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Anuria following roentgen therapy for pelvic tumors
ABSTRACTS
over the size of a 4 months’ pregnancy the reduction incidence was reduced to 36.7 per cent. Large pedunculated fibroids show some tendency to degeneration, and should be operated upon if possible. Only 4 of the 986 patients developed carcinoma (3 fundal and 1 cervical), and it is suggested that radiation may have a protective effect in the prevention of malignancy. WILLIAM BERMAN.
Chamberlin,Payne, and Stevens: Anuria Following RoentgenTherapy for Pelvic TUUIOIS, Radiology
35: 346, 1940.
Anuria, due to obstruction of, both ureters; is a rare complication during roentgen therapy of tumors within the pelvis. Still rarer is the occurrence of bilateral symmetrical tumors, each involving the lower end of a ureter. The authors have been unable to find any other such case in the literature. ’ There is a dearth of .literature dealing with anuria produced by tissue edema Bugbee has reported 8 and Exley 2 instances of following irradiation therapy. ureteral obstruction following radium therapy for carcinoma of the uterus. All of these, however, may be classified as late effects caused either by continued growth of the tumor, or by fibrosis and constriction due to irradiation therapy. Maintz has cited four instances in which anuria occurred as a complication of roentgen therapy early in the course of treatment for carcinoma of the uterus. His patients remained anuric as long as five days. He attributed the cessation of urinary excretion to swelling of the ureteral mucosa. There seems to be little doubt that in the case reported by the authors irradiation produced sufficient edema in the tumor to cause a complete bilateral ureteral obstruction. This sweIling was evident by rectal and vaginal examinations and also by the fact that the urinary secretion returned several days after roentgen therapy was stopped. In retrospect, it is evident that intravenous urography for the purpose of studying the exact condition of the urinary tract was indicated before roentgen therapy. Furthermore, it must be constant1.y borne in mind that relatively small doses of irradiation to such tumors may produce local swelling sufficient to obstruct the ureters when the margin of safety has already been reduced. J. P. GREENHILL.
Duvergey and Duvergey: Fifteen Casesof Radionecrosisof the Bladder Following Radiation Therapy for Cancer of the Cervix, Compt. rend. Sot. fraq de gym%. 9: 120, 1939. Characteristically, radiation necrosis of the bladder following radium treatment of cancer of the cervix occurs long after the treatment is given. Usually between two and five years elapse, and in one of the authors’ cases t,here was an interval of ten years. Clinically the symptoms are an intense cystitis with pollakiurea, In most cases, the impression is given tenesmus, pain, pyuria, and hematuria. that there is a recurrence of the cancer with invasion of the bladder wall. The way to be certain of the correct diagnosis is to take a biopsy. The usual seat of the bladder necrosis is in the region of the trigone at the base of the bladder at the bladder neck. Radionecrosis of the bladder is the result of two factors. The first is an intense trophic disturbance caused by the radium and the second is infection. Because of an obliterating endarteritis, there is no vasomotor re.action to combat the infection. The treatment of this condition consists of disinfection of the bladder by means of daily bIadder irrigations with antiseptic solutions. If an ulcer is present it In cases of severe hemorrhage cystotomy may have to be excised or coagulated. may be necessary. Regardless of what is done, it must be remembered that complete eicatrization of the ulcer is a long process so one must have patience. J. P. GREENHILL.
over the size of a 4 months’ pregnancy the reduction incidence was reduced to 36.7 per cent. Large pedunculated fibroids show some tendency to degeneration, and should be operated upon if possible. Only 4 of the 986 patients developed carcinoma (3 fundal and 1 cervical), and it is suggested that radiation may have a protective effect in the prevention of malignancy. WILLIAM BERMAN.
Chamberlin,Payne, and Stevens: Anuria Following RoentgenTherapy for Pelvic TUUIOIS, Radiology
35: 346, 1940.
Anuria, due to obstruction of, both ureters; is a rare complication during roentgen therapy of tumors within the pelvis. Still rarer is the occurrence of bilateral symmetrical tumors, each involving the lower end of a ureter. The authors have been unable to find any other such case in the literature. ’ There is a dearth of .literature dealing with anuria produced by tissue edema Bugbee has reported 8 and Exley 2 instances of following irradiation therapy. ureteral obstruction following radium therapy for carcinoma of the uterus. All of these, however, may be classified as late effects caused either by continued growth of the tumor, or by fibrosis and constriction due to irradiation therapy. Maintz has cited four instances in which anuria occurred as a complication of roentgen therapy early in the course of treatment for carcinoma of the uterus. His patients remained anuric as long as five days. He attributed the cessation of urinary excretion to swelling of the ureteral mucosa. There seems to be little doubt that in the case reported by the authors irradiation produced sufficient edema in the tumor to cause a complete bilateral ureteral obstruction. This sweIling was evident by rectal and vaginal examinations and also by the fact that the urinary secretion returned several days after roentgen therapy was stopped. In retrospect, it is evident that intravenous urography for the purpose of studying the exact condition of the urinary tract was indicated before roentgen therapy. Furthermore, it must be constant1.y borne in mind that relatively small doses of irradiation to such tumors may produce local swelling sufficient to obstruct the ureters when the margin of safety has already been reduced. J. P. GREENHILL.
Duvergey and Duvergey: Fifteen Casesof Radionecrosisof the Bladder Following Radiation Therapy for Cancer of the Cervix, Compt. rend. Sot. fraq de gym%. 9: 120, 1939. Characteristically, radiation necrosis of the bladder following radium treatment of cancer of the cervix occurs long after the treatment is given. Usually between two and five years elapse, and in one of the authors’ cases t,here was an interval of ten years. Clinically the symptoms are an intense cystitis with pollakiurea, In most cases, the impression is given tenesmus, pain, pyuria, and hematuria. that there is a recurrence of the cancer with invasion of the bladder wall. The way to be certain of the correct diagnosis is to take a biopsy. The usual seat of the bladder necrosis is in the region of the trigone at the base of the bladder at the bladder neck. Radionecrosis of the bladder is the result of two factors. The first is an intense trophic disturbance caused by the radium and the second is infection. Because of an obliterating endarteritis, there is no vasomotor re.action to combat the infection. The treatment of this condition consists of disinfection of the bladder by means of daily bIadder irrigations with antiseptic solutions. If an ulcer is present it In cases of severe hemorrhage cystotomy may have to be excised or coagulated. may be necessary. Regardless of what is done, it must be remembered that complete eicatrization of the ulcer is a long process so one must have patience. J. P. GREENHILL.