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The head and neck radiotherapy patient: Part 1--Oral manifestations of radiation therapy.

The incidence of head and neck cancer increases annually in the United States, and radiation therapy is frequently a primary or adjunctive mode of therapy. As the number of radiotherapy patients rises, the need for proper detection, diagnosis, and treatment of oral lesions likewise increases. Depending on tumor site and size, radiation dosage, and preexisting oral conditions, a variety of oral radiation side effects may be present. These range from mild and reversible changes to severe and potentially disfiguring or life-threatening alterations. This article, in two parts, will review the oral manifestations of cancer radiation therapy and appropriate management techniques.

Cranial Irradiation↗

Smell and other sensory disturbances in migraine.

Osmophobia or hyperosmia featured in 25 of 50 migraineurs during the headache phase of their attacks. Pleasant or unpleasant odours could precipitate migraines in 11 patients in this series. Other sensory disturbances and precipitants were also studied. Neurological precipitation of attacks provides further support for a primary neural rather than a vascular pathogenesis of migraine.

Adolescent↗

Psychologic aspects of patients with symptoms presumed to be caused by electricity or visual display units.

Psychologic factors were studied in 10 patients with symptoms presumed to be caused by electricity (EG) and in 10 patients with symptoms presumed to be caused by visual display units (VG) and compared with a sex- and age-matched control group (CG). Psychologic differences between the EG and VG were also measured. The symptoms presumed to be caused by electricity or visual display units were registered, and the personality, psychologic functioning, and quality of life were determined by using the Karolinska Scales of Personality (KSP), an additional Personality Scale (PS), a Psychological Functioning Scale (PFS), and a quality of Life Scale (QLS). The results showed that the commonest general symptoms in the EG/VG were skin complaints, fatigue, pain, and dizziness, and the commonest oral symptoms were gustatory disturbance, burning mouth, and temporomandibular joint dysfunction. The patients in the EG described more different types of both general and oral symptoms than those in the VG. The result showed that the VG scored significantly higher only in the KSP Somatic Anxiety and Muscular Tension scales, and the EG scored significantly lower in the KSP Socialization scale and significantly higher in the Somatic Anxiety, Muscular Tension, and Psychasthenia scales. In addition, only the EG differed significantly on the PS, PFS, and QLS. The EG differed significantly in such psychologic aspects as being more fatigued in the PS, in having more difficulty in concentrating, in taking the initiative, and in getting on with people in the PFS and experiencing inactivity and visiting other people rarely in the QLS. The conclusion was that patients with symptoms presumed to be caused by electricity and visual display units differed from each other psychologically and, therefore, should be handled clinically in different ways. The need for an interdisciplinary approach to these patients is emphasized.

Adult↗

[Complications during and following tonsillectomy].

Not considering the complications due to anesthesia, postoperative hemorrhage is certainly the most frequent complication following tonsillectomy. When injury of a major vessel can be ruled out as the cause of bleeding, a discrete disturbance of hemostasis must be considered. These are mainly thrombocytopathies or a pathologically increased fibrinolysis which were not detected by routine tests and the past history. Preoperatively one should ask for more or less regular use of analgesics containing salicylates which should not be administered postoperatively. The worst attitude is case of a post-tonsillectomy hemorrhage is to do nothing or to rely on non-specific measures hoping that the bleeding will stop anyway.

Aged↗

Berg-adder bite.

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Abducens Nerve↗

Nutritional consequences of radiotherapy.

Curative doses of radiotherapy, when directed to any portion of the gastrointestinal tract, may result in serious nutritional consequences from the effects of radiation on the altered function of normal tissues. Symptoms from radiotherapy resulting in nutritional alterations are usually dependent upon dose, time, and fractionation of radiation administered, and the volume included in the treatment field. These effects directly related to radiation may be enhanced by other associated cancer therapy, e.g., surgery or chemotherapy. Careful observation and prompt attention to supportive therapy are mandatory to minimize the nutritional consequences of radiation injury. Well-designed clinical trials are necessary to demonstrate any possible increased tolerance to radiation therapy and the preventative benefits of nutritional support.

Abdominal Neoplasms↗

Alterations of nutritional status: impact of chemotherapy and radiation therapy.

The nutritional status of a cancer patient may be affected by the tumor, the chemotherapy and/or radiation therapy directed against the tumor, and by complications associated with that therapy. Chemotherapy-radiotherapy is not confined exclusively to malignant cell populations; thus, normal tissues may also be affected by the therapy and may contribute to specific nutritional problems. Impaired nutrition due to anorexia, mucositis, nausea, vomiting, and diarrhea may be dependent upon the specific chemotherapeutic agent, dose, or schedule utilized. Similar side effects from radiation therapy depend upon the dose, fractionation, and volume irradiated. When combined modality treatment is given the nutritional consequences may be magnified. Prospective, randomized clinical trials are underway to investigate the efficacy of nutritional support during chemotherapy-radiotherapy on tolerance to treatment, complications from treatment, and response rates to treatment. Preliminary results demonstrate that the administration of total parenteral nutrition is successful in maintaining weight during radiation therapy and chemotherapy, but that weight loss occurs after discontinuation of nutritional support. Thus, long-term evaluation is mandatory to learn the impact of nutritional support on survival, disease-free survival, and complication rates, as well as on the possible prevention of morbidity associated with aggressive chemotherapy-radiation therapy.

Abdominal Neoplasms↗