Surgical solution of the extensive post-radiation defect developped 33 years after radiotherapy for breast carcinoma case report.

INTRODUCTION: Damage of the skin and its underlying structures is a common side effect of radiotherapy. These conditions limit further treatment and dealing with these complications is a routine practice of clinical oncologist. The majority of the complications are immediate, with a perspective of healing ad integrum within a few weeks. Less frequently, but sometimes with severe manifestations, chronic toxicity occurs belatedly after months, or even many years after irradiation, in form of post-radiation ulcer, for instance with potential of secondary malignant transformation. Regarding surgery, it might be one of the most challenging chronic wounds to treat. In extreme cases, extensive resection of the entire affected area is needed, inevitably ending with demanding reconstruction of the resulting defect. CASE REPORT: This case report presents a female patient with rapidly progressive post-radiation chest wall defect 33 years after the irradiation, when relatively insignificant skin injury occured. Prior to this sudden deterioration, only long-term, non-progressive changes, without a cutaneous defect, were described during the dispensarisation. After a protracted outpatient treatment with unsatisfactory results, when the patient repeatedly refused mastectomy, the condition inevitably led to the complex surgical procedure with necessary cooperation of breast, plastic and thoracic surgeons. CONCLUSION: Although changes of the similar severity rarely occur even after many years following the treatment, we havent found such a dramatic change of the patients condition three decades after the therapy with urgency of this type of complex,  surgical intervention in current literature.

[Duodenal duplication. Case report and review of the literature]. / Duplikatur am Duodenum. Bericht über einen Fall und Literaturübersicht.

A case of duodenal duplication (cyst) in a 42-year-old male is reported. The late manifestation of this rare, little-known, but noteworthy congenital malformation was characterized by repeated attacks of acute pancreatitis and development of a high, duodenal obstruction. Radiographic examination and fiberoptic endoscopy was followed by exploratory laparotomy which demonstrated the accurate diagnosis. A review of the literature including 39 duodenal duplications in more than 300 duplications of the alimentary tract is presented.