ABSTRACT
Resumen La radioterapia mediastínica es uno de los tratamientos fundamentales de las enfermedades malignas torácicas, pero también representa una causa potencial de complicaciones, tanto a corto como a largo plazo. Se presenta una serie de casos de rotura de vena innominada durante esternotomía media en pacientes con fibrosis mediastínica. Los tres casos descritos corresponden a pacientes intervenidos de cirugía cardiaca con antecedentes de radioterapia mediastínica, entre 15-30 años antes de la cirugía, por tres diferentes enfermedades malignas (linfoma de Hodgkin, timoma y cáncer de mama). En los tres casos se reporta rotura de la vena innominada, con desinserción de su origen en la vena cava superior debido a fibrosis mediastínica intensa.
Abstract Although mediastinal radiotherapy is one of the basic treatments of malignant thoracic diseases, it is also a potential cause of short and long-term complications. A series of cases of rupture of the innominate vein during sternotomy are presented in patients with mediastinal fibrosis. The three cases described correspond to patients intervened by cardiac surgery, with a history of mediastinal radiotherapy between 15 to 30 years before the surgery, due to three different malignant diseases (Hodgkin lymphoma, thymoma, and breast cancer). In the three cases, a rupture of the innominate vein is reported; with de-insertion of its origin in the superior vena cava sue to intense mediastinal fibrosis.
Subject(s)
Humans , Female , Middle Aged , Thoracic Surgery , Fibrosis , Vena Cava, Superior , Breast Neoplasms , Hodgkin Disease , Brachiocephalic VeinsABSTRACT
We report a patient, who had neuropathic pain after radiation, called “chronic post-radiation pain syndrome,” who was successfully treated by Shimbuto. The patient was a 83-year-old man, diagnosed with Stage IB non-small cell lung cancer of the left upper lobe. Although the lesion had a surgical indication, he selected radiotherapy, and stereotactic body radiotherapy was performed. A few months later, he experienced neuropathic pain in his anterolateral chest wall. Loxoprofen and acetaminophen had little effect; moreover, tramadol hydrochloride/acetaminophen combination tablets and pregabalin induced drowsiness and dizziness. He then wanted to take Kampo medicine (Japanese traditional medicine) and was observed to have susceptibility to gastrointestinal disorders and cold intolerance by Kampo diagnosis. We prescribed Shimbuto 5 g per day, along with pregabalin. After 2 months, the pain had almost disappeared and he could stop taking pregabalin. Shimbuto is usually prescribed to patients at a risk of gastrointestinal disorders, pain, numbness, and other symptoms induced by cold intolerance. Shimbuto includes the extract of processed aconite root, which is effective for pain and numbness; therefore, it might be a good option for treating neuropathic pain when we have difficulties with Western medicine.
ABSTRACT
Las complicaciones de la radioterapia se pueden presentar de manera aguda, subaguda o retardada y son diferentes en sus manifestaciones, según afecten al cerebro, la médula espinal o los nervios periféricos. Se presentaron 2 pacientes que recibieron tratamiento con radioterapia y después de un año del proceder terapéutico desarrollaron manifestaciones clínicas e imaginológicas compatibles con una mielopatía posradiación. Ninguno ha tenido progresión de la enfermedad con el uso de los esteroides aplicados...
Complications of radiation therapy can occur in acute, subacute or delayed manner and they are different in manifestations, as they affect the brain, spinal cord or peripheral nerves. Two patients who were treated with radiotherapy were presented and after a year of therapeutic procedure, they developed clinical manifestations and imaging features consistent with a post-radiation myelopathy. None had disease progression with the use of steroids...
Subject(s)
Humans , Spinal Cord Diseases/complications , Spinal Cord Diseases/radiotherapy , Myelitis/diagnosis , Myelitis/prevention & control , Radiotherapy/adverse effects , Radiation RisksABSTRACT
A 71-year-old man with double vessel disease (left anterior descending artery and right coronary artery) was surgically treated by off-pump coronary artery bypass grafting. He had undergone pre-sternal subcutaneous gastric tube reconstruction and mediastinal radiation therapy 19 years previously due to esophageal cancer. The gastric tube prevented the median sternotomy that is commonly necessary for cardiac surgery. In cases with difficulties of median sternotomy, left anterolateral thoracotomy and the use of the subclavian artery as inflow root for bypass grafting are available. Both radial arteries were harvested as graft conduit, because of prospective severe adhesion of left internal thoracic artery due to previous radiation. The radial artery was anastomosed on the back side of the left subclavian artery with side-to-end fashion. Y-shaped composite graft was made with the other arterial graft. Both ends were anastomosed to the left anterior descending artery and the right posterior descending branch on the beating heart status without cardiopulmonary bypass. Intra-operative SPY images showed good patency of both bypass grafts. The post-operative course was eventful. The catheter angiography revealed all graft patency 5 years after the surgery.
