Influence of surgical margins on outcome in patients with preoperatively irradiated extremity soft tissue sarcomas.

Background: Limb-sparing surgery for soft tissue sarcomas of the extremities may result in microscopically positive surgical margins. The consequences of these microscopically positive margins are unknown. We have analyzed the influence of surgical margins on local disease control and overall survival in patients with extremity soft tissue sarcomas who received preoperative radiation therapy followed by limb-sparing surgery.

Reflections on radiotherapy in Vietnam: political lessons still to be learned.

Radiotherapy in Vietnam represents a stark contrast to the level of care available in the United States. The issue of efficient administration of cancer care with available resources is common to both nations. The challenge for each country is to develop treatment strategies and political policies for effective and accessible care within budgetary constraints.

The psychopharmacology of social phobia and comorbid disorders.

The pharmacotherapy of social phobia includes agents from different classes with different mechanisms of action and has recently become the focus of more attention in the research community. The authors highlight drug treatments with reported efficacy, including: (1) certain antidepressants: monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and other antidepressants not yet available in the United States such as reversible inhibitors of MAO-A; (2) high-potency benzodiazepines; and (3) beta-adrenergic blocking drugs (mainly for performance anxiety). The frequent co-occurrence of social phobia with other psychiatric disorders often complicates patient management, treatment, and outcome.

Diagnosing intramuscular myxoma by fine-needle aspiration: a multidisciplinary approach.

The gross and microscopic appearances of aspirates from ten intramuscular myxomas are reported. The specimens were obtained from seven women and three men, ages 43 to 75, who had tumors involving the muscles of the thigh (7), upper arm (2), and forearm (1). Magnetic resonance (MR) imaging performed in six of the ten cases revealed well-defined, sharply demarcated tumors exhibiting low signal intensity relative to muscle on the T1-weighted images.

Immediate versus delayed free-tissue transfer salvage of the lower extremity in soft tissue sarcoma patients.

Background: Free tissue transfer (FTT) can extend the limits of limb salvage in patients with soft tissue sarcoma (STS), but few data exist on the efficacy and morbidity in this patient population.

Methods: We prospectively examined 19 patients who underwent resection of STS and an immediate or a delayed FTT reconstruction between November 1989 and May 1992.

Results: There were 11 immediate and eight delayed FTT reconstructions (mean age 52 years).

Limb-sparing therapy for soft tissue sarcomas.

Effective therapy for soft tissue sarcoma of the extremities continues in its lengthy evolution from mandatory amputation or radical compartment resection to multimodality limb salvage procedures. This current approach typically includes preoperative neoadjuvant systemic chemotherapy, followed by negative margin surgical resection in conjunction with radiotherapy. The scope and functional outcome of these resections has been markedly enhanced by the application of microvascular-dependent free tissue transfer techniques.

Cancer education in Viet Nam: a need for foreign input.

In Viet Nam cancer education has a low priority because of political and social factors. Knowledge about cancer staging and basic management principles is stagnated by restricted communication with foreign colleagues and by limitations of available techniques. Participation in either formal residency programs or conferences for continuing education outside Viet Nam is restricted to select individuals of high rank.

Radiation therapy for alveolar soft-part sarcoma.

A clinical experience with radiotherapy in 18 patients with alveolar soft-part sarcoma is presented. Adjuvant radiotherapy was associated with prolonged local control in six of six patients without metastatic disease at diagnosis; later one patient relapsed systematically. Meaningful palliation was achieved in all patients with extra-skeletal (and possibly skeletal) metastatic disease.

Glenohumeral Instability: Evaluation and Treatment.

Glenohumeral instability encompasses a spectrum of disorders of varying degree, direction, and etiology. The keys to accurate diagnosis are a thorough history and physical examination. Plain radiographs are frequently negative, especially in subtle forms of instability.

Isolated splenic metastases from colon carcinoma.

