This report documents the case of a male in his sixties who developed multiple lymph node metastases after receiving external beam radiation therapy and androgen deprivation therapy for locally advanced prostate cancer. Agglomerated pelvic lymph node metastases caused lower extremity lymphedema, however the patient was administered systemic chemotherapy with docetaxel. Because surrounding normal tissue was already irradiated by the prior therapy, radiation against pelvic lymph nodes by LINAC was in danger of exceeding tolerance dose. Therefore, the patient received stereotactic radiosurgery by cyberknife that has a high degree of accuracy in target identification and localization for pelvic lymph node metastases. The lower extremity lymphedema was declined and his activity of daily living was recovered without obvious side effects. Here we report the case of successfully controlled lymphedema by palliative cyberknife therapy.

Between March 1985 and May 1988 we performed valve replacement to 86 cases using 92 Duromedics prosthetic valves in the atrioventricular position. Long term results were obtained, we examined the problem (especially thrombosed valve). The cumulative follow-up was 313.6 patients-year (p-y). The 6-year actuarial survival rate including early mortality was 83.4±4.1%. The valve-related complications were as follows; peripheral embolism 3 cases (1.0%/p-y), thrombosed valve 7 cases (2.2%/p-y), hemorrhage and paravalvular leakage each 1 case (0.3%/p-y). All valve-related complications were 12 cases (3.8%/p-y). Reoperation for valve-related complications were 5 cases (1.6%/p-y), it was all to thrombosed prosthetic valve. Thrombosed valve were seen 7 cases (4 cases in mitral, 3 cases in tricuspid position). The event free rate of thrombosed valve was 89.1±4.0%. It was high incidence in tricuspid position. We concluded that it was necessary to be done early reoperation the time of fixed with one leaflet alone.