Cases reported "Radiation Injuries"

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1/9. 'Full dose' reirradiation of human cervical spinal cord.

    With the progress of modern multimodality cancer treatment, retreatment of late recurrences or second tumors became more commonly encountered in management of patients with cancer. spinal cord retreatment with radiation is a common problem in this regard. Because radiation myelopathy may result in functional deficits, many oncologists are concerned about radiation-induced myelopathy when retreating tumors located within or immediately adjacent to the previous radiation portal. The treatment decision is complicated because it requires a pertinent assessment of prognostic factors with and without reirradiation, radiobiologic estimation of recovery of occult spinal cord damage from the previous treatment, as well as interactions because of multimodality treatment. Recent studies regarding reirradiation of spinal cord in animals using limb paralysis as an endpoint have shown substantial and almost complete recovery of spinal cord injury after a sufficient time after the initial radiotherapy. We report a case of "full" dose reirradiation of the entire cervical spinal cord in a patient who has not developed clinically detectable radiation-induced myelopathy on long-term follow-up of 17 years after the first radiotherapy and 5 years after the second radiotherapy.
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2/9. The role of radiation in delayed hearing loss in nasopharyngeal carcinoma.

    Although radiation damage to the inner ear can be induced experimentally in animals, its incidence in humans as a complication of therapy for nasopharyngeal carcinoma (NPC) remains a matter of conjecture due to inadequate histological validation. A case of advanced NPC with a mixed conductive and neurosensory hearing loss is presented that at necropsy showed tumour invasion of the VIIIth cranial nerve in the internal auditory meatus with associated infection. The architecture of the organ of corti was well-preserved despite heavy doses of radiation but degeneration, the cause of which could not be substantiated, was present in the auditory nerve pathway. A diagnosis of radiation damage to the end-organ of hearing in the absence of supporting histological evidence should be made with caution.
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3/9. Synergism between radiotherapy and vascular risk factors in the accelerated development of atherosclerosis: a report of three cases.

    radiotherapy is commonly used in the management of testicular tumors. However, to date the risk of radiation-induced vascular occlusive disease in men following radiotherapy for testicular cancer has not been regarded as a major factor in their long-term care. Several animal studies have shown the importance of established vascular risk factors such as hypercholesterolemia and hypertension in the pathogenesis of radiation-induced atherosclerosis. This report presents three cases of premature chronic iliofemoral arterial disease presenting 5,13, and 16 years following exposure to therapeutic irradiation for the treatment of testicular cancer. The patients were in the age group of 40-45 years and all demonstrated associated known atherosclerotic risk factors. The patients had received radiotherapy in the dose of 3,500-4,000 rads in a standard "dog-leg" fashion to the ipsilateral aortoiliac lymphatic chain. Our results showed that young men treated with radiotherapy for testicular cancer may be targeted from the outset for atherosclerotic risk factor reduction to minimize the risk of development of late chronic occlusive arterial disease. It may be that a cohort of men so treated with historical regimes of radiotherapy and now entering middle age should be screened for arterial disease and risk factor reduction.
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4/9. Bilateral retinal phototoxic injury during cataract surgery in a child.

    The intense illumination of the operating microscope has been implicated in photic retinopathy in patients and in animal studies. We report a case of bilateral macular phototoxicity occurring in an eleven-year-old child who underwent bilateral cataract surgery for radiation cataracts. We are unaware of other reports of retinal toxicity occurring during pediatric cataract surgery. We hypothesize that this child may have been predisposed to macular injury because of previous chemotherapy and radiotherapy exposure. Ophthalmic surgeons should be aware that light toxicity from the operating microscope might also occur in the pediatric population.
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5/9. Isolated left main coronary stenosis and mediastinal irradiation.

    This report draws an association between mediastinal irradiation and isolated left main coronary artery stenosis. The report highlights two patients who developed selective left main coronary artery stenosis post mediastinal treatment. In the animal model, it has been shown that high serum cholesterol levels at the time of, or soon after, irradiation are necessary to initiate arteriosclerotic plaque formation.
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6/9. Management of laryngeal radionecrosis: animal and clinical experience.