ABSTRACT
La terapia de coagulación con argón plasma (APC) ha tomado importancia en la última década en la endoscopia gastrointestinal, y está posicionada como una técnica efectiva en el tratamiento de lesiones del tracto digestivo. Su efectividad fue inicialmente reportada en el tratamiento paliativo de neoplasias gastrointestinales y, posteriormente, su uso se ha extendido para múltiples indicaciones, entre ellas el tratamiento de sangrado debido a angiodisplasias, proctitis por radioterapia y hoy en día es utilizada para control de hemorragia gastrointestinal en lesiones vasculares como Dieulafoy. En la actualidad su uso se ha extendido, con el advenimiento de la enteroscopia, a lesiones del intestino delgado en especial las angioectasias. En este estudio se describe la experiencia de dos instituciones con el uso endoscópico del APC, y se exponen las indicaciones y efectividad del tratamiento. Métodos: Entre noviembre del 2007 y abril del 2009, la terapia con argón plasma se utilizó para el tratamiento de 65 pacientes con patologías del tracto digestivo con fin terapéutico, ya fuera curativo o paliativo con un total de 134 sesiones. El tratamiento se efectuó en dos centros de cuarto nivel de atención, el Hospital Universitario San Ignacio y la Clínica de Marly en Bogotá - Colombia. Resultados: El tratamiento con APC se realizó en 65 pacientes, utilizando en total 134 sesiones de argón. Las indicaciones para su uso son similares a las reportadas en la literatura: proctitis actínica, angiodisplasias, ectasia vascular antral y control de sangrado por lesiones tumorales. Se utilizó además en control de sangrado por lesión vascular de Dieulafoy y en el control de hemorragia por úlcera péptica sangrante con vaso expuesto. No se presentaron complicaciones mayores, lo que respalda lo expuesto en la literatura en relación a que es una técnica efectiva y segura para el manejo de diversas patologías del tracto digestivo.Conclusiones: La experiencia recogida en este estudio descriptivo demuestra el posicionamiento de la técnica del APC en nuestro medio, con una amplia gama de indicaciones sobre patologías del tracto digestivo y un excelente margen de efectividad y seguridad. Si se tienen presentes las indicaciones y recomendaciones para su aplicación, el uso del argón es una técnica sencilla, útil y efectiva.
In the last decade Argon Plasma Coagulation therapy (APC) has become important in gastrointestinal endoscopy. It is regarded as an effective technique in the treatment of lesions in the gastrointestinal tract. Its effectiveness was initially reported in the palliative treatment of gastrointestinal neoplasm, but its use has subsequently been extended to multiple indications such as treatment of bleeding angiodysplastic lesions, proctitis via radiotherapy and for gastrointestinal hemorrhage control of lesions such as Dieulafoys lesion. With the advent of enteroscopy its use has been extended to small intestinal lesions, especially to Angioectasias. This study describes indications and effectiveness of treatment in the experience of two institutions that make endoscopic use of APC.Methods: Between November, 2007 and April, 2009 Argon Plasma therapy was used in a total of 134 sessions for either curative or palliative treatment of 65 patients with digestive tract pathologies. Treatments were performed in two level four attention centers, the San Ignacio University Hospital and the Marly Clinic, both located in Bogotá, Colombia. Results: 65 patients received APC treatment in a total of 134 sessions. Indications for its use were similar to those reported in the literature: actinic proctitis, angiodysplasia, antral vascular ectasia and control of bleeding due to tumoral lesions. It was also used to control bleeding from vascular lesions such as Dieulafoys lesion and for hemorrhage control for bleeding peptic ulcers with exposed vessels. The absence of greater higher complications validates reports in the literature that this is a safe and effective technique for management of several digestive tract pathologies. Conclusions: The experience collected in this descriptive study shows that the addition of the APC technique in our environment provides a high range of indications about digestive tract pathologies with good effectiveness and safety margin. Reasonable use of Argon Plasma Coagulation therapy (APC), keeping in mind indications and recommendations for its application, is a simple, useful and effective technique
Subject(s)
Humans , Male , Adult , Aged, 80 and over , Aged , Female , Argon , Dilatation, Pathologic , Gastric Antral Vascular Ectasia , Gastrointestinal Tract , Hemorrhage , Plasma , ProctitisABSTRACT
Purpose To describe the clinical and pathological features of atypical vascular lesions (AVLs) after conservative surgery and radiation of the breast cancer,and to discuss the association with post-radiation angiosarcoma.Methods The clinical and pathological features in one case of AVLs was evaluated.The literatures were reviewed.Results The patient is a 57-yeAR~-old female who underwent a conservative surgery of the right breast because of a carcinoma.She received standard dose of radiation as adjuvant therapy.Three years later, multiple erythematous plaques developed around the former scar, which radiated to the nipple.Clinically,the plaques were considered as relapses of the carcinoma.However, fine needle aspiration gave negative results.Biopsy of one large plague revealed a circumscribed vascular lesion confined to the superficial dermis.It was composed of thin-walled anastomosing lymphatic vessels lined by attenuated endothelial cells.In focal areas, the vessels extended to the mid-dermis.Immunohistochemically, the endothelial cells were positive for CD31, CD34 and D2-40,with absent of α-SMA positive pericytes.Review of the breast tumor sections showed an invasive micropapillary carcinoma.Conclusions AVLs is a rare vascular lesion related with conservative surgery and post-radiation therapy of the breast.AVLs may represent as a precursor of breast angiosarcoma.Being familiar with the clinicopathologic characteristics of AVLs is important not only for the pathologists but also for the clinicians.
