Hypersensitivity reactions to ibuprofen and acetaminophen: A report of case with literature review

The higher the use of nonsteroidal anti-inflammatory drugs (NSAIDs), the more reports of adverse drug reactions, especially in children than in adults. As patients with fever take several NSAIDs alternatively, suspected symptoms allergic to drugs with different chemical structures are also experienced in the clinical field. This is because it appears not only through immunological mechanisms but also through cross-intolerant reactions. Therefore, when hypersensitivity to one or more NSAIDs is present, it is important to distinguish between the 2 mechanisms for future treatment planning. Although it is difficult to distinguish between the 2 mechanisms by clinical history, drug provocation test with aspirin is helpful in diagnosis. A 4-year-old patient who had urticaria/angioedema and shortness of breath after taking ibuprofen and acetaminophen visited Kangwon National University Hospital for a treatment plan using antipyretics and/or analgegics forward. We propose a diagnosis and treatment protocol for such patients with a brief literature review.

Reduction of Electron ContaminationUsing a Filter for 6MV Photon Beam / 대한치료방사선과학회지

PURPOSE: Secondary electrons generated by interaction between primary X-ray beam and block tray in megavoltage irradiation, result in excess soft radiation dose to the surface layer. To reduce the surface dose from the electron contamination, electron filters were attached under the tray when a customized block was used. MATERIALS AND METHODS: Cu, Al or Cu/Al combined plate with different thickness was used as a filter and the surface dose reduction was measured for each case. The measurement to find optimal filter was performed with 10cm x 10cm field size and 78.5cm source to surface distance. The measurement points are positioned with 2mm intervals from surface to maximum build-up point. To acquire the effect of field size dependence on optimal electron filter, the measurement was performed from 4cm x 4cm to 25cm x 25cm field sizes. RESULTS: The surface dose was slowly increased by increasing irradiation field but rapidly increased beyond 15cm x 15cm field size. Al plate was found to be inadequate filter because of the failure to have surface dose kept lowering than the dose of deep area. Cu 0.5mm plate and Cu/Al= 0.28mm/1.5mm combined plate were found to be optimal filters. By using these 2 filters, the absorbed dose to the surface layer was effectively reduced by 5.5%, 11.3%, and 22.3% for the field size 4cm x 4cm, 10cm x 10cm, and 25cm x 25cm, respectively. CONCLUSION: The surface dose attributable to electron contamination had a dependence on field size. The electron contamination was increased when tray was used. Specially the electron contamination in the surface layer was greater when the larger field was used. 0.5mm Cu plate and Cu/Al=0.28mm/1.5mm combined plates were selected as optimal electron filters. When the optimal electron filter was attached under the tray, excessive surface dose was decreased effectively. The effect of these electron filters was better when a larger field was used.

