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Several methods to reduce respiratory-induced motion have been described in literature, with the goal of increasing accuracy of treatment to minimize normal tissue toxicity or increase dose to the target volume. We analyzed two different techniques of respiratory gating: the deep inspiration breath hold technique and the respiratory gating using the Real-time Position Management (RPM) system. The first method is a self-gating technique in which radiation treatment take place during a phase of breath-holding. The second technique use a reflective marker placed on the patient’s anterior surface. The motion of the marker is tracked using a camera interfaced to a computer. The gating thresholds are set when the tumor is in the desired portion of the respiratory cycle. These thresholds determine when the gating system turns the treatment beam on and off. We compared both techniques with a standard external radiation treatment. The dosimetric analysis has led to considerable advantage of these methods compared to the external radiation treatment, particularly in reducing the dose to the lung.

La chirurgia con ultrasuoni focalizzati guidati da MRI (MR-g-FUS) è un trattamento di minima invasività, guidato dal più sofisticato strumento di imaging a disposizione, che utilizza a scopo diagnostico e terapeutico forme di energia non ionizzante. Le sue caratteristiche portano a pensare un suo possibile e promettente utilizzo in numerose aree della patologia umana, in particolare scheletrica. L'osteoma osteoide affligge frequentemente pazienti di giovane età, è una patologia benigna, con origine ed evoluzione non chiare, e trova nella termoablazione con radiofrequenza continua sotto guida CT (CT-g-RFA) il suo trattamento di elezione. Questo lavoro ha valutato l’efficacia, gli effetti e la sicurezza del trattamento dell’osteoma osteoide con MR-g-FUS. Sono stati presi in considerazione pazienti arruolati per MR-g-FUS e, come gruppo di controllo, pazienti sottoposti a CT-g-RFA, che hanno raggiunto un follow-up minimo di 18 mesi (rispettivamente 6 e 24 pazienti). Due pazienti erano stati esclusi dal trattamento MR-g-FUS per claustrofobia (2/8). Tutti i trattamenti sono stati portati a termine con successo tecnico e clinico. Non sono state registrate complicanze o eventi avversi correlati all’anestesia o alle procedure di trattamento, e tutti i pazienti sono stati dimessi regolarmente dopo 12-24 ore. La durata media dei trattamenti di MR-g-FUS è stata di 40±21 min. Da valori di score VAS pre-trattamento oscillanti tra 6 e 10 (su scala 0-10), i trattamenti hanno condotto tutti i pazienti a VAS 0 (senza integrazioni farmacologiche). Nessun paziente ha manifestato segni di persistenza di malattia o di recidiva al follow-up. Nonostante la neurolisi e la risoluzione dei sintomi, la perfusione del nidus è stata ritrovata ancora presente in oltre il 70% dei casi sottoposti a MR-g-FUS (4/6 pazienti). I risultati derivati da un'analisi estesa a pazienti più recentemente arruolati confermano questi dati. Il trattamento con MR-g-FUS sembra essere efficace e sicuro nel risolvere la sintomatologia dell'osteoma osteoide. / Magnetic Resonance guided Focused Ultrasound Surgery (MR-g-FUS) is a minimally invasive treatment guided by the most sophisticated imaging tool available in today clinical practice. Both imaging and therapeutic sides of the equipment are based on non-ionizing energy. This technique is a very promising option as potential treatment of several pathologies, including skeletal disorders. Osteoid osteoma is considered a benign lesion of the bone, and it usually affects young patients. Although the origin and evolution of the disease have not been completely understood, the treatment of choice was found in thermal ablation by continuous radiofrequency under CT guidance (CT-g-RFA). This work aimed at the evaluation of the efficacy, the effects and the safety of MR-g-FUS in the treatment of osteoid osteoma. Patients enrolled for MR-g-FUS treatment of osteoid osteoma were included, as well as a control group made up of patients routinely submitted to CT-g-RFA. Only patients with a minimum follow-up period of 18 months were considered (6 and 24 patients, for MR-g-FUS and CT-g-RFA respectively). Two patients had been previously excluded from MR-g-FUS, because of claustrophobia (2/8 patients). All treatments were concluded with technical and clinical success. No complications or adverse events were registered. The mean duration of an entire MR-g-FUS procedure was 40(±21) min, and all patients were discharged after 12-24 h. The interventional procedures took the patients from pre-treatment VAS ranging 6-10 to post-treatment score 0 (removing drugs). No patient showed persistence or recurrence of the disease during the follow-up. Despite the neurolysis carried out by MR-g-FUS, the nidus presented with still active vascularization at imaging follow-up in over 70% of lesions undergoing MR-g-FUS (4/6 patients). Results achieved by extending the analysis to more recently recruited patients confirm data as preliminarily reported. MR-g-FUS seems to be effective and safe in the treatment of symptoms related to osteoid osteoma.

