Carbon-ion radiotherapy in osteosarcoma of the mandible: a case report

Carbon-ion radiotherapy (CIRT) is on the rise as a treatment choice for malignant tumor. Compared to conventional radiotherapy, particle beams have different physical and biological properties. Particle beam provides a low entry dose, deposits most of the energy at the endpoint of the flight path, and forms an asymptotic dose peak (the “Bragg peak”). Compared to protons, carbon with its larger mass decreases beam scattering, resulting in a sharper dose distribution border. We report a 50-year-old male who underwent CIRT without surgical resection on osteosarcoma of the mandible. After CIRT, the patient’s pain was gone, and the malignant mass remained stable with accompanying necrosis. Nine months later, however, magnetic resonance imaging demonstrated progression of the left mandibular osteosarcoma with pulmonary metastases. After multidisciplinary discussion, concurrent chemoradiotherapy was conducted. While necrotic bone segments came out of the mandible during subsequent periodic outpatient visits, the tumor itself was stable. Thirty months after his first visit and diagnosis, the patient is waiting for chemotherapy. Although CIRT is superior in treating radioresistant hypoxic disease, CIRT is in its infancy, so care must be taken for its indications and complications.

Carbon-ion radiotherapy in osteosarcoma of the mandible: a case report

Carbon-ion radiotherapy (CIRT) is on the rise as a treatment choice for malignant tumor. Compared to conventional radiotherapy, particle beams have different physical and biological properties. Particle beam provides a low entry dose, deposits most of the energy at the endpoint of the flight path, and forms an asymptotic dose peak (the “Bragg peak”). Compared to protons, carbon with its larger mass decreases beam scattering, resulting in a sharper dose distribution border. We report a 50-year-old male who underwent CIRT without surgical resection on osteosarcoma of the mandible. After CIRT, the patient’s pain was gone, and the malignant mass remained stable with accompanying necrosis. Nine months later, however, magnetic resonance imaging demonstrated progression of the left mandibular osteosarcoma with pulmonary metastases. After multidisciplinary discussion, concurrent chemoradiotherapy was conducted. While necrotic bone segments came out of the mandible during subsequent periodic outpatient visits, the tumor itself was stable. Thirty months after his first visit and diagnosis, the patient is waiting for chemotherapy. Although CIRT is superior in treating radioresistant hypoxic disease, CIRT is in its infancy, so care must be taken for its indications and complications.

A case of unexpected adjacent tooth extrusion after implant fixed prosthetic treatment, who had undergone mandibular resection and reconstruction due to ameloblastoma / 대한치과보철학회지

Ameloblastoma is a benign odontogenic epithelial tumor with high recurrence rate and requires extensive resection of the surrounding tissue and reconstruction of defect site. Because of the anatomical limitation of the reconstruction site, prosthetic treatment with implants is the first recommendation. This is a case of prosthetic restoration of the reconstruction site with implant fixed prosthesis in patient who underwent mandibular resection and iliac bone reconstruction due to ameloblastoma. However 14 months after completion of implant prosthesis, adjacent natural tooth erupted unexpectedly, resulting in 1mm infra-occlusion occurred including posterior implant prosthesis and anterior natural teeth. In adults, implant infra-occlusion may occur due to residual growth after placement of the maxillary anterior implant. But this case, hypo-occlusion of molar implant and open bite of anterior natural teeth is occurred due to extrusion of adjacent tooth, is rare. Thus we report the treatment process including orthodontic treatment with intrusion of the posterior tooth, and investigate the causes of sudden, unexpected tooth extrusion.

Scoring Methods for Prognosis of Patients with Acute Severe Organophosphate Intoxication

PURPOSE: Although, there have been many reports about factors involved in the severity and prognosis of organophosphate toxicity, there are few reports on integrated application of scoring methods using those factors for prognosis. Our report is about the possible application of such scoring methods in the early stage of organophosphate intoxication. METHODS: This study included organophosphate intoxication patients who were admitted to the Emergency department (ED) between March 1, 2004 and February 28, 2008. We limited enrolment in the study to patients who had required assisted mechanical ventilation and used atropine for therapy. This was a retrospective study about age, drug toxicity, mental status, existence of metabolic acidosis and QT prolongation for each patient. RESULTS: Thirty seven patients were enrolled in this study. Among the 37, 22 survived and 15 died. For survivors, drug toxicity and mental status were correlated with total dose of atropine, and the existence of metabolic acidosis was correlated with the duration of mechanical ventilation. Survivors had lower total scores than non-survivors. CONCLUSION: Application of scoring methods that include five factors (age, drug toxicity, mental status, existence of metabolic acidosis, existence of QTc prolongation) when acute, severe, organophosphate poisoning patients arrive at an ED can be helpful for their prognosis.

Management of choroidal neovascularization following laser photocoagulation for central serous chorioretinopathy

Little is known about the natural history and management of choroidal neovascularization (CNV) which developed as a complication of laser photocoagulation for central serous chorioretinopathy (CSC). We experienced two patients with CNV which developed after laser treatment for CSC. Submacular membranectomy was performed on both cases after the confirmation of subretinal CNV with optical coherence tomography. One patient received photodynamic therapy for recurrent CNV. The vision of both patients has been improved over 6 months of follow up. These cases suggest that active intervention, including submacular surgery, improves the visual prognosis of this condition.

Clinical Outcomes of Phacoemulsification Technique with Intraocular Lens Implantation in Leprosy Patients

PURPOSE: To evaluate the surgical results and complications in leprosy patients with cataract who underwent phacoemulsification and intraocular lens implantation retrospectively. METHODS: A total of 17 eyes of 13 leprosy patients with cataract underwent a phacoemulsification and posterior chamber intraocular lens implantation. We performed pupillary sphicterectomy or sector iridectomy for miotic pupils. RESULTS: With mean age of 73 years and a mean follow-up of 8.2 months, patients admitted for 3.2 days. The average visual acuity was 0.1 (0.04~0.3) preoperatively, 0.5 (0.04~1.0) at 1 week after operation, and 0.6 (0.1~1.0) at 2 months after operation. Intraoperative complications were posterior capsular rupture (2 eyes) and vitreous loss (1 eye). Common Postoperative complications were after cataract (4 eyes) and hyphema (2eyes). CONCLUSIONS: We thought the phacoemulsification and intraocular lens implantation was useful method for cataract of leprosy patient for increased life quality and satisfaction.