Radiation-induced lumbar plexopathy
Radiation-induced lumbar plexopathy or radiation-induced lumbosacral plexopathy is nerve damage in the pelvis and lower spine area occurring as a late side effect of external beam radiation therapy. In general terms, such nerve damage may present in stages, earlier as demyelination and as complications of chronic radiation fibrosis. RILP occurs as a result of radiation therapy administered to treat lymphoma or cancers within the abdomen or pelvic area such as cervical, bladder, kidney, prostate, colorectal, rectal or anal cancer; the lumbosacral plexus area is radiosensitive and radiation plexopathy can occur after exposure to mean or maximum radiation levels of 50-60 Gray with a significant rate difference noted within that range. Lumbosacral plexopathy is characterized by any of the following symptoms. Lower limb dysaesthesia, abnormal sensations of touch or feeling Lower limb weakness Lower limb numbness Lower limb paresthesia, e.g. foot drop, muscle atrophy Lower limb painSymptoms are a step-wise progression with periods of stability in between, weakness appearing years later.
Weakness presents in the lower leg muscle groups. Symptoms are irreversible. Initial onset of symptoms may occur as early as 2 to 3 months after radiotherapy; the median onset is 5 years, but can be variable, 2-3 decades after radiation therapy. One case study recorded the initial onset occurring 31 years post treatment; the treatment's ionizing radiation is an activation mechanism for apoptosis within the targeted cancer, but it can impact nearby healthy radiosensitive tissues, like the lumbosacral plexus. The occurrence and severity of RILP is related to the magnitude of ionizing radiation and the radiosensitivity of peripheral nerves may be further aggravated when combined with chemotherapy, like taxanes and platinum drugs, during treatment; the pathophysiological process behind radiation's RILP nerve damage has been discussed and posited since the 1960s and still is without precise definition. Consensus exists on a progression of symptoms, with a stepping between initial inflammation and subsequent retractile fibrosis.
Proposed mechanisms of nerve damage include microvascular damage supplying the myelin, radiation damage of the myelin, oxygen free radical cell damage, nerve compression neuropathy and a late fibro-atrophic poorly vascularised phase with retractile fibrosis. The more common source of lumbar plexopathy is a direct or secondary tumor involvement of the plexus with MRI being the typical confirmation tool. Tumors present with enhancement of nerve roots and T2-weighted hyperintensity; the differential consideration of RILP requires taking neurologic examination. RILP's neurological symptoms can mimic other nerve disorders. People may present with pure lower motor neuron syndrome, a symptom of amyotrophic lateral sclerosis. RILP may be misdiagnosed as leptomeningeal metastasis showing nodular MRI enhancement of the cauda equina nerve roots or having increased CSF protein content. Other differential diagnoses to consider are Chronic Inflammatory Demyelinating Polyradiculoneuropathy, neoplastic lumbosacral plexopathy, paraneoplastic neuronopathy, diabetic lumbosacral plexopathy, degenerative disk disease, Osteoarthritis of the spine, Lumbar Spinal Stenosis, post-infectious plexopathy, carcinomatous meningitis, mononeuritis multiplex, chemotherapy-induced plexopathy.
The testing to resolve a RILP diagnosis involves blood serum analysis, X-rays, EMG, MRI and Cerebrospinal Fluid analysis. Since RILP's neurological changes are irreversible and a curative strategy has yet to be defined, prevention is the best approach. Treating the primary cancer remains an obvious requirement, but lower levels of lumbar plexus radiation dosing will minimize or eliminate RILP. One method to reduce the lumbosacral plexus' dosing is to include it with other at-risk organs that get spared from radiation. Key to prevention is resolving the lack of clinical evidence between dosing the lumbar plexus and the late onset of neurological problems, a relationship confounded by low toxicity rates and the lack of an adequate population size, the lack of aggregate data pooling across multiple institutions. Treatment of RILP is supportive with mental and social aspects and consideration of any aggravating neurological factors. To prevent compounding existing RILP symptoms and to minimize further progression Remove co-morbidity factorscontrol diabetes and hypertension avoid alcohol abuse avoiding any local trauma in the irradiated volume controlling acute edema control acute inflammation.
