Archive for January, 2015

The primary approval of the local Helsinki Committee

January 19th, 2015 No comments

Patient 1 and patient 5 were treated initially by repeated laser interventions, and patient 2 and patient 3 were referred immediately the Radiotherapy Unit for HDR brachytherapy. Due to the novelty of the procedure, the first patient had to undergo eight laser interventions before he was offered the option of brachytherapy.

All the procedures were conducted following the primary approval of the local Helsinki Committee, requiring a detailed explanation and a signed informed consent. The procedures were performed under sedation in the ambulatory bronchoscopy unit, according to a modification of the protocol in use for malignant diseases. We used an Olympus P30 bronchoscope (Olympus; Tokyo, Japan) to visualize the airway, and positioned it just above the stent. Nd-YAG laser was then applied when needed in order to clear the granulation tissue.

Canadian Health Care News on

Under direct fluoroscopic guidance, HDR brachytherapy catheters were passed through the metal stents and secured externally to the patient’s nose. At this stage, the bronchoscopes were removed and the patients were transferred to the Radiation Therapy Unit. On simulation, a single dose of 10 Gy was prescribed to a distance of 1 cm from the center of the source, with a margin of 1 cm from the proximal and distal ends of the stent. Treatment planning was performed with the CadPlan BT brachytherapy planning system (Varian Medical Systems; Palo Alto, CA). Radiation was delivered with the Varisource HDR brachytherapy remote afterloader with an Ir source (10 Ci nominal activity) [Varian Medical Systems].

Following the procedure, repeated bronchoscopies were performed at 3-month intervals in the first half year and every 6 months thereafter, or as clinically required. Pulmonary function tests were routinely done before and after the procedure, as well as chest radiography.

Case 1

A 19-year-old man presented in November 1997 with atelectasis of the right lung. Four months earlier, he had sustained multitrauma injuries, including chest contusion in a motor vehicle accident. He was initially treated in an ICU in another hospital and received mechanical ventilation for 4 weeks.