Radiation-Induced Breast Angiosarcoma

2016 ◽  
Vol 20 (4) ◽  
pp. 304-307 ◽  
Author(s):  
Cheryl Brus Peterson ◽  
Solange Beauregard
Keyword(s):  
Radiation Treatment ◽  
Treatment Options ◽  
Left Breast ◽  
Diagnostic Methods ◽  
Aggressive Disease ◽  
Patient Reported ◽  
Impact On Survival ◽  
Long Term Follow Up ◽  
Radiation Induced ◽  
High Index Of Suspicion

Importance: Radiation-induced angiosarcoma after conservative treatment of breast cancer affects a small percentage of patients but has a significant impact on survival. Early detection requires a high index of suspicion and is important for optimal management of this aggressive disease. Observations: The patient reported here presented with radiation-induced angiosarcoma of the left breast 14 years after radiation therapy. Histopathology was positive for anti-CD31, anti-CD34, D2-40, and anti–factor VIII (von Willebrand). She underwent a total mastectomy and is still in remission 20 months later. The authors present a review of the clinical presentation, diagnostic methods, and treatment options. Conclusions: This case report demonstrates the importance of long-term follow-up and investigation of even the subtlest cutaneous changes in the breast after radiation treatment, because radiation-induced angiosarcoma is a very aggressive disease that could benefit from early diagnosis and management.

Treatment of hepatocellular carcinoma (HCC) after sorafenib (S) over the last 10 years.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 438-438
Author(s):  
Andrea S. Fung ◽  
Richard M. Lee-Ying ◽  
Daniel E. Meyers ◽  
Hao-Wen Sim ◽  
Jennifer J. Knox ◽  
...  
Keyword(s):  
Radiation Treatment ◽  
Performance Status ◽  
Treatment Options ◽  
Poor Performance ◽  
Outcome Data ◽  
Subsequent Treatment ◽  
Poor Performance Status ◽  
Kaplan Meier ◽  
Impact On Survival ◽  
Prognostic Group

438 Background: Until recently there were no standard treatments for HCC patients after S. This study characterizes subsequent treatments (STx) received by HCC patients over the past 10 years and assesses their impact on survival. Methods: HCC patients treated with S between 01/2008 – 06/2017 in British Columbia, Alberta, and two cancer centers in Toronto, Ontario, Canada (Princess Margaret and Sunnybrook Cancer Centre) were included. Clinical, pathologic, laboratory, treatment, and outcome data were collected. The Kaplan-Meier method was used to assess overall survival (OS) based on STx, and stratified according to a better prognostic group (BPG), defined as ECOG 0-1 and CP-A, and worse prognostic group (WPG), defined as ECOG≥2 or CP-B/C. Results: A total of 730 patients were identified. 177 (24.2%) received STx (table). Patients who received STx had longer median OS (mOS) than those who had no further treatment (12.1 vs. 3.3 months; p < 0.001). For patients treated with localized, systemic, or palliative radiation treatment, mOS was 16.8, 10.5 and 8.6 months, respectively (p < 0.001). After S, there were 206 (30.7%) patients in the BPG and 464 (69.3%) in the WPG. BPG patients were more likely to receive STx compared to WPG patients (60.5% vs. 39.5%, p < 0.001). BPG patients who received STx had better mOS than those who did not (15.9 vs. 7.0 months; p < 0.001). WPG patients also had better mOS if they received STx compared to those who did not (6.0 vs. 2.6 months; p < 0.001). Conclusions: Only a small proportion of HCC patients received subsequent treatment after sorafenib. This is likely due to poor performance status, liver dysfunction, or lack of treatment options. Patients who received subsequent treatment had improved mOS, regardless of whether they were in the better or worse prognostic group. [Table: see text]

Bilateral congenital choanal atresia encountered in late adulthood

2012 ◽  
Vol 126 (9) ◽  
pp. 949-951 ◽  
Author(s):  
E Ç Tatar ◽  
A Özdek ◽  
F Akcan ◽  
H Korkmaz
Keyword(s):  
English Language ◽  
Treatment Options ◽  
Choanal Atresia ◽  
Diagnostic Methods ◽  
Nasal Discharge ◽  
Nasal Breathing ◽  
Transnasal Approach ◽  
English Language Literature ◽  
Patient Reported ◽  
Language Literature