It is generally accepted that splenic metastases from colorectal carcinoma occur concurrently with widespread dissemination of the tumor. The case reviewed is notable for its long disease-free interval, isolated splenic metastasis and favorable-outcome postsplenectomy. It represents the fourth case report in the English literature of surgical resection for an isolated splenic metastasis from colorectal carcinoma.

Babesiosis in Washington State: a new species of Babesia?

Objective: To characterize the etiologic agent (WA1) of the first reported case of babesiosis acquired in Washington State.

Design: Case report, and serologic, molecular, and epizootiologic studies.

Setting: South-central Washington State.

Durable hepatic tumor regression after arterial chemoembolization-infusion in patients with islet cell carcinoma of the pancreas metastatic to the liver.

Background: Islet cell carcinoma of the pancreas is a neuroendocrine tumor often presenting with left upper quadrant mass and radiographic evidence of liver metastases. Because survival among these patients is determined largely by the pace of metastatic events in the liver, significant palliation may be achieved by regional hepatic therapy.

Methods: Five patients with islet cell carcinoma of the pancreas metastatic to the liver (four nonfunctional, one gastrin producing), were treated by hepatic arterial chemoembolization-infusion consisting of a mixture of polyvinyl alcohol sponge (150 mg) and cisplatin (150 mg) followed by 2-hour intraarterial infusion of vinblastine (10 mg/m2).

Recurrent posterior shoulder instability. Diagnosis and treatment.

Recurrent posterior glenohumeral instability is regarded as a difficult problem to diagnose and treat. A careful history and physical examination are the most helpful tools in making this diagnosis. A positive posterior stress test, demonstrable posterior subluxation, and a sulcus sign are frequently present on examination.

PDGF and its receptors in the developing rodent retina and optic nerve.

We have used in situ hybridization to visualize cells in the developing rat retina and optic nerve that express mRNAs encoding the A and B chains of platelet-derived growth factor (PDGF-A and PDGF-B), and the alpha and beta subunits of the PDGF receptor (PDGF-alpha R and PDGF-beta R). We have also visualized PDGF-A protein in these tissues by immunohistochemistry. In the retina, PDGF-A mRNA is present in pigment epithelial cells, ganglion neurons and a subset of amacrine neurons.

Effect of surgery on peripheral blood lymphocyte locomotion through type I collagen.

Background: Locomotion of peripheral blood lymphocytes (PBL) through peritumoral matrix is obligatory for tumor cell killing. The authors investigated the effect of surgery on lymphocyte locomotion and compared it with the effect on natural killer cell cytotoxicity (NKCC).

Methods: PBL from 12 patients with cancer were assessed for locomotion in Type I rat-tail collagen.

Canine parvovirus.

Canine parvovirus is a truly new pathogen of dogs that emerged in the late 1970s. Initially seen as epidemic disease in all dogs, parvoviral enteritis is now primarily a disease of 1- to 6-month-old dogs. Maternal antibody interference with immunization accounts for the vast majority of vaccine "breaks.

Altering the boundaries of Hox3.1 expression: evidence for antipodal gene regulation.

To investigate the function of region-specific patterns of mouse homeobox gene expression during embryogenesis, we programmed a minimal change in the distribution of Hox3.1 transcripts along the anteroposterior body axis in transgenic mice. Regulatory sequences from Hox1.

Surgical stress impairs natural killer cell programming of tumor for lysis in patients with sarcomas and other solid tumors.

Background: Natural killer (NK) cells may provide a first line of defense against the metastatic implantation of circulating tumor emboli. Because tumor emboli are discharged systemically in patients undergoing solid tumor resection, it is important to determine the nature of surgical-stress impairment of perioperative NK cell cytotoxic function.

Methods: The authors studied 85 patients undergoing surgical resection of solid tumors, most of whom had an abrupt and marked decrease in NK cell cytotoxicity that was detectable within 18 hours of surgical resection.