Obiettivo: Il nostro obiettivo è stato quello di confrontare la tomoterapia (HT) e la protonterapia ad intensità modulata (IMPT) nel trattamento del tumore prostatico, seguendo un protocollo di boost simultaneo (SIB) e moderatamente ipofrazionato. Materiali e metodi: Abbiamo selezionato 8 pazienti, trattati con HT e abbiamo rielaborato i piani con 2 campi IMPT. La dose prescritta è stata di 74 Gy sul PTV1 (prostata e vescicole seminali prossimali), 65.8 Gy sul PTV2 (vescicole seminali distali) e 54 Gy sul PTV3 (linfonodi pelvici). Risultati: Sia con IMPT che con HT abbiamo ottenuto una copertura e una omogeneità di dose del target sovrapponibile. Oltre i 65 Gy, HT e IMPT erano equivalenti per il retto, mentre con l’IMPT c’era maggior risparmio della vescica e del bulbo penieno da 0 a 70 Gy. Da 0 fino a 60 Gy, i valori dosimetrici dell’IMPT erano molto più bassi per tutti gli organi a rischio (OARs), eccetto che per le teste femorali, dove la HT aveva un vantaggio dosimetrico rispetto all’IMPT nel range di dose 25-35 Gy. La dose media agli OARs era ridotta del 30-50% con l’IMPT. Conclusioni: Con le due tecniche di trattamento (HT e IMPT) si ottiene una simile distribuzione di dose nel target. Un chiaro vantaggio dosimetrico dell’IMPT sul HT è ottenuto dalle medie e basse dosi. Le attuali conoscenze sulle relazioni dose-effetto e sul risparmio delle madie e basse dosi con l’IMPT non sono ancora state quantificate dal punto di vista clinico. / Purpose: To compare helical tomotherapy (HT) and intensity modulated proton therapy (IMPT) on prostate cancer treatments delivered with simultaneous integrated boost (SIB) in moderate hypofractionation. Material and methods: Eight patients treated with HT were replanned with two-field IMPT (2fIMPT). The prescribed dose was 74 Gy in 28 fractions on PTV1 (prostate + proximal seminal vesicles) and 65.8 Gy on PTV2 (distal seminal vesicles) and 54 Gy on PTV3 (pelvic lymph-node). Results: IMPT and HT achieved similar target coverage and dose homogeneity. Above 65 Gy, HT and IMPT were equivalent in the rectum, while IMPT spared the bladder and the penile bulb from 0 to 70 Gy. From 0 up to 60 Gy, IMPT dosimetric values were (much) lower for all OARs except the femur heads, where HT was better than 2fIMPT in the 25–35 Gy dose range. OARs mean doses were typically reduced by 30–50% by IMPT. Conclusions: HT and IMPT produce similar dose distributions in the target volume. A clear dosimetric advantage of IMPT on HT is obtained with medium and low doses. The current knowledge on dose–effect relations does not allow to quantify the clinical impact of the large sparing of IMPT at medium-to-low doses.