AbstractObjective:We describe a case of bilateral congenital choanal atresia in the oldest patient reported with this condition in the recent English language literature.Method:Case report and a review of the relevant English language literature, presenting the embryopathogenesis, diagnostic methods and treatment options for this condition.Results:A 53-year-old woman having difficulty with nasal breathing, and with a continuous nasal discharge, was admitted to our clinic. Bilateral congenital choanal atresia was diagnosed by endoscopic examination and paranasal sinus computed tomography. Surgical treatment used an endoscopic transnasal approach. The follow-up examination a year later revealed adequate choanal openings bilaterally.Conclusion:To our knowledge, this is the oldest patient with bilateral congenital choanal atresia to be reported in the recent literature. This condition is rarely encountered in adulthood but should be considered as a possible differential diagnosis of persistent nasal obstruction.

scholarly journals Vesical Gossypiboma with Urethral Migration Causing Acute Urinary Retention: A Case Report and Review of the Literature

2022 ◽  
Author(s):  
Kaleab Habtemichael Gebreselassie ◽  
Ferid Ousman Mummed ◽  
Fitsum Gebreegziabher Gebrehiwot ◽  
Mubarek Bargicho Adem ◽  
Ramzi Yessuf Adem ◽  
...  
Keyword(s):  
Urinary Retention ◽  
Acute Urinary Retention ◽  
Treatment Options ◽  
Pelvic Surgery ◽  
Surgical Removal ◽  
Diagnostic Challenge ◽  
Surgical Sponge ◽  
Retained Surgical Sponge ◽  
Patient Reported ◽  
High Index Of Suspicion

Abstract Introduction: Vesical gossypiboma is a retained surgical sponge in the urinary bladder following abdominal or pelvic surgery. It is probably under-reported due to medico-legal issues. It usually poses a diagnostic challenge to clinicians. A high index of suspicion is essential to make a timely diagnosis. Case Presentation: We present a case of vesical gossypiboma in a 64-year-old male patient who presented with a history of persistent lower urinary tract symptoms (LUTS) and acute urinary retention following trans-vesical prostatectomy. The urinary retention was relieved by a suprapubic cystostomy. On cystoscopic examination, a large whitish spongiform structure in the urethra and bladder was revealed. A gentle attempt of cystoscopic removal was failed. At exploration, a retained surgical sponge was revealed and removed from the bladder. Postoperatively, the patient reported improvement of symptoms and was passing urine normally. Discussion Vesical gossypiboma is relatively rare as very few isolated cases have been reported, and its migration through the urethra is even rarer. Patients with intravesical gossypiboma may manifest with either acute or chronic symptoms due to complications. Gossypiboma is an avoidable condition, and its occurrence can be prevented by thorough exploration of the surgical site and count of surgical materials at the end of the procedure. Conclusion Vesical gossypiboma should be considered as a differential diagnosis in patients with persistent LUTS following open bladder or prostate surgery. Open surgical removal is one of the feasible treatment options. But prevention is a preferable solution.

A retrospective case series looking at the effectiveness of hyperbaric oxygen in treating radiation cystitis.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 127-127 ◽  
Author(s):  
Scott Gorenstein ◽  
Aaron Katz ◽  
Kimberly Regan ◽  
Donna Hangan
Keyword(s):  
Radiation Therapy ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Radiation Treatment ◽  
Case Series ◽  
University Hospital ◽  
Radiation Cystitis ◽  
Patient Reported ◽  
Radiation Induced

127 Background: A side effect of radiation therapy to treat genitourinary cancers is radiation-induced cystitis, which in its most severe form can be hemorrhagic cystitis (HC). Some studies have found the incidence of HC in radiation patients to range from 3% to 6.5% after radiation therapy and can develop anywhere from 6 months after radiation therapy to 10 years or more after the last treatment. The severity of symptoms, which includes hematuria, may drastically reduce quality of life. Recent studies have shown that hyperbaric oxygen therapy has improved symptoms of radiation cystitis in around 80% of patients. Methods: Sixty patients who received hyperbaric oxygen therapy (HBOT) for radiation-induced cystitis since 2010 at Winthrop University Hospital were identified. IRB approval was obtained for contacting these patients to gather outcome data. Patient reported outcomes were evaluated using a questionnaire that assessed the type and duration of radiation treatment, treatment other than HBOT for HC symptoms, surgical intervention, and patient perceived outcomes of HBOT. Results: 36 patients were consented. The average age of the patient was 71 with a range from 29-91. The majority of the patients 78% had prostate cancer with the Colon, Uterinem, Bladder and Testicular cancer also included The average time from completion of radiation to onset of symptoms was 3 years. The mean number of treatments was 35 with a range of 18-120 treatments. All treatments were for 90 minutes at 2.4 ATA. The majority of the patients (24) had external beam radiaiation and 12 patients had a urological procedure after completion of their therapy. 78 % of the patients reports either moderate improvement or complete resolution of symptoms. Conclusions: This case series seems to demonstrate that Hyperbaric Oxygen Therapy appears to be an effective treatment for radiation cystitis, however additional studies are necessary.

