[Occupational dermatoses in stomatological centre staff (author's transl)].
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Radiotherapy may be either an effective alternative to surgery or a valuable adjunct to surgery and/or chemotherapy in the locoregional treatment of malignant head and neck tumors. The care of patients with head and neck cancer undergoing radiotherapy or who have completed treatment is a multidisciplinary effort. Oral health care providers can expect to be called upon to care for patients with head and neck cancer undergoing radiotherapy. Early, active participation in developing preventive and therapeutic strategies, in implementing the plan, and in the education and rehabilitation of the patients is paramount in addressing quality of life issues. To provide timely and competent care, oral health care providers must understand the disease, its treatment, and the impact the disease and/or its treatment may have on these patients. Oral health care providers should develop and implement preventive and therapeutic strategies with the same ethical, moral, and professional standards of care as may be appropriate in the management of any other patient.
Total skin electron beam therapy (TSEBT) is a technically complicated treatment used in the management of mycosis fungoides (MF). A variety of technical and clinically oriented issues relating to TSEBT and its effects for patients with MF are reviewed.
In experiments on mice radioprotective properties of indraline, phenyleprine and melatonin were compared at topical application as an ointment at a place of local exposure of animal hind to a dose of 38.3 Gy of 60Co gamma-quanta. Factor of dose reduction was 1.27-1.32 for indraline (1-10% ointment) and 1.29 for phenyleprine (0.25% ointment). Antioxidants were low efficient at radiation skin burn. At later local radiation injuries, such as hind contracture, the efficiency of indraline was 1.33-1.5, that of phenyleprine was 1.28, and that of melatonine (2 and 5% ointment) was 1.23-1.47.
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We describe results and complications of combined (surgery and radiotherapy) treatment of parotid gland cancer. 86 patients, 31 women and 55 men, have been treated between the years 1984-1997 in Cancer Center--Institute in Warsaw. Mean age of patients was 56.6 years and ranged from 15 to 84 years. Surgical treatment was microscopically radical in 16 patients, macroscopically radical in 59 patients and debulking was performed on 11 patients. 5-year overall survival has been estimated as 58.2%. Distant metastases were observed in 23.3% of patients, local recurrences were observed in 12.8% of patients. Late serious postirradiation skin reaction (grade IV EORTC) was observed 6 months after completion of radiotherapy in 1 patient, and symptoms subsided completely during next 18 months. Late mucosal postirradiation complications (grade I and II EORTC) after 6 to 8 months after radiotherapy were described in 22.9% of patients and after 24-26 months in 15.9% of patients. There were no serious--grade III and IV EORTC--mucosal complications. Observed xerostomia was minimal due to compensation of saliva production by contralateral major salivary glands and did not worsen patients quality of life. Early middle ear postradiological inflammation occurred in 18.6% of patients, late reaction in the middle ear (6 to 8 months after completion of radiotherapy) was observed in 19% of all patients. In the group of 57 patients who survived 2 years after radiotherapy 1 developed temporo-mandibular joint fibrosis. Late postradiological changes in petrosal bone were detected in 2 patients (1 in Rtg imaging and 1 in CT imaging)-they were painful and primarily suspected as recurrence. None of the patients had clinically overt temporal lobe complications. Our patients survival results were a little worse than reported in the literature. Observed tolerance of combined treatment was very good.
Radiation-induced fibrosis (RIF) is an uncommon complication of radiation therapy. RIF most often occurs in the extremities; it is rare in the head and neck. Only a few medical treatments for RIF are available, and they have been mediocre at best. We describe a case of RIF of the face that was treated successfully with a nonmedical modality: manual compression therapy.
Local radiotherapy of a tumor is frequently applied in combination with chemotherapy or surgical measures. Possibly occurring toxicity must therefore be considered within the overall context. The radiosensitivity of the various organs is dependent on the sensitivity of the respective stem or mature end cells, and shows considerable differences within the individual cell systems. Apart from the application of prophylactic procedures, some radiation sequelae can be ameliorated by initiating specific measures (e.g. cosmetic products, drug treatment).
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The purpose of this study was to examine the effect of postreconstruction radiation therapy on patients undergoing pedicled TRAM flap breast reconstruction. Post-TRAM radiation patients were compared with patients who received pre-TRAM radiation and a control TRAM-only group who received no radiation. Overall aesthetic appearance, evidence of symmetry, flap contracture, and hyperpigmentation were assessed by blinded reviewers. A total of 171 pedicled TRAM reconstructions were performed in 150 patients. Total flap complications were seen in 49.5 percent of the control patients, 57.1 percent of pre-TRAM radiation patients, and 50 percent of post-TRAM radiation patients but were not statistically different. The complete flap necrosis rate was 0.6 percent and the partial flap necrosis rate was 7.6 percent, again with no statistical differences among the groups. Donor-site complications occurred in approximately one third of patients in each of the groups. Deep venous thrombosis and pulmonary embolus each occurred once and only in the post-TRAM radiation group. In terms of overall aesthetic outcome, symmetry, and contracture, the control group consistently rated better than the pre-TRAM (p = 0.021, p = 0.03, p = 0.03, respectively) and the post-TRAM (p = 0.0001, p = 0.0001, and p =0.0001, respectively) radiation groups. The control group also had clinically and statistically significant less hyperpigmentation than the post-TRAM radiation group (p = 0.0002). In contrast, irradiated postreconstruction patients had scores, including aesthetic outcome, symmetry, and contracture, worse than those of irradiated prereconstruction patients. When these two groups were compared with each other, except for contracture, no statistical significance, because of a small patient sample, was found. Neither preoperative nor postoperative radiation increased the risk for flap or donor-site complications. In contrast, radiation of any type did affect aesthetic appearance, symmetry, contracture, and hyperpigmentation. The authors recommend that TRAM flap breast reconstruction be postponed in those patients known or expected to receive postmastectomy radiation.
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Radiation synovectomy is an effective method of treatment of chronic synovitis in patients with conditions such as rheumatoid arthritis, haemophilic synovitis and pigmented villonodular synovitis. This case demonstrates one of the potential complications of this procedure in a 46 year old man treated with bilateral radiation synovectomy for haemophilic synovitis. Cutaneous radiation necrosis is a known but rare complication of this procedure and this case is reported to demonstrate this known complication and to highlight that appropriate technique is required to avoid this.
We report the case of a 47-year-old HIV-negative male affected by a perianal ulcer which occurred after chemoradiation delivered for anal cancer. In spite of a negative biopsy the lesion was highly suspected to be a disease recurrence. Uncontrollable pain and anal stenosis were also present; abdominoperineal resection with a large excision of perianal tissues and reconstruction with bilateral musculocutaneous gracilis flaps was therefore performed. Histology did not confirm tumor recurrence. Thirteen months after surgery, the patient is still alive and free of disease. The introduction of radiotherapy and concomitant chemotherapy has revolutionized the treatment of anal cancer, avoiding demolitive surgery in a large subset of patients. Radionecrosis is an uncommon but potentially devastating event occurring in up to 10% of patients undergoing radiotherapy for anal cancer. It causes clinical (pain, anal stenosis, mucositis and diarrhea) and diagnostic problems (recurrence vs. benign post-attinic lesion). In the present article we review this uncommon complication, discuss the technical surgical aspects associated with a very large perianal tissue removal, and data of the most recent literature in this field.
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