Results of Radiotherapy in Nasopharyngeal Cancer / 대한치료방사선과학회지

PURPOSE: The aim of this study was to assess the effectiveness, survival rate and complication of radiation therapy in nasopharyngeal cancer. MATERIALS AND METHODS: From January 1980 to May 1989, Fifty Patients who had nasopharyngeal carcinoma treated with curative radiation therapy at Kosin Medical Center were retrospectively studied. Thirty seven patients(74%) were treated with radiation therapy alone(Group I) and 13 patients (26%) treated with combination fo chemotherapy and radiation(Group II). Age distribution was 16-75 years(median:45.8 years). In histologic type, squamous cell carcinoma was in 30 patients(60%), undifferentiated carcinoma in 17 patinets(34%), and lymphoepithelioma in 3 patients(6%). According to AJCC staging system, 4 patinets(8%) were in T1, 13 patients(2%) in T2, 20 patients(40%) in T3, 13 patients(26%) in T4 and 7 patients(14%) in N0, 6 patients(12%) in N1, 23 patients(46%) in N2, 14 patients (28%) in N3. Total radiaton dose ranges were 5250-9200 cGy(median : 7355 cGy) in Group I and 5360-8400 cGy(median :6758cGy) in Group II. Radiotherapy on 4-6MV linear accelerator and/or 6-12MeV electron in boost radiation was given with conventional thechnique to 26 patinets(52%), with hyperfractionation(115-120cGy/fr., 2times/day) to 16 patients(32%), with accelerated fractionation(160cGy/fr., 2 times/day) to 8 patients(16%). In Chemotherapy, 5 FU 1000mg daily for 5 consecutive days, pepleomycin 10mg on days 1 and 3, and cisplatin 100mg on day 1 were administered with 3 weeks interval, total 1 to 3 cycles(average 1.8cycles) prior to radiation therapy. Follow up duration was 6-140 months(mean:58 months). Statistics was calculated with Chi-square and Fisher's exact test. RESULTS: Complete local control rates in Group I and II were 75.7%, 69.2%. Overall 5 year survival rates in Group I and II were 56.8%, 30.8%. Five year survival rates by histologic type in Group I and II were 52.2, 14.3% in squamous cell carcinoma an d 54.5%, 50% in undifferentiated carcinoma. Survival rates in Group I were superior to those of Group II though there were not statistically significant. In both group, survival rates seem to be increased according to increasing total dose of radiation up to 7500cGy, but not increased beyond it. There were not statistically significant differences in survival rates by age, , stage, and radiation tehchniques in both group. Twenty four patients (48%) experienced treatment failures. Complications were found in 12 patients(24%). The most common one was osteomyelitis(4 patients, 33.3%) involving mandible (3 patients) and maxilla(1patient). CONCLUSION: Chemotherapy in combination with radiotherapy was found to be not effective to nasopharyngeal cancer and the survival rate was also inferior to that of radiation alone group though it was statistically not significant due to small population in chemotherapy combined group.

Results of Radiation Therapy in Stage III Uterine Cevical Cancer / 대한치료방사선과학회지

PURPOSE: The aim of this study is to analyze the survival rate, treatment failure and complication of radiation therapy alone in stage III uterine cervical cancer. MATERIALS AND METHODS: From January 1980 through December 1985, 227 patients with stage II uterine cervical cancer treated with radiation therapy at Kosin Medical Center were retrospectively studied. Among 227 patients, 72 patients(31.7%) were stage IIIa, and 155 patients(68.3%) were stage IIIb according to FIGO classification. Age distribution was 32-71 years(median: 62 years). Sixty nine patients(95.8%) in stage IIIa and 150 patients(96.8%) in stage IIIb were squamous cell carcinoma. Pelvic lymphnode metastasis at initial diagnosis was 8 patients (11.1%) in stage IIIa and 29 patients(18.7%) in stage IIIb. Among 72 patients with stage IIIa, 36 patients(50%) were treated with external radiation therapy alone by conventional technique (180-200 cGy/fr). And 36 patients(50%) were treated with external radiation therapy with intracavitary radiotherapy(ICR) with Cs137 sources, and among 155 patients with stage IIIb, 80 patients(51.6%) were treated with external radiation therapy alone and 75 patients(48.4%) were treated with external radiation therapy with ICR. Total radiation doses of stage IIIa and IIIb were 65-105 Gy(median : 78.5 Gy) and 65-125.5 Gy (median :83.5 Gy). Survival rate was calculated by life-table method. RESULTS: Complete response rates were 58.3% (42 patients) in state IIIa and 56.1%(87 patients) in stage Iiib. Overall 5 year survival rates were 57% in stage IIIa and 40% in stage IIIb. Five year survival rates by radiation technique in stage IIIa and IIIb were 64%, 40% in group treated in combination of external radiation and ICR, and 50%, 40% in the group of external radiation therapy alone(P=NS). Five year survival rates by response of radiation therapy in stage IIIa and IIIb were 90%, 66% in responder group, and 10%, 7% in non-responder group (p<0.01). There were statistically no significances of 5 year survival rate by total radiation doses and external radiation doses (40 Gy vs 50 Gy) of whole or true pelvis in stage IIIa and IIIb(P=NS). Treatement failures rates were 40.3%(29 patients) in stage IIIa and 57.4%(89 patients) in stage IIIb, 17 patients (23.6%) in stage IIIa and 46 patients (29.7%) in stage IIIb experienced complications. Total radiation doses more than 85 Gy produced serious complication in both stage IIIa(50%) and Iib(50%), Serious complicaton rates were higher in group received externl radiaton doses of 50 Gy than 40 Gy to whole or true pelvis in stage IIIa and IIIb. Seious rectal complication developed in rectal doses more than 65 Gy, and serious bladder complication developed in bladder doses more than 75 Gy. Major cause of deah was cachexia due to locoregional failure in both stage IIIa(34.7%) and IIIb(43.9%). CONCLUSION: From this study, we found that external radiation therapy with ICR was found to have a tendency to be superior to external radiation therapy alone in survival rate, local control rate and complication rate but not different in statistics, and external radiation doses of 50 Gy than 40 Gy tho whole or true pelvis produced serious rectal and bladder complications in stage III uterine cervical cancer.

