Cases reported "Radiation Injuries"

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1/12. Fatal hemorrhage complicating carcinoma of the esophagus. Report of four cases.

    Four cases of esophageal carcinoma complicated by fatal hemorrhage are reported. All four patients had recently completed radiation therapy. An aortoesophageal fistula was present in two cases; fibrinoid necrosis of the esophageal arteries was present in the other two. The esophageal tumor was localized in two cases and had disappeared in one case. In one patient it had metastasized widely. Ninety-nine other reports of esophageal cancer and fatal hemorrhage are reviewed from the literature. Aortoesophageal fistula was the cause of hemorrhage in 78 cases. Occlusion of the vasa vasorum by thrombosis, inflammation, neoplastic cells or radiation injury appears to be the cause of aortic necrosis and fistula formation. Prompt surgical approach, if possible, should be used to control hemorrhage, as the primary tumor may be localized to the esophagus only.
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keywords = esophagus
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2/12. Case of radiation-induced esophageal ulcer worsened after endoscopic biopsy.

    Esophageal ulcer is one of the most important late complications of the esophagus treated with radiation therapy, especially with intraluminal brachytherapy. We encountered a patient with esophageal cancer treated with external radiation therapy and intraluminal brachytherapy, who developed radiation ulcer and who had severe dysphagia soon after endoscopic biopsy of the ulcer edge. A 55-year-old man was diagnosed as esophageal cancer without symptoms. He received 60 Gy/30 Fr of external radiation therapy and 12 Gy/3 Fr of intraluminal brachytherapy at a point of 5 mm in depth from the mucosa surface. He developed an asymptomatic esophageal ulcer 13 months after treatment, and endoscopic biopsy was obtained from the edge of the ulcer. Thereafter, swallowing difficulties appeared, and endoscopy revealed severe esophageal stenosis and a deep ulcer. A possibility that the biopsy contributed to worsening the ulcer can be considered. Except for cases where relapse is apparent, endoscopic biopsy is considered to be avoided.
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ranking = 0.2
keywords = esophagus
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3/12. Surgical repair of esophagobronchial fistula caused by radiation injury.

    We present an unusual case of a benign esophagobronchial fistula caused by radiotherapy to treat esophageal carcinoma which was closed successfully. A 62-year-old man with superficial squamous cell carcinoma of the esophagus underwent radiotherapy, including 60 Gy externally and 10 Gy intraluminally from January to March 1995. Esophagography revealed a fistula between the esophagus and left main stem bronchus on January 14, 1996. No residual cancer existed. Neither stenting with a silicone tube nor with a covered flexible metallic stent occluded the fistula. Thoracic esophagectomy, closure of the esophagobronchial fistula using a 2-cm nubbin of esophageal wall, surrounding the orifice of the fistula and antesternal gastric pull-through reconstruction with mediastinal lymphadenectomy were performed. The postoperative course was uneventful and there is no evidence of recurrence of the fistula or the cancer 5 years postoperatively. Radiotherapy may cause esophagobronchial fistula even in cases of superficial esophageal cancer. Bypass surgery should be considered because stenting is not effective for benign fistula without stricture.
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ranking = 0.4
keywords = esophagus
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4/12. Treatment of a radiation-induced esophageal web with retrograde esophagoscopy and puncture.

    OBJECTIVE: To present a technique for the treatment of complete esophageal stenosis in the post-radiation patient that may be applied to selected patients with obstructing stenoses. STUDY DESIGN: A case report of the treatment of a post-radiation esophageal web. methods: A review of the patient's history of treatment and a discussion of reported treatment options. RESULTS: A complete obstruction of the cervical esophagus was diagnosed in a patient after chemoradiation for a hypopharyngeal carcinoma. Retrograde esophagoscopy through the patient's percutaneous endoscopic gastrostomy tube site aided visualization and perforation of the obstructing tissue. Subsequent dilation has allowed the patient to resume oral intake of a regular diet without restrictions. CONCLUSION: Combined direct laryngoscopy with retrograde esophagoscopy represents a viable alternative to more extensive approaches for recannulization of selected obstructing esophageal stenoses.
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keywords = esophagus
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5/12. Esophageal motor dysfunction years after radiation therapy.

