Incidence of radiation myelitis of the cervical spinal cord at doses of 5500 cGy or greater

Article Abstract:

Radiation myelitis is inflammation of the spinal cord that can occur as a complication of radiation therapy. It is a late complication and does not appear until six months to two years after the end of the radiation therapy. In many cases, the inflammation resolves spontaneously; there is no effective treatment, however. In some cases, permanent spinal cord damage results and may progress to total paralysis. Radiation therapy is an important part of the treatment protocol for head and neck cancer, and often the spinal cord must receive a large dose of radiation during this treatment. A review of cases of head and neck cancer identified 176 patients who received doses of radiation from 5,500 to 6,800 cGy. (A Gy, or Gray, is a dose of radiation equivalent to one joule of energy absorbed per kilogram of tissue. It is equal to 100 rads.) Seventy-two of these patients were followed for at least two years. Seven patients developed Lhermitte's sign in which the patient experiences a shock almost like an electric shock when flexing the neck. Lhermitte's sign is an indication of trauma to the spinal cord in the neck region. In five of these cases, the condition resolved spontaneously. In the remaining two cases, the patients developed permanent spinal cord damage, which was mild and resulted in only leg weakness. Two additional patients developed Brown-Sequard syndrome, in which one side of the body is paralyzed and pain and temperature sensation is reduced on the opposite side. (In one of the two cases presented here, however, the pain and temperature senses seemed to be normal.) Therefore, a total of four patients (5.6 percent) experienced permanent damage from radiation myelitis. However, these four patients were not among those who had received the highest doses of radiation. Radiotherapy is usually not given all at once, but in many dose fractions to reduce the risks of damage to healthy tissues. The patients who developed radiation myelitis did not receive any out-of-the-ordinary treatment. Neither did the four patients possess any characteristics suggestive of a higher risk of radiation myelitis. The present study could find no indication of why these patients developed permanent spinal cord damage while the majority did not. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Radiotherapy, Inflammation, Spinal cord, Head and neck cancer

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State-of-the-art breast reconstruction

Article Abstract:

Breast reconstruction is often chosen by women who have undergone mastectomy for breast cancer. During the last 20 years, many refinements have been made in the techniques of breast reconstruction. The authors provide a detailed discussion of various procedures of breast reconstruction. Breast implants may be used, which may be filled with silicone gel or saline solution. Expansion techniques may be used for women with tight chest skin. In this technique, an expander is placed underneath detached chest muscle and expanded by the injection of saline solution. Another technique gaining in popularity is the TRAM method, for transverse rectus abdominal muscle. This is an autologous tissue method in which skin, underlying fat, and muscle are removed from the patient's abdomen and placed in the breast area. All techniques, however, have disadvantages. While implant techniques require little surgery and leave minimal scars, there may be shifting of the implant. Furthermore, there have recently been some suggestions that the silicone materials used in some implants may not be completely safe. The TRAM method, often used when patients prefer natural tissue to implants, or when radiation damage makes implants impractical, has excellent cosmetic results but leaves some weakness in the abdomen. The method also requires longer surgery and results in multiple scars. Except for the most conservative of breast cancer surgery, it will be necessary to construct a nipple for satisfactory cosmetic results. The nipple is difficult to construct, and generally reconstructed nipples will eventually be resorbed and become flattened. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Surgery, Breast cancer, Surgery, Plastic, Plastic surgery, Mammaplasty, Breast reconstruction

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