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At least 631 records · Page 35Linked to original sources
PubMed2001

Deterministic effects in interventional radiology.

Since the development of interventional radiology, the number and complexity of procedures has increased significantly and continues to grow. Interventional radiology procedures offer substantial health care benefits. However, associated with the increasing complexity as well as a lack of quality control programmes and specific training in radiation protection, there is an increase in the occurrence of deterministic effects in both patients and staff. There is a growing literature of case reports describing deterministic effects. A review of some case reports and the response of various international organisations is presented. It is important that workers in interventional radiology are aware of the potential for deterministic effects and the dose threshold for their onset, so that patients can be followed up appropriately.

Adolescent↗
PubMed2006

Evaluation of risk of deterministic effects in fluoroscopically guided procedures.

A methodology for the evaluation of skin dose distribution and possible skin injuries on patients undergoing interventional procedures has been developed as part of the European DIMOND programme. Relevant dosimetric data from the procedures are recorded and other specific measurements for skin dose evaluation (slow films for therapy, radiochromic films, thermoluminescence dosemeters and optically stimulated luminescence dosemeters) have been carried out. For non-cardiac and for some cardiac procedures, dose-area product values of 200 and 300 Gy cm2 were proposed, respectively, as a trigger level for further detailed skin dose investigation and possible clinical follow-up. Results from a survey of 191 selected complex procedures are reported. Out of all the patients included in the trial, 16% received skin doses > or =1.5 Gy. No skin injuries were found in any of the patients followed.

Dose-Response Relationship, Radiation↗
PubMed2006

Retrospective evaluation of occurrence of skin injuries in interventional cardiac procedures.

Interventional cardiology procedures can involve high doses to patients and, in particular, to patients' skin, the tissue at greatest risk of deterministic injuries. The evaluation of skin dose from interventional procedures is recommended, but difficult because of the amount of different X-ray fields and projections used in a procedure. For this reason, a retrospective follow-up study has been developed to identify skin injuries in patients submitted to one or more cardiac interventions in the Udine hospital between 1998 and 2002. Seventy-eight patients with a cumulative dose-area product >300 Gy cm2 were selected from 3332 patients, who underwent 5039 procedures. In this group the maximum skin dose was 6.7 Gy. The clinical follow-up, performed using the LENT-SOMA methodology, has not detected skin injuries and this result allows a frequency to be estimated for skin injuries in patients undergoing repeated cardiac procedures of <3 x 10(-4) in our centre.

Aged↗
PubMed1998

Atypical cells in radiation dermatitis express factor XIIIa.

Dendritic cells that express factor XIIIa are present in the normal dermis and are increased in a variety of pathologic conditions. Atypical dermal cells are often seen in biopsy specimens of skin that has been previously irradiated. We sought to determine whether the atypical dermal cells in chronic radiation dermatitis express factor XIIIa. We employed standard immunohistochemical techniques with antibodies to factor XIIIa and CD34 to study 16 biopsy samples showing changes of radiation dermatitis. All cases showed diffuse positive cytoplasmic staining of atypical dermal cells with antibody to factor XIIIa. Of 16 cases, 10 showed focal staining of dermal cells with antibody to CD34, but this antibody did not react with most of the atypical dermal cells. We conclude that the majority of atypical dermal cells in radiation dermatitis are derived from dermal dendritic cells which express factor XIIIa.

Adult↗
PubMed2004

Radiation recall dermatitis, panniculitis, and myositis following cyclophosphamide therapy: histopathologic findings of a patient affected by multiple myeloma.

Radiation recall dermatitis is one of the skin sequelae that may affect oncology patients. It occurs in a previously irradiated field, when subsequent chemotherapy is given. The eruption may be elicited by chemotherapy, even several months after radiotherapy. Its mechanism is poorly understood, and the histopathologic findings have received, to date, only sketchy descriptions. A 55-year-old male affected by multiple myeloma received radiation therapy both on his left coxofemoral area, and lumbar region (D11-L1). After cyclophosphamide administration, he developed 2 well defined square-shaped, infiltrated erythematoviolaceous plaques in the prior irradiated fields. Histopathologic findings revealed a diffusely fibrosclerosing process, involving deep dermis, hypodermis, as well as the underlying muscle, while sparing the epidermis and superficial-mid dermis. Histopathology was indistinguishable from deep radio-dermatitis, panniculitis, and myositis. This is the first case providing clear evidence of the causative role of cyclophosphamide in inducing a cutaneous and subcutaneous radiation recall reaction.

Antineoplastic Agents, Alkylating↗
PubMed1998

Angiosarcoma of the breast mimicking radiation dermatitis arising after lumpectomy and breast irradiation: a case report.

Angiosarcoma arising in the breast is a very rare malignancy. Of the small number of reported cases, most arose in the breast after breast irradiation. A case is reported of angiosarcoma arising in the breast more than 7 years after lumpectomy and breast irradiation for carcinoma of the breast. The initial appearance was very similar to the changes of late radiation dermatitis and the true nature of the malignant lesion was not known for 23 months.

Breast Neoplasms↗
PubMed2000

Radiation recall dermatitis induced by methotrexate in a patient with Hodgkin's disease.

