross-over, blinded cohort study of dogs weighing <15 kg and presenting for neurologic signs localised to the cervical region. In mid-sagittal T2-weighted MR images, dorsal cervical compression and cerebellar compression were evaluated. Dorsal cervical compression ratios were calculated and compared to determine the effect of the endotracheal tube tie on the atlantoaxial region depending on whether dogs were in extended or flexed neck position.

RESULTS

Prevalence of dorsal cervical spinal compression consistent with an atlantoaxial band was 32/44 (73%) dogs without tie pressure and 37/44 (84%) dogs with tie pressure. Significantly higher compression ratios were found with tie placement over the craniocervical region. Dorsal compression ratios of dogs with cerebellar compression were significantly greater than those without it.

CLINICAL SIGNIFICANCE

The location of the endotracheal tube tie can influence interpretation of MR images of the craniocervical region of small breed dogs. These breeds more often had greater dorsal cervical spinal compression with tie pressure, especially when they had cerebellar compression.