    Radiation necrosis of the laryngeal cartilages is an uncommon complication of radiotherapy for laryngeal carcinoma. It is a devastating process for which there is no one acceptable treatment. Medical management offers only temporary, symptomatic relief, which further necessitates surgical treatment. Surgical management may start with a tracheotomy; however, it often ends with a total laryngectomy. Physiologically, the necrotic cartilages are the source of the problem. It is a general surgical principle that nonviable tissue must be excised to promote healing. Therefore, if the affected laryngeal cartilages were removed, the larynx should heal. Total or near total removal of the thyroid and cricoid cartilages with preservation of the endolaryngeal soft tissues has not been reported in the literature. Theoretically, if the entire cartilaginous framework is removed, there would be no structural support for the airway. We have found using animal models, that submucosal resection of the laryngeal cartilages, leaving the perichondrium and endolaryngeal soft tissues intact can result in a competent airway. Animal and clinical experience will be presented.
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7/9. Unexpected toxicity from radiation therapy in two patients with Kaposi's sarcoma receiving interferon.

    Two homosexual men with Kaposi's sarcoma and acquired immune deficiency received radiation therapy to the oral mucosa while treatment with recombinant leukocyte A interferon was being given systemically at a dose of 36 million units. Symptoms of radiation mucositis developed after the administration of 900 rad in the first patient and 1,050 rad in the second patient. Radiation therapy had to be stopped after doses of 1,100 and 2,100 rad, respectively, had been given. Both patients had to be admitted to the hospital for supportive care and the second patient required placement of a feeding tube. To our knowledge, no other clinical observations suggesting interactions of radiation therapy and interferon have been reported. We discuss the results of experiments with cultured cells and experimental animals which suggest that such interactions occur and may be successfully exploited therapeutically.
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8/9. High-frequency electromagnetic radiation injury to the upper extremity: local and systemic effects.

    Industrial use of radiofrequency and microwave energy sources (nonionizing, high-frequency electromagnetic radiation) is a growing and widespread phenomenon, with projected risks of exposure to more than 20 million workers in the united states. A description of the nature of this form of electromagnetic energy is given, with emphasis on the variability of energy absorption by humans. The current state of biological research is reviewed, and a summary of the known effects of radiofrequency and microwave radiation exposure on animals and humans provided. These known effects appear to be principally thermal, similar to conventional electrical burn injuries, but with some unique systemic expression. Derangements of cardiovascular, gastrointestinal, endocrine, hematological, ophthalmological, and behavioral functions are well described in animal experimentation. Two patients are presented--one a young woman exposed to a high-density radiofrequency field in an industrial setting, leading to necrosis of the entire hand and wrist as well as to a constellation of systemic effects, and one an older woman exposed to excessive microwave radiation from a malfunctioning microwave oven, leading to chronic hand pain and paresthesias resembling median nerve entrapment at the carpus. The prevalence of potential exposure in certain industries is noted and recommendations for follow-up care of workers exposed to this form of trauma are delineated.
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9/9. Complete small bowel obstruction in the early postoperative period complicating surgical sling procedure.

    The surgical insertion of an absorbable sling mesh has become the most promising technique for excluding the small bowel from the pelvis prior to radiotherapy. Both human and animal studies suggest that this procedure is very safe. The author reports what appears to be the first significant mesh-related complication. A 69-year-old man suffered early postoperative complete mechanical small bowel obstruction after insertion of a polyglactin 910 (Vicryl) surgical sling mesh at the time of low anterior resection for a stromal sarcoma of the rectum. Urgent laparotomy was required and revealed that the Vicryl mesh was associated with an intense inflammatory reaction. Radiation therapy is a critical component of contemporary multimodal treatment of patients with rectal cancer. This case suggests that inserting biodegradeable mesh to protect the small bowel from radiation effects is not without complications.
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