We investigate whether Swedish insiders use an information advantage on future goodwill impairments to engage in net selling activity prior to public announcement. We further hypothesize greater insider net selling in impairment firms with a higher degree of goodwill in their balance sheets and in impairment firms in less transparent information environments. The insider trading is traced two years prior to the announcement of goodwill impairments in a sample between 2004-2012. Univariate and multivariate analyses are performed, comparing impairment firms with non-impairment firms. The results indicate that impairment firms engage in abnormal net selling up to six months prior to the announcement date. In addition, impairment firms with a higher degree of goodwill and with higher transparency are net selling to a higher extent up to six months prior to announcement date, although these findings only provide moderate predicting values. No significant results are discovered earlier than six months prior to announcement. These findings are incongruent with previous research.

Obiettivo: valutare la tossicità ed il controllo di malattia di un trattamento radioterapico ipofrazionato ad alte dosi con tecnica ad intensità modulata (IMRT) guidata dalle immagini (IGRT) in pazienti affetti da carcinoma prostatico a rischio intermedio, alto ed altissimo di recidiva. Materiali e metodi: tutti i pazienti candidati al trattamento sono stati stadiati e sottoposti al posizionamento di tre “markers” fiduciali intraprostatici necessari per l’IGRT. Mediante tecnica SIB – IMRT sono stati erogati alla prostata 67,50 Gy in 25 frazioni (EQD2 = 81 Gy), alle vescichette 56,25 Gy in 25 frazioni (EQD2 = 60,35 Gy) e ai linfonodi pelvici, qualora irradiati, 50 Gy in 25 frazioni. La tossicità gastrointestinale (GI) e genitourinaria (GU) è stata valutata mediante i CTCAE v. 4.03. Per individuare una possibile correlazione tra i potenziali fattori di rischio e la tossicità registrata è stato utilizzato il test esatto di Fisher e la sopravvivenza libera da malattia è stata calcolata mediante il metodo di Kaplan-Meier. Risultati: sono stati arruolati 71 pazienti. Il follow up medio è di 19 mesi (3-35 mesi). Nessun paziente ha dovuto interrompere il trattamento per la tossicità acuta. Il 14% dei pazienti (10 casi) ha presentato una tossicità acuta GI G ≥ 2 e il 15% (11 pazienti) ha riportato una tossicità acuta GU G2. Per quanto riguarda la tossicità tardiva GI e GU G ≥ 2, essa è stata documentata, rispettivamente, nel 14% dei casi (9 pazienti) e nell’11% (7 pazienti). Non è stata riscontrata nessuna tossicità, acuta o cronica, G4. Nessun fattore di rischio correlava con la tossicità. La sopravvivenza libera da malattia a 2 anni è del 94%. Conclusioni: il trattamento radioterapico ipofrazionato ad alte dosi con IMRT-IGRT appare essere sicuro ed efficace. Sono comunque necessari ulteriori studi per confermare questi dati ed i presupposti radiobiologici dell’ipofrazionamento del carcinoma prostatico. / Purpose: to evaluate toxicity and control of disease with hypofractionated high-dose intensity-modulated (IMRT) and image guided (IGRT) radiotherapy in patients with intermediate, high and very high risk of prostate cancer. Materials and Methods: patients eligible for treatment were staged and three fiducial "markers" needed for IGRT were implanted in the prostate. It was delivering with SIB- IMRT 67,50 Gy in 25 fractions (EQD2 = 81 Gy) to the prostate, 56,25 Gy in 25 fractions (EQD2 = 60,35 Gy) to the seminal vesicles and 50 Gy in 25 fractions to the pelvic lymph nodes, when irradiated. Gastrointestinal (GI) and genitourinary (GU) toxicity were assessed using CTCAE v. 4.03. Correlation between potential risk factors and toxicity was performed using the Fisher's test and disease-free survival was calculated using the Kaplan-Meier method. Results: seventy-one patients were evaluated. The mean follow-up was 19 months (3-35 months). No patient had to discontinue treatment for acute toxicity. 14% of patients (10 cases) presented acute GI G ≥ 2 and 15% (11 patients) reported acute toxicity GU G2. Regarding the late toxicity GI and GU G ≥ 2, it has been detected, respectively, in 14% (9 patients) and 11% of cases (7 patients). There was no incidence of any acute or late toxicity G4. No risk factor correlated with toxicity. The disease-free survival at 2 years was 94%. Conclusions: hypofractionated high-dose IMRT-IGRT radiotherapy appears to be safe and effective. However, further studies are needed to confirm these data and the radiobiological bases of hypofractionated radiotherapy of prostate cancer.