Dosimetric Consideration of the Lung Block in the Mantle Field / 대한치료방사선과학회지

PURPOSE: To evaluate the dose under lung block as a function of depth and the effectiveness of a block as a function of block width. MATERIALS AND METHODS: Field size of mantle field was 22.8 x 32.4 cm2 . Dose distribution of the mantle field was measured with two dimensional water phantom system. To analyze the effectiveness of the lung block, central axis plane, 5cm off-axis plane, and 10cm off-axis plane were studied. RESULTS: The dose under the lung block was recorded with maximum at the depth between , 5cm and 10cm . In the central axis plane, dosimetric block width was 10-15% les than physical block width. In the 5cm off-axis plane. Dosimetric block width was 4-9% less than physical block width. In the 10cm off-axis plane, dosimetric block width was 2% less than physical block width. CONCLUSION: Depth dependence of the dose under the lung block was founded. Also, block width dependence of the lung block was founded. To induce the accurate relation between the physical block width and the "effective" block width, it needs more detailed understanding of the variables involved.

The Study of Tissue Dose Perturbation by Air Cavity with 6MV Photon Beam / 대한치료방사선과학회지

PURPOSE: To determine the perturbation effect in the tissue downstream from surface layers of lesions located in the air/tumor-tissue interface of larynx using 6MV photon beam. MATERIALS AND METHODS: Thermoluminescent dosimeters(TLDs). Were embedded at 3 measurement locations in slab no.7 of a humanoid phantom and exposed to forward and backward direction using various field sizes(4X4cm2 - 15X15 cm2). RESULTS: At the air/tissue interface, forward dose perturbation factor(FDPF) is about 1.085 with 4X4 cm2, 1.05 with 7X7 cm2, 1.048 with 10X10cm2, and 1.041 with 15X15cm2. Backscatter dose perturbation factor(BDPF) is about 0.99 with 4X4cm2, 0.981 with 7X7cm2, 0.956 with 10X10cm2 and 0.97 with 15X15cm2 . CONCLUSION: FDPF is greater as field size is smaller. And FDPF is smaller as the distance is further from the air/tissue interface.

The Study of Tissue Dose Perturbation by Air Cavity with 6MV Photon Beam / 대한치료방사선과학회지

PURPOSE: To determine the perturbation effect in the tissue downstream from surface layers of lesions located in the air/tumor-tissue interface of larynx using 6MV photon beam. MATERIALS AND METHODS: Thermoluminescent dosimeters(TLDs). Were embedded at 3 measurement locations in slab no.7 of a humanoid phantom and exposed to forward and backward direction using various field sizes(4X4cm2 - 15X15 cm2). RESULTS: At the air/tissue interface, forward dose perturbation factor(FDPF) is about 1.085 with 4X4 cm2, 1.05 with 7X7 cm2, 1.048 with 10X10cm2, and 1.041 with 15X15cm2. Backscatter dose perturbation factor(BDPF) is about 0.99 with 4X4cm2, 0.981 with 7X7cm2, 0.956 with 10X10cm2 and 0.97 with 15X15cm2 . CONCLUSION: FDPF is greater as field size is smaller. And FDPF is smaller as the distance is further from the air/tissue interface.