Radiation recall dermatitis refers to an inflammatory skin reaction at a previously irradiated field subsequent to chemotherapy administration. A number of antineoplastic agents have been reported to cause this phenomenon. We observed radiation recall dermatitis in a patient with stage IV nodular sclerosing Hodgkin's disease after methotrexate therapy for acute graft-versus-host disease (GVHD) prophylaxis. The patient had previously undergone matched related bone marrow transplantation with busulfan and cyclophosphamide as a preparative regimen. Subsequently, she received cyclosporine and methotrexate for acute GVHD prophylaxis. Two areas of skin previously irradiated to 3,000 cGy developed radiation recall dermatitis after two doses of methotrexate given 2 days apart and exacerbated by the third and fourth doses. This reaction occurred 34 days after the last dose of radiation therapy (RT). We believe this is the first case of radiation recall dermatitis after methotrexate therapy. Given the increased use of methotrexate in several neoadjuvant and adjuvant protocols in association with RT, its potential to produce radiation recall reactions should be considered.

Adult↗
PubMed1994

Radiation necrosis overlying the ankle joint after injection with yttrium-90.

A 35-year-old woman with rheumatoid arthritis presented with radiation necrosis and an open wound overlying her ankle joint, 8 months after injection with yttrium-90 to facilitate radiosynovectomy. This problem was successfully treated by surgical excision of the area of radiation damage and closure with a fasciocutaneous flap.

Adult↗
PubMed1995

Reconstruction of extensive scalp defects with rectus free flaps.

This review represents the largest reported series involving reconstruction of complex scalp and calvarial defects with rectus abdominis free flaps. Sixteen patients presented with extensive (up to 300 cm2) scalp and calvarial defects requiring free tissue transfer for closure. All of the 11 patients who underwent a rectus abdominis free flap had a technically successful microvascular transfer. The defects encountered involved a wide spectrum of complexities including extensive multilaminar defects with exposed brain and dura, irradiated fields, and infection. In our institutions, the rectus abdominis muscle has evolved as a uniquely superior donor choice for restoring extensive scalp defects for several reasons: (1) accessibility, which eliminates intraoperative patient repositioning and allows for a simultaneous two-team approach; (2) minimal donor-site morbidity; (3) vascular reliability; and (4) the ability to supply abundant, easily contoured tissue.

Adult↗
PubMed1995

Chest wall reconstruction for radionecrosis after breast carcinoma therapy.

This study aimed at evaluating various reconstructive procedures for chest wall radionecrosis after breast carcinoma therapy. Four different techniques were performed between 1973 and 1992 in 120 patients: latissimus dorsi musculocutaneous flap (LDF; n = 81); transposed omentum and split-thickness skin graft (TGO; n = 20); fasciocutaneous flap (FCF; n = 10), and transverse rectus abdominis musculocutaneous flap (TRAM; n = 9). Initial dose of irradiation ranged from 60 to 110 Gy. The average interval between initial treatment and reconstruction was 11 years. Local recurrence was suspected in 26 patients and was histologically proven after removal in 36 (30%). Surgical procedure results were analyzed by mean hospital stay (8 days for LDF vs. 52 days for TGO), early (13% LDF vs. 60% TGO) and late (7% LDF vs. 35% FCF) complications, second surgery (15% LDF vs. 53% FCF), and functional and cosmetic outcomes. In our experience, the LDF was the first-line flap. The TRAM was used to cover very large defects and when breast reconstruction was needed. When these flaps were impossible or dangerous, we performed a TGO. These three procedures have replaced FCF indications.

Adult↗
PubMed1995

Tissue expansion-assisted prefabrication of the forehead flap for nasal reconstruction.

A new technique for nasal reconstruction is described. This method--expansion-assisted flap prefabrication--is essentially a simultaneous application of pretransfer grafting and tissue-expansion procedures for creating custom-made forehead flaps to meet varying requirements of nasal reconstruction. We have applied this new technique on seven patients, with full-thickness nasal defects during a 3-year period. Results from these patients are presented with a review of different use of flap prefabrication principles in nasal reconstruction.

Adolescent↗
PubMed1997

The histopathological changes in irradiated vs. nonradiated tissue-expanded skin in the porcine model.

This study examined the histological changes following irradiation on nonexpanded and tissue-expanded pigskin. Six Yorkshire pigs received 4860 cGy radiation to one flank with the opposite side serving as the control. A histopathological comparison of tissue expansion in irradiated tissue to nonradiated tissue showed a reduction in the thickness of the dermal and subcutaneous layers, with less prominent rete ridges and a thicker stratum spinosum (p < 0.05). Nonexpanded irradiated tissue showed a reduction of thickness in the dermis and subcutaneous layer, less prominent rete ridges, and a thicker stratum spinosum layer (p < 0.05) when compared with nonradiated tissue. Tissue-expanded irradiated tissue showed no significant differences (p > 0.05) in any of these parameters when compared with nonexpanded irradiated tissue. This study demonstrates that radiation produced a significant change in porcine skin, but tissue expansion did not further alter the histological changes associated with irradiation.

Animals↗