Pharmaceuticals that may be effective are corticosteroids avoid stretching a plexus immobilized by fibrosis, e.g. carrying heavy loads or extensive movements, which may cause sudden neurological decompensation. The effect on the person with the condition, depends upon the type of impairment. Handicaps may include physical challenges, bowel and/or bladder dysfunction and may occur in multiple settings of work and home. Physical and occupational therapy are important elements in maintaining mobility and use of the lower extremities, along with assistive aides such as Ankle-Foot-Orthotics, walkers, etc. Sensory reeducation techniques may be necessary for balance and lymphedema management may be required. Pharmaceuticals that may be effective for RILP's neuropathic pain are tricyclic antidepressants Antiepileptics or anticonvulsants Selective serotonin re-uptake inhibitors
Outline of exercise
____________Attention: THIS IS AN OUTLINE___________________________ part of the set of 740+ outlines listed at Portal:Contents/Outlines. Wikipedia outlines are a special type of list article, they make up one of Wikipedia's content navigation systems See Wikipedia:Outlines for more details. Further improvements to this outline are on the way...--> The following outline is provided as an overview of and topical guide to exercise: Exercise – any bodily activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons including strengthening muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance, as well as for the purpose of enjoyment. Frequent and regular physical exercise boosts the immune system, helps prevent the "diseases of affluence" such as heart disease, cardiovascular disease, Type 2 diabetes and obesity. Aerobic exercise – Aerobics Circuit training Cycling Hiking Running Skipping rope Swimming Walking Power walking Anaerobic exercise – Bodybuilding Eccentric training Functional training Sprint Weight training Strength training Quadriceps Leg extension Leg press Lunge Squat Hamstrings Deadlift Good-morning Leg curl Squat Calves Calf raise Pectorals Bench press Chest fly Dips Machine fly Push-up Lats and trapezius Bent-over row Chin-up Pulldown Pullup Seated row Shoulder shrug Supine row Deltoids Front raise Head stand into Handstand push-up Lateral raise Military press Rear delt raise Shoulder press Upright row Biceps Biceps curl Pull ups with a supinated grip Triceps Close-grip bench press Dip Pushdown Triceps extension Forearms Wrist curl Wrist extension Abdomen and obliques Crunch Leg raise Russian twist Sit-up Lower back Deadlift Good-morning Hyperextension Pelvis Vaginal weightlifting Extended length conditioning Calisthenics Abdominal exercise Calf-raises Crunches Dips Hyperextensions Jumping jacks Leg raises Lunges Plank Pull-ups Muscle-ups Push-ups Sit-ups Squat jumps Squats Stretching – Ballistic stretching Dynamic stretching PNF stretching Static stretching Passive stretching Altitude training Boxing training Circuit training Complex training Cross training Endurance training Long slow distance Grip strength training Interval training Plyometrics Strength training High intensity training Weight training Resistance training Training to failure Physical therapy Pilates Yoga Exercise trends Aerobic conditioning Neurobiological effects of physical exercise - improves: Executive function Memory Stress management Physical fitness, including improving and maintaining these aspects of it: Accuracy Agility Balance Coordination Endurance Flexibility Power Speed Stamina Strength Prevention – exercise helps prevent: Cancer Drug addiction Hypertension Major depressive disorder Neurodegenerative disorders Obesity Osteoporosis Type 2 Diabetes Cramps Dehydration Heat stroke Overtraining Sports injury Sprain – pull or rupture ligaments Strain – pull or rupture muscles Tendon rupture Achilles tendon rupture Reps – Sets – Workout – Warm up – yes Ripped – Buff – Recovery –NutritionalFormula – Dietary supplement – Protein – Whey protein – Energy drink – Snack bar – Amino acid – Creatine Vitamin B2 Vitamin B6 Vitamin B12BiologicalMuscle – Muscle tissue – Muscle fiber – Joint – Tendon – Aerobic exercise § History Bodybuilding § History Exercise § History Exercise physiology § History Exercise trends Fitness boot camp § History Fitness culture Physical culture Outdoor fitness § History List of exercise equipment Dumbbell Barbell Chin-up bar Kettlebell Treadmill Punching bag Metal bar Bench Barbell Bench Bowflex Bulgarian Bag Cable machine Captains of Crush Grippers Dip bar Dumbbell Halteres Indian clubs Iron rings IronMind Ivanko Barbell Company Kettlebell Leg press Power cage Shake Weight Smith machine Soloflex Total Gym Trap bar Universal Gym Equipment Weight machine York Barbell Exercise physiology Aerobic exercise Anaerobic exercise Exercise induced nausea Grip strength Muscle hypertrophy Overtraining Stretching Supercompensation Warming up Weight cutting Weight loss Remote physiological monitoring Body fat percentage Blood pressure Heart rate Pulse rate Respiration rate Fitness professional Personal trainer Weighted clothing Roger Bannister Lance Armstrong John Basedow Robyn Landis Joseph Pilates Susan Powter Arnold Schwarzenegger Jack LaLanne Erwan Le Corre Georges Hébert List of exercise equipment List of weight training exercises Outline of health Outline of nutrition Outline of sports Sportswear Yahoo!
