1/65. Mediastinal irradiation: A risk factor for atherosclerosis of the internal thoracic arteries.Previous radiotherapy to the thorax is a risk factor for coronary artery disease. patients with radiation-induced atherosclerosis tend to be young and frequently have lesions involving the coronary ostia and left anterior descending artery. Bypass is often the most suitable method of revascularization, and given the young age of the patient, arterial conduits would be considered superior to vein grafts. However, the internal thoracic arteries can lie within the radiation field and may not be free of atherosclerosis. A 40-year-old man who required coronary artery bypass grafting for multivessel coronary artery disease 11 years following radiotherapy for Hodgkin's lymphoma is reported. Preoperative angiography showed that the right internal thoracic artery had significant atherosclerosis and was unsuitable as a conduit.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/65. Superior vena cava obstruction caused by radiation induced venous fibrosis.superior vena cava syndrome is most often caused by lung carcinoma. Two cases are described in whom venous obstruction in the superior mediastinum was caused by local vascular fibrosis due to radiotherapy five and seven years earlier. The development of radiation injury to greater vessels is discussed, together with the possibilities for treatment of superior vena cava syndrome.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/65. Radiation-induced blood-brain barrier damage in astrocytoma: relation to elevated gelatinase B and urokinase.Successful management of brain tumors prolongs life, raising the risk of delayed injury secondary to the treatment. Radiation therapy, a mainstay of brain tumor treatment, can damage the cerebral blood vessels. Acutely a breakdown of the blood-brain barrier (BBB) may be seen, but fibrosis complicates radiation injury in the chronic phase. matrix metalloproteinases (MMPs) and plasminogen activators are two matrix-degrading proteolytic enzymes, which are induced by radiation. They disrupt the basal lamina around cerebral capillaries and open the BBB. We report a patient with an astrocytoma managed by partial resection and external beam irradiation to maximal tolerable doses. The patient later developed malignant brain edema shortly after stereotactic radiosurgery. Tissue obtained during surgical debulking to control the edema showed very high levels of gelatinase B (92 kDa type IV collagenase) and urokinase-type plasminogen activator (uPA). Tumor cells were absent from the biopsy and subsequent autopsy specimens, but necrosis with fibrosis of the blood vessels was seen. If abnormal matrix enzyme function participates in the expression of radiation injury, then inhibitors to such enzymes may provide one strategy for controlling cerebrovascular damage after therapeutic brain radiation.- - - - - - - - - - ranking = 7.4909424459207keywords = blood vessel, vessel (Clic here for more details about this article) |
4/65. Pseudo-aneurysm of the carotid bifurcation secondary to radiation.Pseudoaneurysms of the extracranial carotid vessels have a varied etiopathogenesis. Cases have been attributed to spontaneous rupture, following tonsillectomy or peritonsillar abscesses, trauma, postanastamotic and, rarely, postirradiation, and ECMO. The authors present a case of a pseudoaneurysm involving the carotid artery bifurcation following radiation therapy. A saphenous vein graft was used to establish continuity between the common and the internal carotid arteries. A vascular shunt was used to maintain cerebral perfusion during surgery. This case highlights the technical difficulties encountered in correcting this condition. This case exemplifies the technical difficulties that are encountered in a complicated case such as this. Numerous previous operations and radiotherapy compounded the hazards of the surgical procedure. Although technically challenging, every attempt must be made to resect pseudoaneurysms caused by radiation induced vascular damage.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/65. L-dopa-resistant parkinsonism syndrome following cerebral radiation therapy for neoplasm.A bradykinetic form of parkinsonism, unresponsive to levo-dopa therapy developed in four patients two to eight weeks after completion of external beam irradiation (39.2 Gy to 59.4 Gy) of their intracranial neoplasm. In the absence of other causative factors, we relate the movement disorder to radiation-induced changes within the basal ganglia. At post-mortem examination one patient had putamenal gliosis and thickened vessels with loss of nigral neurons.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/65. Radiation injury involving the internal carotid artery. Report of two cases.Radiation therapy is an uncommon cause of stenosis and occlusions of the cervical internal carotid artery (ICA). We describe two cases of cerebral ischemia due to ICA stenosis in patients irradiated for malignant tumors (lymphoma and breast cancer). The first patient, a 32-year-old man, presented with an episode of cerebral ischemia. Six years previously he had received irradiation therapy for a left laterocervical mass histologically diagnosed at biopsy as a Hodgkin's lymphoma. cerebral angiography on entry revealed bilateral occlusion of the cervical ICA, with a 2-cm stump at the origin of the left ICA. Despite anti-platelet aggregation therapy the ischemic attacks persisted, necessitating a stumpectomy. After vascular-repair surgery the patient had no further ischemic symptoms. The second patient, a 42-year-old woman, began to experience the sudden onset of pain