Cases reported "Radiation Injuries"

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1/11. Use of polyglactin 910 mesh (Vicryl) in pelvic oncologic surgery.

    Various synthetic materials have been shown to be useful surgical adjuncts in shielding the small intestine from pelvic radiation or in creating a new pelvic floor after major radical resections. Promising preliminary results with a polyglactin 910 (Vicryl) mesh in preventing radiation enteropathy prompted the authors to evaluate its clinical usefulness in reconstruction of the pelvic floor. Use of this mesh in pelvic exenterations (five total, one posterior) for advanced or recurrent gynecologic malignancies was associated with one enteroperineal fistula but no pelvic infection. In comparison with other pelvic reconstruction devices, this absorbable mesh significantly reduced intestinal morbidities in pelvic exenterations. This procedure appears to be feasible, reproducible, and safe, especially in patients who have undergone previous irradiation or those with an unsuitable omentum.
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ranking = 1
keywords = gynecologic
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2/11. radiation-associated ischemic coloproctitis: report of two cases.

    radiation-associated ischemic coloproctitis is a rare clinical entity caused by vascular insufficiency to the rectosigmoid colon. It most commonly occurs after radiotherapy for gynecological cancer. We present herein the cases of two patients who developed radiation-associated coloproctitis with transmural necrosis and eventual perforation. Perforation of the rectosigmoid colon occurred 3.5 years after radiotherapy in case 1, a 46-year-old woman, and presented as a well-defined small area of transmural necrosis. Conversely, in case 2, a 55-year-old woman, it occurred 1.5 years after radiotherapy, and presented as segmental, diffuse transmural necrosis. The lesion in case 1 had been caused by intramural vascular obliteration due to marked fibrosis of the bowel wall, while that in case 2 had been caused by occlusion of the mesenteric artery with thrombosis. Both patients underwent Hartmann's resection without rectal excision, and survived the perforative event.
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ranking = 1
keywords = gynecologic
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3/11. Fatal recurrent ureteroarterial fistulas after exenteration for cervical cancer.

    BACKGROUND: Ureteroarterial fistula (UAF) is a rare occurrence. It can be difficult to diagnose with a high mortality. We report a case of a recurrent UAF. CASE: A 38-year-old women diagnosed with cervical cancer had undergone pelvic exenteration for severe radiation-induced necrosis with a vesicovaginal and rectovaginal fistula after primary radiation therapy. hemorrhage into the urinary tract necessitated surgical intervention and vascular repair with a femoral-femoral bypass. Although these measures were effective, the patient died 6 months later following an acute hemorrhage into her conduit. Arteriogram revealed a second UAF. CONCLUSION: When urinary tract bleeding occurs in patients previously diagnosed with a gynecologic malignancy and treated with radiation therapy and extensive surgery with urinary diversion, UAF should be considered in the differential diagnoses.
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ranking = 1
keywords = gynecologic
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4/11. Early-onset sigmoid colon perforation during concurrent chemoradiation in a patient with cervical cancer.

    radiation-induced colon perforation is a rare adverse effect caused by vascular and connective tissue injury to the rectosigmoid colon. It usually occurs a few months to years after radiotherapy for gynecological cancer. Herein, we present a patient who developed sigmoid colon perforation during concurrent chemoradiotherapy for cervical cancer. The patient was a 64-year-old clinical stage IIB woman who received concurrent chemoradiotherapy as a standard treatment. The chemotherapeutic protocol was cisplatin 50 mg/m(2) and 5-fluorouracil 4000 mg, starting together with radiotherapy. After the completion of external beam radiation for 4500 cGy, the patient developed sigmoid colon perforation presenting with fecal peritoneum and sepsis. An emergency end ileostomy with resection of entire sigmoid colon was performed and the patient was discharged 3 months later in good condition. Clinicians must be highly suspicious of serious bowel perforation, even if the full dose of radiation has not been completed. Whether or not the chemotherapy was the trigger factor is in need of further clarification.
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ranking = 1
keywords = gynecologic
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5/11. Incorporation of SPECT bone marrow imaging into intensity modulated whole-pelvic radiation therapy treatment planning for gynecologic malignancies.