scholarly journals Vesical Gossypiboma with Urethral Migration Causing Acute Urinary Retention: A Case Report and Literature Review

2022 ◽  
Author(s):  
Kaleab Habtemichael Gebreselassie ◽  
Ferid Ousman Mummed ◽  
Fitsum Gebreegziabher Gebrehiwot ◽  
Mubarek Bargicho Adam ◽  
Ramzi Yesuf Adam ◽  
...  
Keyword(s):  
Urinary Retention ◽  
Acute Urinary Retention ◽  
Treatment Options ◽  
Pelvic Surgery ◽  
Surgical Removal ◽  
Diagnostic Challenge ◽  
Surgical Sponge ◽  
Retained Surgical Sponge ◽  
Patient Reported ◽  
High Index Of Suspicion

Abstract Introduction: Vesical gossypiboma is a retained surgical sponge in the urinary bladder following abdominal or pelvic surgery. It is probably under-reported due to medico-legal issues. It usually poses a diagnostic challenge to clinicians. A high index of suspicion is essential to make a timely diagnosis. Case Presentation: We present a case of vesical gossypiboma in a 64-year-old male patient who presented with a history of persistent lower urinary tract symptoms (LUTS) and acute urinary retention following trans-vesical prostatectomy. The urinary retention was relieved by a suprapubic cystostomy. On cystoscopic examination, a large whitish spongiform structure in the urethra and bladder was revealed. A gentle attempt of cystoscopic removal was failed. At exploration, a retained surgical sponge was revealed and removed from the bladder. Postoperatively, the patient reported improvement of symptoms and was passing urine normally. Clinical Discussion: Vesical gossypiboma is relatively rare as very few isolated cases have been reported, and its migration through the urethra is even rarer. Patients with intravesical gossypiboma may manifest with either acute or chronic symptoms due to complications. Gossypiboma is an avoidable condition, and its occurrence can be prevented by thorough exploration of the surgical site and count of surgical materials at the end of the procedure. Conclusion Vesical gossypiboma should be considered as a differential diagnosis in patients with persistent LUTS following open bladder or prostate surgery. Open surgical removal is one of the feasible treatment options. But prevention is a preferable solution.

scholarly journals Buccal mucosal graft urethroplasty for radiation-induced urethral strictures: an evaluation using the extended Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM)

2020 ◽  
Vol 38 (11) ◽  
pp. 2863-2872 ◽  
Author(s):  
Malte W. Vetterlein ◽  
◽  
Luis A. Kluth ◽  
Valentin Zumstein ◽  
Christian P. Meyer ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Urethral Stricture ◽  
Outcome Measure ◽  
Patient Reported Outcome ◽  
Patient Reported Outcome Measure ◽  
Urethral Strictures ◽  
Buccal Mucosal Graft ◽  
Surgery Patient ◽  
Patient Reported ◽  
Radiation Induced

Abstract Objectives To evaluate objective treatment success and subjective patient-reported outcomes in patients with radiation-induced urethral strictures undergoing single-stage urethroplasty. Patients and methods Monocentric study of patients who underwent single-stage ventral onlay buccal mucosal graft urethroplasty for a radiation-induced stricture between January 2009 and December 2016. Patients were characterized by descriptive analyses. Kaplan–Meier estimates were employed to plot recurrence-free survival. Recurrence was defined as any subsequent urethral instrumentation (dilation, urethrotomy, urethroplasty). Patient-reported functional outcomes were evaluated using the validated German extension of the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM). Results Overall, 47 patients were available for final analyses. Median age was 70 (IQR 65–74). Except for two, all patients had undergone pelvic radiation therapy for prostate cancer. Predominant modality was external beam radiation therapy in 70% of patients. Stricture recurrence rate was 33% at a median follow-up of 44 months (IQR 28–68). In 37 patients with available USS PROM data, mean six-item LUTS score was 7.2 (SD 4.3). Mean ICIQ sum score was 9.8 (SD 5.4). Overall, 53% of patients reported daily leaking and of all, 26% patients underwent subsequent artificial urinary sphincter implantation. Mean IIEF-EF score was 4.4 (SD 7.1), indicating severe erectile dysfunction. In 38 patients with data regarding the generic health status and treatment satisfaction, mean EQ-5D index score and EQ VAS score was 0.91 (SD 0.15) and 65 (SD 21), respectively. Overall, 71% of patients were satisfied with the outcome. Conclusion The success rate and functional outcome after BMGU for radiation-induced strictures were reasonable. However, compared to existing long-term data on non-irradiated patients, the outcome is impaired and patients should be counseled accordingly.

