The impact of pre-radiotherapy surgery on radiation-induced lung injury

AimsThe use of postoperative radiation therapy (PORT) is predicated by an assessment of the potential benefits and risks, including radiation-induced lung injury. In this study, the risk of radiation-induced lung injury is assessed in patients who received PORT, and compared with a group of patients who received radiation without prior surgery, to determine if surgery increases the risk of radiation pneumonitis.Materials and methodsFrom 1991 to 2003, 251 patients with lung cancer were enrolled into a prospective study to assess radiation-induced lung injury. All patients received three-dimensional-planned, external-beam radiotherapy. One hundred and seventy-seven patients with over 6-months follow-up were eligible. For the current analysis, 49 patients (28%) had surgical intervention before radiotherapy. The rates of Grade 2 symptomatic pneumonitis in subgroups, based on the type of pre-radiation surgery, were computed and compared using Fisher's Exact Test. To consider the confounding factor of irradiated lung volume, patient subgroups were further defined on the basis of the mean lung dose.ResultsSurgical procedures included pneumonectomy (n = 9), lobectomy (n = 16), wedge resection (n = 8) and exploration without resection (n = 16). Radiation-induced lung injury occurred in 33 out of 177 (19%) patients, including 18% of the surgical group and 19% of the non-surgical group. Additionally, no statistically significant difference was found in the rate of radiation-induced lung injury based on the extent of resection.ConclusionsThe incidence of pneumonitis is similar in the surgical and non-surgical groups. Thus, PORT may be safely given to selected patients after surgical exploration or resection.     

Kinetic parameters of serum and lung tissue angiotensin-converting enzyme in patients with lung cancer

Angiotensin-converting enzyme activity and its kinetic parameters were determined in both serum and lung tissue samples obtained from 17 patients with lung cancer and 21 control subjects, regardless of ethical base. The specific activities for cancerous and normal lung tissues were 67.2 +/- 27.3 (mean +/- SD) U/g protein and 28.5 +/- 5.4 U/g protein, respectively (P less than 0.001). Serum enzyme activity, on the other hand, was found to be higher in controls (198 +/- 42 U/L) than in patients (237 +/- 68 U/L) (P less than 0.01). The effects of chloride and zinc ions, pH and temperature on the enzyme activity were investigated as kinetic parameters in both serum and tissue samples.     

Isolated internal auditory artery aneurysm

Anticoagulant therapy is effective and prevents death in more than 95% of patients with pulmonary embolism following deep vein thrombosis. We report a patient who developed deep vein thrombosis following rupture of a dissecting aneurysm of the internal auditory artery. The parent artery was occluded before anticoagulant therapy as a prophylactic measure to prevent intracranial haemorrhage. We discuss some of the clinical features, therapeutic difficulties, and pitfalls in the management of internal auditory artery aneurysm complicated by deep vein thrombosis.     

COMPARISON OF INTRAOCULAR PRES-SURE CHANGES AFTER PHACOEMULSIFI-CATION IN EYES WITH AND WITHOUT PSEUDOEXFOLIATION

Purpose: To examine intraocular pressure (IOP) changes in eyes with and without pseudoexfoliation (PxfS), after phacoemulsifi-cation. Methods: IOP changes in 39 eyes with PxfS and cataract and 40 eyes with cataract, prospectively evaluated after pha-coemulsification and IOL implantation. IOPs were measured preoperatively (preop) and 1 day, 1 week, 1 and 3 months post-operatively (postop). IOP changes during the follow-up period     

PACHYMETRIC ANALYSIS IN PRIMARY OPEN ANGLE GLAUCOMA PSEUDOEXFO- LIATIVE GLAUCOMA AND PSEUDOEXFO- LIATIVE SYNDROME

Purpose: To comparative evaluation of the central corneal thick-ness (CCT) in the eyes with primary open angle glaauco-ma (POAG), pseudoexfoliative glaucoma (PXFG), pseudoexfolia-tive syndrome (PXFS) and normal subjects. Materials and Methods: In this prospective study, pachmetric CCT measurements of 68 eyes with POAG, 39 eyes with PXFG and 37 eyes with PXFS were performed. Intraocular pressure (IOP) was measured before ultrasonographic pachymetric examinatioa Sitxy-six eyes of     

Pernicious anemia in Turkey.

Pernicious anemia patients who were diagnosed during a 5-year period in Cukurova University Hospital, Adana, Turkey were reviewed. Of approximately 200 new patients per year accepted by the Hematology Unit 44 were diagnosed as having pernicious anemia. There were 30 males and 14 females. The mean age for men was 49.14 +/- 18.11 and that for women was 40.00 +/- 14.05. Both values and the mean age overall were lower than the reported mean age for Whites, Blacks and Latin Americans living in the United States.     

Temozolomide after Radiotherapy for Newly Diagnosed High-grade Glioma and Unfavorable Low-grade Glioma in Children

Summary Chemotherapy is commonly used in the treatment of children with high-grade glioma, although its usefulness is uncertain. We conducted a multi-institutional study to evaluate the efficacy of temozolomide given after radiotherapy in children with newly diagnosed high-grade glioma and unfavorable low-grade glioma (gliomatosis cerebri or bithalamic involvement). Optional window therapy of intravenous irinotecan (10 doses of 20 mg/m² per cycle × 2) was given over 6 weeks. The 5-day schedule of temozolomide (200 mg/m² per day) started 4 weeks after the completion of radiotherapy and continued for a total of 6 cycles. Thirty-one eligible patients (median age: 12.3 years) participated. Tumors most commonly involved cerebral hemispheres (n = 13, 42%) and thalamus (n = 14, 45%). Whereas six patients underwent radical resection, the remainder had limited surgery, including biopsy (n = 14, 45%). The predominant histologic diagnoses were glioblastoma multiforme (n = 15, 48%) and anaplastic astrocytoma (n = 10, 32%). Two patients had bithalamic grade II astrocytoma. Twenty-seven patients received radiotherapy (median dose: 59.4 Gy), including craniospinal irradiation in 3 because of leptomeningeal spread. Four patients did not receive radiotherapy in this study because of consent withdrawn (n = 2), toxicity during window therapy (n = 1), or at the physician’s discretion (n = 1). Twenty-three patients received 112 cycles of temozolomide therapy. The 2-year progression-free and overall survival estimates were 11 ± 5% and 21 ± 7%, respectively. Although the heterogeneity of prognostic factors in our patients made assessment of treatment outcome more difficult, the addition of 6 cycles of temozolomide after radiotherapy did not seem to alter the poor outcome of these patients.     

Nasopharyngeal carcinoma with extensive nodular skin metastases: a case report

Skin metastasis from nasopharyngeal carcinoma is a rare clinical finding. The most common form of appearance is a few solitary skin nodules. However, massive and extensive nodular dissemination or diffuse dermal lymphatic infiltration is extremely rare. We here present a case of a 40-year-old man with widespread nodular skin metastases from undifferentiated nasopharyngeal carcinoma.