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A pig-borne virus causing viral encephalitis amongst human beings in Malaysia was detected in 1997 by the Ministry of Health. Initially, the disease was considered to be Japanese encephalitis. Subsequently, it was thought to be a Hendra-like viral encephalitis, but on 10th April, 1999 the Minister of Health announced this mysterious and deadly virus to be a new virus named Nipah virus. AIMS: To present the interim results of a phase I trial on stereotactic radiosurgery (SRS) delivered using volumetric modulated arc therapy (VMAT) in patients with primary or metastatic tumours in different extracranial sites.MATERIALS AND METHODS: Patients were enrolled in different arms according to tumour site and clinical stage, and sequentially assigned to a given dose level. Acute toxicity, tumour response and early local control were investigated and reported.RESULTS: One hundred lesions in 65 consecutive patients (male/female: 30/35, median age: 66 years; range: 40-89) were treated. Of these 100 lesions, 21 were primary or metastatic lung tumours, 24 were liver metastases, 30 were bone metastases, 24 were nodal metastases and one was a primary vulvar melanoma. The commonest symptom was jaundice (unconjugated 2). Other symptoms were left hypochondrial pain, tiredness, syncope and failure to thrive. Ray Ban Store Splenomegaly and microcytosis was detected in all. PURPOSE: The goals of any treatment for ischemic vascular disease are to relieve pain, allow wound healing, and regain/maintain ambulatory abilities. To determine if endovascular therapy could accomplish these goals in patients with limbs at risk, we undertook a retrospective analysis of the results of percutaneous transluminal angioplasty (PTA) and thrombolysis in leg salvage.METHODS: Over an 8-year period ending in 1993, 327 patients (209 males, 118 females) with limb-threatening ischemia (defined as one or more of the following: ischemic rest pain, ischemic ulceration, or gangrene) in 361 limbs were seen. These patients had an ankle-brachial index < or = 0.40 in nondiabetic patients and/or toe-brachial index < or = 0.30 in diabetic patients. Well-crafted systemically developed clinical practice guidelines (CPGs) are intended to frame current medical knowledge in a manner that will assist health care providers in delivering high quality care. CPGs are being used in Ray Ban Frames the malpractice arena to define a credible standard of care to measure the accused physician for an alleged problem addressed. This may occur despite a medical society's disclaimer that they are not intended, nor devised, for that purpose.  

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