scholarly journals Three-year clinical and radiological results of a cruciate-retaining type of the knee prosthesis with anatomical geometry developed in Japan

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Arata Nakajima ◽  
Manabu Yamada ◽  
Masato Sonobe ◽  
Yorikazu Akatsu ◽  
Masahiko Saito ◽  
...  
Keyword(s):  
Knee Prosthesis ◽  
Cruciate Retaining ◽  
Radiolucent Lines ◽  
Radiographic Outcomes ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Total Knee ◽  
Clinical And Radiological Results ◽  
Anatomical Geometry

Abstract Background The FINE total knee was developed in Japan and clinical use began in 2001. It has unique design features, including an oblique 3o femorotibial joint line that reproduces anatomical geometry. Although 20 years have passed since the FINE knee was clinically used for the first time in Japan, a formal clinical evaluation including patient-reported and radiographic outcomes has not been undertaken. Methods A total of 175 consecutive primary cruciate-retaining (CR)-FINE total knee arthroplasties (TKAs) at our hospital between February 2015 and March 2017 were included in this study. Three years postoperatively, range of motion (ROM), Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint Score (FJS) were recorded and compared with preoperative scores. Radiographic analyses including mechanical alignment, component alignment, and incidence of radiolucent lines also were undertaken based on the radiographs 3 years postoperatively. Results One-hundred twenty-two knees (70%) were available for 3-year follow-up data using KOOS, except for the sports subscale. Postoperative KOOS-symptom, −pain and -ADL were > 85 points, but KOOS-sports, −QOL and FJS were less satisfactory. ROM, KSS and all the subscales of KOOS were significantly improved compared with preoperative scores. Postoperative mean FJS was 66 and was significantly correlated with all the subscales of KOOS, but not with postoperative ROM. Radiolucent lines ≧1 mm wide were detected in five knees (4.1%). There were no major complications needing revision surgeries. Conclusions Patient-reported outcomes (PROs) for symptoms, pain and ADL after the CR-FINE TKA were generally improved, but those for sports, QOL and FJS were improved less. The incidence of radiolucent lines was rare but detected around the femoral components. With the mid- to long-term follow-up, improvements of surgical technique will be necessary to achieve better PROs from patients receiving the FINE knee.

scholarly journals The ‘wave sign’ in hip arthroscopy: a systematic review of epidemiological factors, current diagnostic methods and treatment options

2020 ◽  
Author(s):  
Jason Derry Onggo ◽  
James Randolph Onggo ◽  
Mithun Nambiar ◽  
Andrew Duong ◽  
Olufemi R Ayeni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Protective Factor ◽  
Treatment Options ◽  
Arthroscopic Surgery ◽  
Classification Systems ◽  
Diagnostic Methods ◽  
Suture Repair ◽  
Significant Heterogeneity ◽  
Epidemiological Factors

ABSTRACT This study aims to present a systematic review and synthesized evidence on the epidemiological factors, diagnostic methods and treatment options available for this phenomenon. A multi-database search (OVID Medline, EMBASE and PubMed) was performed according to PRISMA guidelines on 18 June 2019. All studies of any study design discussing on the epidemiological factors, diagnostic methods, classification systems and treatment options of the wave sign were included. The Newcastle–Ottawa quality assessment tool was used to appraise articles. No quantitative analysis could be performed due to heterogeneous data reported; 11 studies with a total of 501 patients with the wave sign were included. Three studies examined risk factors for wave sign and concluded that cam lesions were most common. Other risk factors include alpha angle &gt;65° (OR=4.00, 95% CI: 1.26–12.71, P=0.02), male gender (OR 2.24, 95% CI: 1.09–4.62, P=0.03) and older age (OR=1.04, 95% CI: 1.01–1.07, P=0.03). Increased acetabular coverage in setting of concurrent cam lesions may be a protective factor. Wave signs most commonly occur at the anterior, superior and anterosuperior acetabulum. In terms of staging accuracy, the Haddad classification had the highest coefficients in intraclass correlation (k=0.81, 95% CI: 0.23–0.95, P=0.011), inter-observer reliability (k=0.88, 95% CI: 0.72–0.97, P&lt;0.001) and internal validity (k=0.89). One study investigated the utility of quantitative magnetic imaging for wave sign, concluding that significant heterogeneity in T1ρ and T2 values (P&lt;0.05) of acetabular cartilage is indicative of acetabular debonding. Four studies reported treatment techniques, including bridging suture repair, reverse microfracture with bubble decompression and microfracture with fibrin adhesive glue, with the latter reporting statistically significant improvements in modified Harris hip scores at 6-months (MD=19.2, P&lt;0.05), 12-months (MD=22.0, P&lt;0.05) and 28-months (MD=17.5, P&lt;0.001). No clinical studies were available for other treatment options. There is a scarcity of literature on the wave sign. Identifying at risk symptomatic patients is important to provide prompt diagnosis and treatment. Diagnostic techniques and operative options are still in early developmental stages. More research is needed to understand the natural history of wave sign lesions after arthroscopic surgery and whether intervention can improve long-term outcomes. Level IV, Systematic review of non-homogeneous studies.

