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At least 595 records · Page 33Linked to original sources
PubMed2006

[Changing paradigms in reconstructive surgery by vacuum therapy?].

In modern science the changes of scientific paradigm occur constantly and often unnoticed. Effects of new therapy procedures that are not compatible with the prevailing doctrines first lead to contradictory discussions and may then lead to new doctrines depending upon the general perception. Continuous computer-assisted local negative pressure therapy (vacuum assisted closure therapy/V.A.C., topical negative pressure treatment) has led to unexpected and impressing clinical results since its introduction. This has provoked a recognizable change of different therapeutic concepts in reconstructive surgery. Based on a selection of important clinical examples from reconstructive surgery following a current literature research the attempt is undertaken to point out recognizable changes of paradigms within the treatment algorithms that can be discerned after the the introduction of vacuum therapy in recent years.

Brachytherapy↗
PubMed1985

Surgical treatment of actinic brachial plexus lesions: free microvascular transfer of the greater omentum.

Actinic brachial plexus lesions after mastectomy have been treated in 67 cases. Thirty-nine cases have been operated on, 31 of which by means of a free microvascular transfer of the greater omentum. Indications and contraindications of the procedure are discussed, as well as the types of anatomic-pathologic lesions that have been found, and the surgical technique that has been modified and improved over time is presented. Results indicate that free microvascular greater omentum transfer following neurolysis is currently the best method for relief of pain.

Arm↗
PubMed1998

[Acne comedonica following radiation therapy].

HISTORY AND CLINICAL FINDINGS: A 50-year-old female patient underwent extirpation of a moderately differentiated, partially tubular ductal carcinoma of the left mamma and dissection of the left axilla followed by postoperative radiation therapy (total dose 58/48 gy). 2 weeks after the radiation therapy was stopped, treatment with goserelin subcutaneously was started. 6 weeks later numerous open and closed comedons appeared which were sharply confined to the radiation areas of left mamma and sternum. DIAGNOSIS, TREATMENT AND COURSE: Because of the clinical diagnosis of acne comedonica following radiation therapy a local treatment with benzoyl-peroxide gel 5% and erythromycin cream 2% was performed, which led to improvement of the skin lesions within a few weeks and total restitution within 3 months. During one year no comedons have occurred although the local therapeutics are not applied constantly anymore. CONCLUSION: Acne comedonica in the radiation area is a rarely known side effect of radiation therapy. Although the skin lesions cause no pain or itching they can affect the patient due to cosmetic changes. Local treatment with comedolytic acne therapeutics is effective.

Acne Vulgaris↗
PubMed1997

[Single suture closure and surgical staplers in neck interventions after previous radiotherapy].

BACKGROUND: Impaired wound healing has to be expected more often in a tissue with diminished circulation. The technique of wound closure could have some influence on the healing result in such situations. METHODS: This prospective randomized study was carried out to evaluate whether staples or nylon sutures give better results regarding primary wound healing. Fifty patients who had previously been irradiated for head and neck tumors and underwent secondary surgery of the neck region were included in the study. RESULTS: Four of 26 wounds closed by conventional sutures evidenced delayed healing, while one of 24 wounds closed by stapler showed signs of impaired wound healing. This difference was not statistically significant. Further parameters (duration of operation, high age, high dosage of irradiation, long interval between irradiation and operation, previous chemotherapy, anemia, low body weight, relaxing incision, pharyngotomy) were also not associated with a higher incidence of delayed wound healing. CONCLUSIONS: Even in the irradiated cervical operation field no advantage for staples could be demonstrated in comparison with nylon sutures.

Adult↗
PubMed1988

[Myocutaneous latissimus dorsi flaps for covering defects in local recurrences of breast cancers or radiation ulcers].