    Well-known complications of radiation to the esophagus are acute esophagitis and strictures. Although radiologic studies have demonstrated motor abnormalities after radiation treatment, clinical aspects have not been described adequately, nor have manometric evaluations been reported. Clinical presentation of dysphagia long after treatment also has not been reported. We describe herein three patients who presented with dysphagia years after radiation therapy. Radiographic, endoscopic, histologic, and manometric studies supported our conclusion that these patients suffered from radiation-induced esophageal motor dysfunction. This report indicates the need, in the proper setting, to consider radiation-induced motor dysfunction as a cause of dysphagia even decades after radiation treatment.
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ranking = 0.2
keywords = esophagus
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6/12. Esophageal obstruction 14 years after treatment for Hodgkin's disease.

    The incidence of late radiation injury of the esophagus is not precisely determined but, overall, the occurrence of clinically apparent damage is infrequent. The authors report a complete esophageal obstruction in a 21-year-old man, 14 years after chemo-radiation therapy for Hodgkin's lymphoma. Although endoscopy failed to demonstrate a gross morphologic abnormality, an esophagogram detected abnormal peristalsis and stricture, and esophageal manometry coupled with dynamic isotopic study clearly demonstrated a multilevel secondary neuronal damage. Data in the literature suggest that alteration in motility is by far the most frequent radiologic manifestation. Further prospective studies will probably clarify the actual incidence of late esophageal damage after chemo-radiation therapy.
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ranking = 0.2
keywords = esophagus
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7/12. Chemo-irradiation induced aortoesophageal fistula.

    A patient with squamous cell carcinoma of the esophagus developed fatal aortoesophageal (AE) fistula following a preoperative course of combined chemotherapy plus radiation therapy. This is the first reported case of AE fistula following preoperative chemoradiotherapy. This complication is potentially correctable if suspected early, since the massive hemorrhage characteristic of AE fistula is usually preceded by an initial sentinel hemorrhage. The cause of this complication is not clear, but it may be due to inflammation of the vasa vasorum with necrosis of the aortic wall. The concomitant use of fluorouracil and cisplatin with radiation therapy acts as a radiosensitizer and may have potentiated the radiation effect on the aortic wall.
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ranking = 0.2
keywords = esophagus
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8/12. Treatment of pharyngoesophageal stenosis by polyvinyl prosthesis.

    Many authors have objected to the use of esophageal stents in the palliative management of lesions obstructing the cervical esophagus, especially when the prosthesis must lie within 2 cm of the cricopharyngeus muscle (CPM). Ten patients with stenosis of the cervical esophagus by lesions within 2 cm of or involving the CPM were considered for prosthesis placement. The prosthesis was successfully placed in eight patients, five of whom had a tracheoesophageal fistula (TEF). A prosthesis could not be placed in two patients, and two patients complained of a minimal but tolerable foreign body sensation. Six prostheses were custom-made. The necessity to place a prosthesis within 2 cm of or even immediately proximal to the CPM should not be considered an absolute contraindication to esophageal prosthesis placement in selected patients. Foreign body sensation may be absent or minimal, and stent migration is common.
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ranking = 0.4
keywords = esophagus
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9/12. One-stage repair of a cervical esophagostome with two myocutaneous flaps from the neck and shoulder.

    A large esophagostome in a heavily radiated neck was reconstructed in one stage, using a sternocleidomastoid myocutaneous flap for lining and a trapezius myocutaneous flap for covering. The patient began eating on the seventh day and was discharged on the tenth day following the repair. barium swallow studies demonstrated a widely patent esophagus, and the patient now has good esophageal speech.
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ranking = 0.2
keywords = esophagus
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10/12. A cuffed tube for the treatment of oesophago-bronchial fistulae.

    An oesophageal tube provided with a foam-rubber cuff is described. The outside diameter of the cuff can be diminished while the tube is being introduced. After implantation, the expanded foam-rubber cuff achieves additional sealing of the oesophago-bronchial fistula. The tube described is suitable for sealing off oesophago-bronchial fistulae in the absence of the tumour-induced stenosis of the oesophagus.
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ranking = 0.2
keywords = esophagus
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