in the right arm and left hemiparesis five years after surgery plus irradiation (4500 rad) for breast cancer, and three years after excision of a single cerebral metastasis. cerebral angiography obtained on admission showed occlusion of the right ICA and right subclavian arteries, both lesions necessitating thrombectomy. After surgery the right radial pulse immediately re-appeared and the hemiparesis regressed. In both patients, 2-year follow-up assessment by Doppler ultrasonography and magnetic resonance angiography (MRA) confirmed that the operated arteries remained patent. These two unusual cases underline the potential risk of irradiation-induced ischemic cerebrovascular symptoms, suggesting that patients who have received radiation therapy to the neck and mediastinum who survive for more than 5 years should undergo regular non-invasive imaging of neck vessels (Doppler ultrasonography and MRA).- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/65. Anticoagulation therapy for radiation-induced myelopathy.OBJECTIVE: To report the use of heparin and enoxaparin for radiation-induced myelopathy. CASE SUMMARY: A 48-year-old White woman with presumed metastatic lung cancer presented with worsening numbness and weakness of both legs. The neuro-oncology service was consulted and determined that the symptoms were consistent with radiation-induced myelopathy. The patient briefly responded to steroid treatment. A trial of intravenous heparin therapy was initiated by the primary team and managed by the clinical pharmacy services. Her symptoms improved when heparin was begun. She was able to walk and was subsequently discharged home on enoxaparin. DISCUSSION: spinal cord injury is one of the known adverse effects of radiation. The onset of symptoms can be acute or delayed. The clinical signs and symptoms of delayed neurologic injury are related to the narrowing and occlusion of the vessel lumen, ischemia, edema, and cell death in the surrounding nervous tissue. Treatment often consists of corticosteroids and/or hyperbaric oxygen; however, the outcomes are often disappointing. In addition to the inhibition of serum protein-mediated coagulation, heparin inactivates or prevents the release of mediators of vascular injury inflammation, permeability, and edema. Therefore, patients with radiation-induced spinal cord injury may benefit from anticoagulant therapy. CONCLUSIONS: heparin and/or enoxaparin may be considered as potential treatments for patients with radiation-induced myelopathy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/65. Surgical treatment of the radiation injured bowel.Over the last 10 years, 9 patients treated by surgical procedure for radiation injuries of the bowel were studied with the following conclusions: The damage to the small intestine caused by external irradiation leads to adhesion of the bowel, perforation and postoperative anastomotic dehiscence if the irradiated bowel is used in the anastomosis. Surgical treatment for the small intestine is resection of the damaged loop. In order to determine the extent of the resection it is important that during the operation fibrosis and obstruction of vessels in the submucosa and subserosa is examined by biopsy. On the other hand, rectal ulcer and/or rectovaginal fistula is chiefly caused by intracavitary application plus external irradiation. For these lesion Hartmann operation or colostomy is performed, and the postoperative course is uneventful.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/65. Acute hemorrhage in late radiation necrosis of the temporal lobe: report of five cases and review of the literature.hemorrhage in late cerebral radiation necrosis is a rare complication after radiotherapy for intracranial and extracranial neoplasms. We report 5 cases of acute hemorrhage in late radiation necrosis of the temporal lobe following radiation therapy for nasopharyngeal carcinoma. In a review of the literature, the authors identified a total of 27 such cases. The interval period between the onset of hemorrhage and cranial irradiation is long (mean = 7.8 years). The most prominent histological feature was the proliferation of large, dilated and thin-walled new blood vessels in a background of gliosis and fibrinoid necrosis of vessels. rupture of these thin-walled new blood vessels is the proposed mechanism of hemorrhage in this condition.- - - - - - - - - - ranking = 8.4909424459207keywords = blood vessel, vessel (Clic here for more details about this article) |
10/65. Delayed cerebrovascular consequences of therapeutic radiation. A clinicopathologic study of a stroke associated with radiation-related carotid arteriopathy.A young woman, successfully treated for Hodgkin's disease with radiation and MOPP chemotherapy, incurred a devastating stroke months after radiation therapy to the neck and other areas. There was no premonitory clinical history of cerebrovascular attacks. autopsy showed unilateral thrombotic occlusion of the internal carotid artery unassociated with neoplastic or fibrotic annular constriction of the vessel. There was medial thickening and fibroblastic proliferation within the carotid artery. Areas of focal elastic membrane degeneration involved the cervical portions of the carotid. Thrombus was organized to the damaged vessel wall and was propagated into the intracranial vessels. aneurysm formation and arterial hemorrhages were absent. These vascular changes occurred in an area of extensive radiation (7200 rads). Pathoanatomical studies in this patient indicate that radiation-induced vascular changes were associated with a "delayed" stroke.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
| | Next -> |