The pedicled myocutaneous latissimus dorsi flap is suitable for covering defects following excision of breast cancer recurrencies or irradiation ulcerations. From its bed it may be extended as far as to the shoulder, the axilla, neck and to the chin. We report on experiences on 12 patients with local breast cancer recurrencies or radiation ulcers. The defects were: 8 times thoracic, twice axillary and one each on the upper arm and supraclavicular area. They could always be covered without tissue tension. Complications occurred with 3 marginal or partial flap necroses with secondary wound healing. All other flaps healed primarily. Flap beds could almost always be closed directly. All patients were free from recurrencies during the follow-up period. The procedure meets the standards of radical tumour surgery, is safe even in poorly vascularised soft tissue areas, and yields acceptable cosmetic results.

Aged↗
PubMed1999

[Long-term radiation damage to the skin and eye after combined beta- and gamma- radiation exposure during the reactor accident in Chernobyl].

BACKGROUND: In April 1986, numerous reactor workers and firemen were exposed to high doses of ionizing radiation during the Chernobyl nuclear power plant accident. Apart from high ambient gamma-ray exposures they received inhomogeneous contamination with beta-rays from fission products, resulting in severe skin exposure. PATIENTS AND METHODS: Sixteen of these so called Liquidators were repeatedly examined between 1991 and 1996. Their doses ranged from 0.35 to 9 Gy, partly confirmed by determination of chromosomal aberrations. Ophthalmologic examination included non-subjective assessment of lenticular radiation damage with an electronic Scheimpflug camera system. Digital image analysis allowed the comparison of opacification units to previous and normal findings. RESULTS: Four Liquidators had posterior subcapsular opacifications in different degrees, one presented only after cataract extraction. One patient had dense corticonuclear cataracts and pseudoexfoliation-like changes. Three men had severe dry eye syndrome. Eight men had no ocular complications. Retinal radiation damages were absent. 15 Liquidators suffered from severe chronic cutaneous radiation damage, which led to amputations in 3 cases. CONCLUSIONS: A relation between ocular and dermatological findings was not expected and could, in fact, not be seen. The comparison of posterior subcapsular opacification and doses revealed no distinct relation, although it indicates a correlation that is here not quantified. The doses represent organ doses for the bone marrow which is primarily exposed to deeper penetrating gamma-radiation. Thus they need not be correlated with combined beta- and gamma-doses in organs such as skin and eye because the superficial exposure due to beta-radiation may differ greatly form the whole body exposure as reflected in bone marrow doses.

Accidents, Occupational↗
PubMed1985

[Radiotherapy of vulvar cancer. Treatment results of electron therapy in 446 patients 1956 to 1978].

446 patients with malignant tumour of the vulva were treated from 1956 to 1978. In 432 patients with invasive squamous cell carcinoma, a five-year survival rate of 43.1% was obtained after exclusive exposure to electron radiation. Severe complications were seen in 10.9% of the treated patients. On comparing the results with those obtained after electrocoagulation or vulvectomy, it was seen that a therapy based on electron radiation only yielded more favourable results, especially in cases with advanced stage carcinomas. In younger women with early tumour stages, surgery should be given preference.

Aged↗
PubMed2002

Lichen planus confined to a radiation therapy site.

We report the case of a 58-year-old man with lichen planus localized to a radiation site. To our knowledge, this is the first reported case of radiation-induced lichen planus in the English-language literature.

Humans↗
PubMed2001

A feasibility study using three-dimensional conformal boost technique in locally advanced carcinoma of the nasopharynx.