ABSTRACT
BACKGROUND: 'Eight drugs in a day' was one of the widely used regimen in medulloblastoma. Result of treatment of this regimen and comparison between pre-RT chemotherapy and post-RT chemotherapy were presented. METHODS: Medical records of children who were diagnosed as medulloblastoma and treated with 8 in 1 therapy in Seoul National University Children's Hospital from January 1986 to June 1997 were reviewed. RESULTS: 1) Forty nine cases(male: 30, female: 19) were analyzed. The age at diagnosis was between 3 months and 15 years 3 months and median age was 7 years 10 months. 2) The T stage by Chang classification revealed T1(2%), T2(26%), T3a(9%), T3b(56%), and T4(7%) in 43 cases. M stage revealed M0(46%), M1(15%), M3(37%), and M4(2%) in 41 cases. The surgical results revealed gross total resection(36%), near total resection(18%), subtotal resection(38%), and partial resection(9%). 3) The 5-yr disease free survival(DFS) rate of all tumors was 53%. There was no difference in DFS about sex, age, pathology, T stage, M stage, and surgical result. 4) Difference of 5-year DFS between pre-RT chemotherapy group(53%) and post-RT chemotherapy group(83%) was significant[-2Log(LR), P=0.023], excluding the patient relapsed or too young(below 18 month, who had more chemotherapy to delay radiation) to be received radiation therapy. CONCLUSIONS: DFS in post-RT chemotherapy was better than pre-RT chemotherapy. As medulloblastoma has the property to confine in CNS system, prior treatment with radiation as a intensive local therapy may be more effective than the systemic chemotherapy. Progression or relapse were the main causes of treatment failure. Result of treatment may be improved by more intensive therapy.
Subject(s)
Child , Female , Humans , Classification , Diagnosis , Drug Therapy , Medical Records , Medulloblastoma , Pathology , Recurrence , Seoul , Treatment FailureABSTRACT
Nowday, ionizing radiation is one of the methods eradicating the uterine cervical malignancy. However radiation alone or in combination with surgery have an effect on normal tissue as well as the malignant cells, and their changes have been well described in other countries. Unfortunately, the history of radiation modality for cancer treatment is relatively short and the reports about radiation induced changes are limited in our country. We evaluated the radiation-induced changes in cervico-vaginal smears of 107 uterine cervical cancer patients obtained from March, 1985 to October, 1987. Most patients had been received 5,400 Rads of external radiation and intracavitary radiation. Patient's age ranged from 30 to 67 years old. Of 107 cases, 24 cases were normal, 72 cases showed benign radiation changes, 7 cases revealed radiation dysplasia, and residual and recurrent carcinomas found in one and 3 cases, respectively. Cytoplasmic and nuclear enlargement were the most common and noted in 57 and 38 cases, respectively. Vacuolization and polychromasia of the cytoplasm were identified in 43 and 30 cases, respectively. The most common histiocytic change was multinucleation, which was found in about one third. The radiation changes of the cytoplasm and nuclear enlargement persisted for a long time after completion of radiation, however, nuclear degeneration and multinucleation gradually disappeared after 6 months. The inflammation in background prolonged for a long time but degeneration disappeared after 6 months. The biologic significance of post-radiation dysplasia could not evaluated because of short follow up period.
ABSTRACT
Nowday, ionizing radiation is one of the methods eradicating the uterine cervical malignancy. However radiation alone or in combination with surgery have an effect on normal tissue as well as the malignant cells, and their changes have been well described in other countries. Unfortunately, the history of radiation modality for cancer treatment is relatively short and the reports about radiation induced changes are limited in our country. We evaluated the radiation-induced changes in cervico-vaginal smears of 107 uterine cervical cancer patients obtained from March, 1985 to October, 1987. Most patients had been received 5,400 Rads of external radiation and intracavitary radiation. Patient's age ranged from 30 to 67 years old. Of 107 cases, 24 cases were normal, 72 cases showed benign radiation changes, 7 cases revealed radiation dysplasia, and residual and recurrent carcinomas found in one and 3 cases, respectively. Cytoplasmic and nuclear enlargement were the most common and noted in 57 and 38 cases, respectively. Vacuolization and polychromasia of the cytoplasm were identified in 43 and 30 cases, respectively. The most common histiocytic change was multinucleation, which was found in about one third. The radiation changes of the cytoplasm and nuclear enlargement persisted for a long time after completion of radiation, however, nuclear degeneration and multinucleation gradually disappeared after 6 months. The inflammation in background prolonged for a long time but degeneration disappeared after 6 months. The biologic significance of post-radiation dysplasia could not evaluated because of short follow up period.