scholarly journals Investigation of Changes in Saliva in Radiotherapy-Induced Head Neck Cancer Patients

2021 ◽  
Vol 18 (4) ◽  
pp. 1629
Author(s):  
Christina Winter ◽  
Roman Keimel ◽  
Markus Gugatschka ◽  
Dagmar Kolb ◽  
Gerd Leitinger ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Salivary Glands ◽  
Treatment Options ◽  
Chemical Properties ◽  
Head Neck Cancer ◽  
Potential Candidate ◽  
Adhesive Properties ◽  
Whole Saliva ◽  
Radiation Induced ◽  
Unstimulated Whole Saliva

The intact function of the salivary glands is of utmost importance for oral health. During radiotherapy in patients with head and neck tumors, the salivary glands can be damaged, causing the composition of saliva to change. This leads to xerostomia, which is a primary contributor to oral mucositis. Medications used for protective or palliative treatment often show poor efficacy as radiation-induced changes in the physico-chemical properties of saliva are not well understood. To improve treatment options, this study aimed to carefully examine unstimulated whole saliva of patients receiving radiation therapy and compare it with healthy unstimulated whole saliva. To this end, the pH, osmolality, electrical conductivity, buffer capacity, the whole protein and mucin concentrations, and the viscoelastic and adhesive properties were investigated. Moreover, hyaluronic acid was examined as a potential candidate for a saliva replacement fluid. The results showed that the pH of radiation-induced saliva shifted from neutral to acidic, the osmolality increased and the viscoelastic properties changed due to a disruption of the mucin network and a change in water secretion from the salivary glands. By adopting an aqueous 0.25% hyaluronic acid formulation regarding the lost properties, similar adhesion characteristics as in healthy, unstimulated saliva could be achieved.

scholarly journals Natural history and treatment options of radiation-induced brain cavernomas: a systematic review

2021 ◽  
Author(s):  
Gildas Patet ◽  
Andrea Bartoli ◽  
Torstein R. Meling
Keyword(s):  
Systematic Review ◽  
Natural History ◽  
Radiation Treatment ◽  
Neurological Deficits ◽  
Cochrane Library ◽  
Average Dose ◽  
Cavernous Malformations ◽  
Radiation Induced ◽  
The Mean

AbstractRadiation-induced cavernous malformations (RICMs) are delayed complications of brain irradiation during childhood. Its natural history is largely unknown and its incidence may be underestimated as RCIMS tend to develop several years following radiation. No clear consensus exists regarding the long-term follow-up or treatment. A systematic review of Embase, Cochrane Library, PubMed, Google Scholar, and Web of Science databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed. Based on our inclusion/exclusion criteria, 12 articles were included, totaling 113 children with RICMs, 86 were treated conservatively, and 27 with microsurgery. We were unable to precisely define the incidence and natural history from this data. The mean age at radiation treatment was 7.3 years, with a slight male predominance (54%) and an average dose of 50.0 Gy. The mean time to detection of RICM was 9.2 years after radiation. RICM often developed at distance from the primary lesion, more specifically frontal (35%) and temporal lobe (34%). On average, 2.6 RICMs were discovered per child. Sixty-seven percent were asymptomatic. Twenty-one percent presented signs of hemorrhage. Clinical outcome was favorable in all children except in 2. Follow-up data were lacking in most of the studies. RICM is most often asymptomatic but probably an underestimated complication of cerebral irradiation in the pediatric population. Based on the radiological development of RICMs, many authors suggest a follow-up of at least 15 years. Studies suggest observation for asymptomatic lesions, while surgery is reserved for symptomatic growth, hemorrhage, or focal neurological deficits.

Sign in / Sign up

Export Citation Format

Share Document