Brainstem injury is a rare complication of radiation therapy for both photons and protons. Substantial dosimetric data have been collected for brainstem injury after proton therapy, and established guidelines to allow for safe delivery of proton radiation have been defined. Increased capability exists to incorporate LET optimization; however, further research is needed to fully explore the capabilities of LET- and RBE-based planning.

Purpose of review To describe the principles of pelvic floor physical therapy (PFPT), review the evidence for PFPT as a treatment for pelvic floor dysfunction, and summarize the current recommendations for PFPT as a first-line conservative treatment option for pelvic floor disorders. Recent findings Pelvic floor dysfunction can cause voiding and defecation problems, pelvic organ prolapse (POP), sexual dysfunction, and pelvic pain. PFPT is a program of functional retraining to improve pelvic floor muscle strength, endurance, power, and relaxation in patients with pelvic floor dysfunction. Based on the available evidence, PFPT with or without supplemental modalities can improve or cure symptoms of urinary incontinence, POP, fecal incontinence, peripartum and postpartum pelvic floor dysfunction, and hypertonic pelvic floor disorders, including pelvic floor myofascial pain, dyspareunia, vaginismus, and vulvodynia. Currently, there is conflicting evidence regarding the effectiveness of perioperative PFPT before or after POP and urinary incontinence surgery. Summary PFPT has robust evidence-based support and clear benefit as a first-line treatment for most pelvic floor disorders. Standards of PFPT treatment protocols, however, vary widely and larger well designed trials are recommended to show long-term effectiveness.

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Objective. To determine if colchicine added to nimesulide may have a beneficial effect on osteoarthritis (OA) of the knee. Methods. Colchicine 0.5 mg twice daily or placebo was added to nimesulide (a nonsteroidal antiinflammatory drug) in 36 patients with OA of the knee in a randomized, double-blind, placebo-controlled trial over a 5-month period. Results. The 30% improvement rate at 20 weeks was higher in the colchicine group than in the control group receiving placebo, as measured by total Western Ontario and McMaster University Osteoarthritis scores (57.9% versus 23.5%) and visual analog scale for index knee pain (52.6% versus 17.6%) (primary measures of response). The significance persisted on combined analysis by Mantel-Haenszel test (P ‫؍‬ 0.062). Comparison of means also showed significant improvement in the colchicine group versus the control group in a multivariate analysis performed using T 2 test (P ‫؍‬ 0.0115). Conclusion. Among patients with OA of the knee, the group receiving colchicine plus nimesulide exhibited significantly greater symptomatic benefit at 20 weeks than did the control group receiving nimesulide plus placebo. KEY WORDS: Colchicine; Knee osteoarthritis.Osteoarthritis (OA) is traditionally considered to be an inherently noninflammatory disease, but acute flares are accepted as a component in the course of advanced OA (1). Inflammation in OA is frequently secondary to the presence of calcium-containing crystals, and leads to the production of interleukin-1 (IL-1), an important mediator of cartilage breakdown in OA (2). Because calcium-containing crystals are frequently seen in severe OA (3,4), and colchicine has been shown to be beneficial in preventing calcium crystal-induced inflammation (pseudogout) (5), it is hypothesized that colchicine could have symptom-modifying or even disease-modifying effects in patients with OA. Even though the magnitude of benefit observed with colchicine in acute pyrophosphate arthropathy is not remarkable, a 12-week open clinical trial (6) showed that a regimen consisting of colchicine ϩ piroxicam ϩ intraarticular steroid was better than piroxicam ϩ intraarticular steroid alone in patients with knee OA exhibiting inflammation and calcium pyrophosphate dihydrate (CPPD) crystals in joint fluid. A randomized double-blind placebocontrolled trial (Das SK: unpublished observations) showed significantly better symptom-modifying effects when colchicine was added to piroxicam plus intraarticular steroid over a 5-month period in patients with knee OA presenting with signs of inflammation irrespective of whether CPPD crystals were demonstrable.Crystal deposition in OA is probably not an "on-off" phenomenon as previously thought (7), and may not only contribute to acute flares of inflammation in OA, but may also contribute to chronic low-grade, persistent, clinically nonapparent inflammation (1). This study was undertaken in patients with OA of the knee irrespective of the presence of clinical signs of inflammation. The purpose was to evaluate the benefit conferred...

Proton beam radiotherapy of uveal melanoma and other malignant and benign ocular tumors has shown tremendous development and success over the past four decades. Proton beam is associated with the lowest overall risk of local tumor recurrence in uveal melanoma, compared with other eye-conserving forms of primary treatment. Proton beam is also utilized for other malignant and benign tumors as primary, salvage, or adjuvant treatment with combined modality therapy. The physical characteristics of proton therapy allows for uniform dose distribution, minimal scatter, and sharp dose fall off making it an ideal therapy for ocular tumors in which critical structures lay in close proximity to the tumor. High radiation doses can be delivered to tumors with relative sparing of adjacent tissues from collateral damage. Proton beam therapy for ocular tumors has resulted in overall excellent chances for tumor control, ocular conservation, and visual preservation.