För knappt ett år sedan fann Norges högsta domstol i ett uppmärksammat pleniavgörande att DNB Bank hade ingått ett oskäligt investeringsavtal med småspararen Røeggen. Domen är intressant för svenskt vidkommande i förhållande till både oskälighetsbedömningen och valet av rättsföljd. Syftet med uppsatsen är att utifrån ett praktiskt perspektiv analysera oskälighetsbedömningen och innebörden av ogiltighet enligt 36 § avtalslagen. Det sker genom en utredning av den oskälighetsbedömning som leder fram till att ett avtal ogiltigförklaras. Vidare företas en analys av ogiltighetens rättsverkningar. Slutsatsen är att betydelsen av ogiltighet enligt 36 § skiljer sig från övriga ogiltighetsregler i avtalslagen. Normalfallet vid en tillämpning av 36 § är att rättshandlingen blir ogiltig för framtiden, medan huvudregeln för de traditionella ogiltighetsgrunderna är att alla prestationer ska gå åter.

Generalklausulen ska vara tillämplig inom hela förmögenhetsrätten, vilket talar för att det således inte bör vara ett bekymmer att tillämpa den vid ett befogenhetsöverskridande i en- lighet med aktiebolagsrätten. Detta är dock inte solklart med tanke på att aktiebolagslagen föreskriver annat. Ett bolag kan t.ex. bli bundet av en rättshandling som företagits av bo- lagsföreträdare eller särskild firmatecknare där denne genom rättshandlingen överskrider sin befogenhet. Bolaget blir härvid bunden av rättshandlingen såvida bolaget självt inte kan påvisa att tredje man varit i ond tro. Ett bolag blir också bundet av en rättshandling som företagits av styrelsen eller den verkställande direktören där befogenhetsöverskridandet sker genom att överträda bolagsordningen eller andra föreskrifter som t.ex. har meddelats av ett annat bolagsorgan. I det här avseendet tar aktiebolagslagen dock varken hänsyn till en överträdelse av bolagets verksamhetsföremål eller det faktum att tredje man likväl kun- nat vara i ond tro, bolaget blir bundet av rättshandlingen gentemot tredje man ändå. Häri- genom blir generalklausulen och jämkning i förhållande till befogenhetsöverskridande i ak- tiebolagslagen av intresse eftersom att en sådan tillämpning i praktiken inte bör vara ett hinder. Norsk domstol har påvisat att ett avtal som företagits genom befogenhetsöverskri- dande kan jämkas med hjälp av generalklausulen i avtalslagen. / The general clause in contract law is said to apply throughout property law and therefore it implies that it should also apply to circumstances in which representatives of a company abuses their right to act on behalf of the company. This situation is however regulated dif- ferently in accordance with company law. Therefore it is not obvious for the general clause to apply to representatives abuses of such, since the company law has other consequences in mind regarding management abuse. A company can, for instance be bound by an act undertaken by the general representative or special signatory where he, by that act exceeds his authority. The company is hereby bound by the act unless the company itself can prove that the third party acted in bad faith. Moreover a company will be bound by an act under- taken by the Board of Directors or the President, where they abuse their right to act on be- half of the company, in violation of statutes or regulations such has been issued by another company organ. With regards to this, the company legislation does not account neither the violation of the company's objects nor the fact that third party nevertheless could have act- ed in bad faith. Regardless, the company is bound by the act of their representative against third party, according to company law. With regards to this the general clause and its possi- bilities to adjustments becomes noteworthy in relation to representatives abuse of acts, considering that such an application should, in practice, not be an obstacle. The Norwegian court has established just that, and an act undertaken via representatives abuse of power can be adjusted by the general clause according to contract law.

Inauguraldiss. Wirtsch.-wiss. Univ. Saarland (Saarbrücken), 2005.