To investigate the feasibility and efficacy of dose escalation using three-dimensional (3-D) conformal boost technique, 21 patients with stage III or IV nasopharyngeal cancer were enrolled in a prospective protocol. All patients with node metastases initially received external radiotherapy by conventional technique up to 70.2 Gy, followed by 3-D conformal radiotherapy (3-D CRT) to the boost part up to 79.2 Gy with 9 Gy increments (daily fraction of 1.8 Gy for 5 days). A modified technique with the same dose escalation of 9 Gy using 3-D CRT was applied to 7 patients without node metastases, who were treated by conventional technique up to 54 Gy, followed by 3-D CRT to boost up to a basic dose of 70.2 Gy, and then finally with dose escalation of 9 Gy. The protocol was relatively well tolerated by the majority of patients. Acute complications during the dose escalation schedule was low, with rare occurrences of grade 3 or 4 toxicity. Although late radiation-induced complications also appeared limited, 1 patient developed a temporal lobe necrosis and 2 patients suffered from sensory-neural hearing loss. There were no radiation-induced fatal complications. At a median follow-up of 48 months, only 3 patients experienced local failure and 2 patients developed distant metastases. The 5-year overall actuarial survival rate and recurrence-free survival rate for all patients were 68% and 85%, respectively. On the basis of acceptable morbidity and encouraging treatment results, we conclude that the dose escalation in 9 Gy increments using a 3-D conformal boost technique is relatively safe and efficacious, enough to be used routinely for locally advanced nasopharyngeal cancers.

Adult↗
PubMed1999

The CHART regimen and morbidity.

In 1984, when the CHART regime was devised, it was predicted that acute reactions in skin and mucosae would be more severe but that there would be a considerable reduction of late effects in normal tissues. The findings from the pilot study conducted from 1985 to 1990 and from the randomized trials, which entered cases from 1990 to 1995, are reviewed. With CHART, it was found that acute mucosal reactions were more severe but tolerable and recoverable. Unexpectedly, acute skin reactions were reduced rather than increased. Late reactions in the central nervous system have led to a dose restriction of 40 Gy. Effects in other normal tissues were significantly reduced but the sparing effect was less than that predicted. This can perhaps be explained by a half-time of repair of sublethal injury in human tissues in excess of 4 h.

Dose Fractionation, Radiation↗
PubMed2000

The use of cryopreserved lymphocytes in assessing inter-individual radiosensitivity with the micronucleus assay.

PURPOSE: The feasibility of using cryopreserved lymphocytes to detect inter-individual differences in chromosomal radiosensitivity was investigated. Typically, such studies are conducted with fresh blood samples but, in a clinical setting, when availability of samples is unpredictable, this is not always convenient. The sensitivity of 23 normal healthy donors, 11 breast cancer patients who had shown severe acute skin reactions to radiotherapy and seven ataxia telangiectasia (A-T) heterozygotes was determined. MATERIALS AND METHODS: Thawed lymphocytes were exposed to high (HDR) or low dose rate (LDR) gamma irradiation (3.5 Gy) in Go, stimulated with PHA, treated with cytochalasin-B 24 h later and then harvested at 90 h for the determination of micronucleus (MN) yields in binucleate cells. RESULTS: Each normal donor was tested one to three times. Mean MN yields were 76.1 +/- 9.3/100 cells at HDR and 44.5 +/- 5.3 at LDR, giving an LDR sparing effect of 39.6 +/- 9.3%. A relatively high proportion of tests failed to yield sufficient binucleate cells for analysis. Inter-experimental variability was also high and it was not possible to demonstrate inter-individual differences in sensitivity in spite of the use of an internal control sample from a single normal donor in each experiment. There was a small but significant increase in radiation-induced MN in the breast cancer patients compared with the normals at LDR (but not at HDR), but a complete overlap with the normal range. There was no increase in sensitivity in the A-T heterozygotes at HDR. The LDR samples failed because the LDR protocol reduced proliferation rates, and radiation-induced mitotic inhibition in this group was higher than in normals. CONCLUSIONS: In comparison with previous experience with fresh blood samples, the use of frozen lymphocytes is not as satisfactory because: (1) experimental failures are higher; (2) inter-experiment variability is higher: (3) dose-rate sparing is lower, suggesting poorer repair; and (4) the ability to discriminate between breast cancer cases and normals is probably lower.

Adult↗