Angiosarcoma of the scalp is a rare aggressive tumor that affects elderly patients. Chemoradiation is the treatment of choice for multicentric and extensive disease. The shape of the scalp represents a dosimetric challenge in terms of achieving a homogeneous concave dose distribution with coverage of the entire target volume and an acceptable organs-at-risk sparing. We report a case of an 81-year-old man with a multifocal angiosarcoma of the scalp treated with Helical TomoTherapy® (Accuray Inc., Sunnyvale, CA, USA) intensity modulated radiotherapy. This technique allows precise and daily verifiable coverage of the target keeping the dose to the organs at risk within the constraints.

EAT may be measured by processing either the CS or CTCA image data sets.

Despite recent developments in microbiological biomolecular techniques, blood culture remains the most practical and reliable method in the diagnosis of bloodstream infections and one of the most important tools in the clinical microbiology laboratory, taking into account the role played by systemic infections as a major cause of mortality and morbidity, especially within the hospital environment. Various continuously monitoring blood culture systems are extensively used in order to increase the rapidity of isolation and identification of microorganisms in blood samples, and paired aerobic and anaerobic blood culture bottles are commonly used in order to obtain better overall recovery of microorganisms, as well as the recovery of specific types of bacteria. The traditional aerobic and anaerobic bacteriological media also detect episodes of candidemia, although the sensitivity in this case is estimated to be only 50% (12). The efficiency of yeast detection in blood samples can be increased by terminal subcultures, but the practice is time-consuming and the risk of underestimating yeast infections remains high. This is unacceptable if we take into account the expanding role of yeasts as agents of nosocomial infections, particularly in intensive-care units (ICUs) (4, 18, 23), and candidemia-associated mortality (40%), the highest of all hospital bloodstream infections (4). In order to facilitate faster and more efficient isolation of fungi from blood, the Bactec automated blood culture system (Becton Dickinson Diagnostic Systems, Sparks, MD) has media specifically formulated for this purpose. In addition to the traditional aerobicanaerobic bacteriological set, their use has been recommended when blood culture is required for patients at risk of fungal infections (7, 16) and when a concomitant bloodstream bacterial infection is suspected of inhibiting yeast detection (16).Nevertheless, fungal media are not routinely employed by many hospitals, as they require additional blood from patients, an increased amount of incubator space, and the additional costs of processing and purchasing bottles (10). Moreover, even the routine use of anaerobic bacteriological bottles in blood culture has been (21), and still is (13), a subject of discussion because of the reportedly declining rates of anaerobic bloodstream infections (2) and the possibility of recognizing them clinically and treating affected patients empirically for such infections (17,19,22).

Abstract. Local therapies such as radiofrequency ablation (RFA) represent a valuable choice in limited hepatocellular carcinoma (HCC) and are increasingly used also in advanced tumors. Medical treatments generally gave frustrating results in advanced HCC especially if comorbidities exist. Several biologic non-chemotherapeutic drugs are currently tested in HCC and, among them, octreotide was evaluated in single series of HCC patients reporting conflicting results. We have treated a series of 35 patients affected by advanced HCC (26 M and 9 F; age range: 55-85 years, median: 73 years) with RFA followed by octreotide to primarily evaluate the safety of combined treatment and to give preliminary evaluation on its activity. We have also evaluated serum VEGF changes during the study. Child A and Child B represented 60% and about 34% of the cases, respectively. Only two patients with Child C compensated cirrhosis were included in this study. All patients have multiple liver HCC nodules and one had bone metastases. Two complete responses, 3 partial responses and 23 disease stabilization for at least three months were obtained (overall response rate, 14,2%; clinical benefit, 80%). Mean overall survival was 31.4 months. The combined treatment was well tolerated. Statistically significant correlation was found between serum VEGF and tumor progression. In conclusion, the combination of RFA and octreotide was active in advanced HCC, however, confirmation in a larger series is required.