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PubMed2006

Enhanced radiation sensitivity and radiation recall dermatitis (RRD) after hypericin therapy -- case report and review of literature.

BACKGROUND: Modern radiotherapy (RT) reduces the side effects at organ at risk. However, skin toxicity is still a major problem in many entities, especially head and neck cancer. Some substances like chemotherapy provide a risk of increased side effects or can induce a "recall phenomenon" imitating acute RT-reactions months after RT. Moreover, some phototoxic drugs seem to enhance side effects of radiotherapy while others do not. We report a case of "radiation recall dermatitis" (RRD) one year after RT as a result of taking hypericin (St. John's wort). CASE REPORT: A 65 year old man with completely resected squamous cell carcinoma of the epiglottis received an adjuvant locoregional RT up to a dose of 64.8 Gy. The patient took hypericin during and months after RT without informing the physician. During radiotherapy the patient developed unusual intensive skin reactions. Five months after RT the skin was completely bland at the first follow up. However, half a year later the patient presented erythema, but only within the area of previously irradiated skin. After local application of a steroid cream the symptoms diminished but returned after the end of steroid therapy. The anamnesis disclosed that the patient took hypericin because of depressive mood. We recommended to discontinue hypericin and the symptoms disappeared afterward. CONCLUSION: Several drugs are able to enhance skin toxicity of RT. Furthermore, the effect of RRD is well known especially for chemotherapy agents such as taxans. However, the underlying mechanisms are not known in detail so far. Moreover, it is unknown whether photosensitising drugs can also be considered to increase radiation sensitivity and whether a recall phenomenon is possible. The first report of a hypericin induced RRD and review of the literature are presented. In clinical practise many interactions between drugs and radiotherapy were not noticed and if registered not published. We recommend to ask especially for complementary or alternative drugs because patients tend to conceal such medication as harmless.

Aged↗
PubMed2000

Inserts--megafillers in composite restorations: a literature review.

Modern insert systems have been available on the dental market since the late 1980s. In general, two major systems can be distinguished: those with and those without preparation instruments in combination with matching standardized inserts. It is claimed that one of the advantages of insert systems is the better marginal adaptation of insert/composite restorations compared to mere composite restorations: the integration of inserts reduces the polymerization shrinkage stress and lowers the overall coefficient of thermal expansion. In vitro data indicate that adapting the insert size to the most precise fit produces a quality of marginal adaptation comparable to that of ceramic inlays. Inserts also facilitate the establishment of a proximal contact. With respect to wear, no significant differences are detected between composite and insert restorations. The bond between insert and composite is susceptible to contamination during operative procedures. Short-term clinical investigations confirm in vitro findings regarding improved marginal adaptation and increased wear resistance. Long-term controlled clinical studies are in progress, but data are not yet available. Based upon the present in vitro and in vivo data it can be concluded that the insert technology shows promising results, but further investigations regarding, for example, stability of the insert/composite bond, fracture resistance of the overall restoration, and wear behavior are necessary to predict the clinical success of this alternative restoration procedure.

Ceramics↗
PubMed1999

Quality of Life after traumatic brain injury: A systematic review of the literature.

In modern industrial countries traumatic brain injury (TBI) is a common sequel after different kinds of accidents especially amongst young male adults. Apart from medical and economic consequences Quality of Life (QoL) after TBI becomes increasingly important in outcome assessment. Besides the classical domains of QoL (physical, psychological, social) cognitive impairments are playing an important role especially for TBI patients. In 1991 the Meran conference set important standards and formulated basic guidelines for defining and measuring QoL in surgery, but a special index for TBI patients has not yet been developed. Instead, QoL research concentrates on physical, medical, psychological and social problems only. Based on the existing QoL concept extended by the cognitive aspect it was the aim of this review to give an overview about the recent QoL research in TBI patients since 1991. Sixteen studies in TBI patients mentioning at least 2 domains of QoL (physical, psychological, social, cognitive) were published since 1991. Five of them considered all 4 domains of QoL. All studies except of one dealt with psychological and social problems. Only half of the studies considered cognitive impairments. Four studies tried to define QoL, but none of them included the cognitive component. There was no consensus regarding the definition and the choice of measurement instrument for QoL after TBI. This review of 16 studies considering outcome and QoL after TBI confirms that a homogenous and clinically relevant QoL concept for this group of patients is still missing. Further research in TBI patients should include all 4 domains of QoL.

Journal Article↗