Health Alberta Centre for Active Living Physical Activity @ Work website American College of Sports Medicine website
Radiophobia is an obsessive fear of ionizing radiation, in particular, fear of X-rays. While in some cases radiation may be harmful, the effects of poor information, understanding, or a traumatic experience may cause unnecessary or irrational fear; the term is used in a non-medical sense to describe the opposition to the use of nuclear technology arising from concerns disproportionately greater than actual risks would merit. The term was used in a paper entitled "Radio-phobia and radio-mania" presented by Dr Albert Soiland of Los Angeles in 1903. In the 1920s, the term was used to describe people who were afraid of radio broadcasting and receiving technology. In 1931, radiophobia was referred to in The Salt Lake Tribune as a "fear of loudspeakers", an affliction that Joan Crawford was reported as suffering; the term "radiophobia" was printed in Australian newspapers in the 1930s and 1940s, assuming a similar meaning. The 1949 poem by Margarent Mercia Baker entitled "Radiophobia" laments the intrusion of advertising into radio broadcasts.
The term remained in use with its original association with radios and radio broadcasting during the 1940s and 1950s. During the 1950s and 1960s, the Science Service associated the term with fear of gamma radiation and the medical use of x-rays. A Science Service article published in several American newspapers proposed that "radiophobia" could be attributed to the publication of information regarding the "genetic hazards" of exposure to ionising radiation by the National Academy of Sciences in 1956. In a newspaper column published in 1970, Dr Harold Pettit MD wrote:"A healthy respect for the hazards of radiation is desirable; when atomic testing began in the early fifties, these hazards were grossly exaggerated, producing a new psychological disorder, called "radiophobia" or "nuclear neurosis". March 1, 1954, the operation Castle Bravo testing of a first of its kind, experimental thermonuclear Shrimp device, overshot its predicted yield of 4–6 megatons and instead produced 15 megatons. 2 weeks after the test and fallout exposure, the 23-member fishing crew began to fall ill, with acute radiation sickness brought on by beta burns that were caused by direct contact between the Bikini snow fallout and their skin, through their practice of scooping the "Bikini snow" into bags with their bare hands.
One member of the crew, Kuboyama Aikichi the boat's chief radioman, died 7 months on September 23, 1954. It was estimated that about a hundred fishing boats were contaminated to some degree by fallout from the test. Inhabitants of the Marshall Islands were exposed to fallout, a number of islands had to be evacuated; this incident, due to the era of secrecy around nuclear weapons, created widespread fear of uncontrolled and unpredictable nuclear weapons, of radioactively contaminated fish affecting the Japanese food supply. With the publication of Joseph Rotblat's findings that the contamination caused by the fallout from the Castle Bravo test was nearly a thousand times greater than that stated outcry in Japan reached such a level that the incident was dubbed by some as "a second Hiroshima". To prevent the subsequent strong anti-nuclear movement from turning into an anti-American movement, the Japanese and U. S. governments agreed on compensation of 2 million dollars for the contaminated fishery, with the surviving 22 crew men receiving about ¥ 2 million each, The surviving crew members, their family, would experience prejudice and discrimination, as local people thought that radiation was contagious.
The Castle Bravo test and the new fears of radioactive fallout inspired a new direction in art and cinema. The Godzilla films, beginning with Ishirō Honda's landmark 1954 film Gojira, are strong metaphors for post-war radiophobia; the opening scene of Gojira echoes the story of the Daigo Fukuryū Maru, from the initial distant flash of light to survivors being found with radiation burns. Although he found the special effects unconvincing, Roger Ebert stated that the film was "an important one" and "properly decoded, was the Fahrenheit 9/11 of its time."A year after the Castle Bravo test, Akira Kurosawa examined one person's unreasoning terror of radiation and nuclear war in his 1955 film I Live in Fear. At the end of the film, the foundry worker who lives in fear has been declared incompetent by his family, but the possible partial validity of his fears has transferred over to his doctor. Nevil Shute's 1957 novel On the Beach depicts a future just six years based on the premise that a nuclear war has released so much radioactive fallout that all life in the Northern Hemisphere has been killed.
The novel is set in Australia, along with the rest of the Southern Hemisphere, awaits a similar and inevitable fate. Helen Caldicott describes reading the novel in adolescence as'a formative event' in her becoming part of the anti-nuclear movement. In the former Soviet Union many patients with negligible radioactive exposure after the Chernobyl disaster displayed extreme anxiety about low level radiation exposure, therefore developed many psychosomatic problems, with an increase in fatalistic alcoholism being observed; as Japanese health and radiation specialist Shunichi Yamashita noted: We know from Chernobyl that the psychological consequences are enormous. Life expectancy of the evacuees