    BACKGROUND AND PURPOSE: To incorporate single-photon emission computed tomography (SPECT) bone marrow (BM) imaging into the treatment planning process to reduce the volume of BM irradiated in gynecologic patients receiving intensity-modulated whole-pelvic radiation therapy (IM-WPRT). MATERIALS AND methods: A planning CT scan was obtained of a patient with early stage endometrial cancer. The same patient also underwent a Tc-99m sulfur colloid SPECT scan of the pelvis. Tc-99m sulfur colloid is sequestered by the macrophages in the BM thereby identifying areas of active (red) BM. Using image fusion software, the SPECT scan was aligned with the planning CT scan and used to delineate regions of active BM. An IMRT plan was then generated to provide coverage of the planning target volume (PTV) while sparing areas of active BM and other normal pelvic structures. RESULTS: The areas of high active BM density were observed predominantly in the lumbar vertebrae, sacrum and medial iliac crests. IMRT planning reduced the dose to these areas by 50% for doses greater than 30Gy compared to conventional planning. Furthermore, the IMRT plan did not compromise coverage of the PTV or sparing of normal tissues. CONCLUSIONS: Our results suggest that SPECT-BM imaging is a useful adjunct to IMRT planning in gynecologic patients undergoing IM-WPRT.
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ranking = 6
keywords = gynecologic
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6/11. Pelvic radiation necrosis and osteomyelitis following chemoradiation for advanced stage vulvar and cervical carcinoma.

    BACKGROUND: The treatment regimen indicated for most advanced stage vulvar, vaginal, and cervical cancer usually involves adjuvant chemoradiation therapy. Although the risk of complications is low, there have been reported cases of radiation necrosis and osteomyelitis following treatment for vulvar, vaginal, and cervical cancer. CASES: We present a vulvar cancer patient and a cervical cancer patient, both of whom were treated with radical surgery and postoperative chemoradiation. Following therapy, they were afflicted with pelvic radiation necrosis and osteomyelitis. The patients underwent surgery to resect the necrotic bone tissue and long-term antibiotic therapy to treat their osteomyelitis. They have since recovered and are followed closely by their gynecologic oncology and infectious disease physicians. CONCLUSION: The radiotherapy utilized to treat advanced stage gynecologic cancer can cause intestinal, vaginal, and urologic complications from micro-vascular damage to the organs. Pelvic bone osteonecrosis is a rare but disabling complication of pelvic radiation. Fortunately, with aggressive therapy, these patients may do well clinically.
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ranking = 2
keywords = gynecologic
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7/11. Postirradiation angiosarcoma of the vaginal vault.

    We describe a unique case of an angiosarcoma arising in the vaginal vault 21 years after hysterectomy and radiotherapy for stage I carcinoma of the cervix. We also review the literature regarding angiosarcomas arising after previous radiation therapy for gynecologic malignancies.
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ranking = 1
keywords = gynecologic
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8/11. Pathologic Malgaigne fracture following pelvic irradiation. A case report.

    A 48-year-old woman developed symptomatic superior and inferior pubic rami fractures with a concomitant subluxation of the ipsilateral sacroiliac joint three years after pelvic irradiation for a gynecologic malignancy. Pathologic pelvic fractures (PPF) caused by irradiation may be difficult to distinguish from those caused by metastatic disease. PPF produce prolonged disability.
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ranking = 1
keywords = gynecologic
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9/11. Fractured ureteral catheters in gynecologic oncology.

    Two cases of fractured polyethylene double-pigtail ureteral catheters in pelvic cancer patients are reported. Current literature leaves a large void in guiding the management of these catheters. Surveillance techniques to help avoid complications in patients requiring these catheters are suggested.
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ranking = 4
keywords = gynecologic
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10/11. Arterial occlusion complicating treatment of gynecologic cancer: a case series.

    The objective in this paper is to describe the severity and outcome of arterial occlusion complicating treatment of women with gynecologic cancer. A series of six patients who underwent amputation were identified. Acute arterial occlusions were seen in three patients. One patient suffered extensive thrombosis of the hand and wrist resulting in amputation 3 weeks after cytoreductive surgery and chemotherapy for Fallopian tube cancer. She had a history of pulmonary embolism and deep-vein thrombosis. This patient was thought to have thrombophilia. One elderly patient with known arteriosclerosis developed sepsis following radical deep excision and groin dissection for vulvar cancer and lost two digits presumably due to microemboli. One patient developed thrombosis of the femoral artery on the second day following cytoreductive surgery for ovarian cancer. She responded to anticoagulation therapy; however, necrosis remained in portions of the heel and toes. Three patients underwent amputation of a lower extremity when they developed chronic arterial insufficiency after pelvic radiotherapy. The patients were irradiated at the ages of 28, 30, and 35 years for cervix cancer in two patients and a low-grade retroperitoneal sarcoma in one patient. Two received neutron beam therapy and one received conventional photon beam therapy. All three had extensive late radiation morbidity to the bladder and rectum and had multiple prior surgeries. The amputations occurred at the ages of 48, 48, and 55 due to accelerated arteriosclerosis. Two patients died as a result of this complication. Acute and chronic arterial occlusions are rare yet dramatic complications of therapy for gynecologic cancer. This series illustrates the predisposing factors, presentation, and management of these unusual events.
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ranking = 6
keywords = gynecologic
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