Soft-tissue sarcomas of the proximal lower extremity

Of 54 patients with soft-tissue sarcomas of the proximal part of the lower extremity, 2 patients (4%) were treated with amputation, while 52 patients (96%) were treated with limb-preserving resection. Adjuvant postoperative irradiation was applied selectively when the minimum margin was less than 2 cm (22 patients). Technical improvements in exposure, resection of involved vessels or nerve, and preservation of function permitted a high rate of limb salvage with satisfactory function. At a median follow-up of 30 months for those subjects still alive, the 5-year disease-free survival rate was 65%, and only 3 patients (6%) had had a local recurrence.     

Reduction of sound levels with antinoise in MR imaging

A combination of active and passive techniques was used to reduce the sound levels in magnetic resonance imagers. These techniques were integrated into an existing audio system. Measurements of sound reduction varied with the protocol being used and averaged 9.9 dB with coaxial cabling and 14.2 dB with fiberoptic conduction of the feedback signal to a controller. Patient comfort and communication were improved.     

Ilioinguinal lymph node dissection

Ilioinguinal node dissection for clinically involved nodes should include in-continuity removal of the inguinal, iliac and obturator lymph nodes. Avoidance of devascularization of the mobilized sartorius muscle and trimming of the skin edges minimize postoperative wound complications.     

Modes of regional chemotherapy.

Injection of Am (2 mg/kg) into the hepatic artery or portal vein of dogs gives higher liver tissue levels (15.1 μg/g) than systemic intravenous administration (6.4 μg/g). This difference is increased by injection of the drug distal to the temporarily occluded hepatic artery or portal vein.Bolus injection of Am (1 mg/kg) into the femoral artery of dogs results in no detectable ipsilateral calf muscle levels and no subsequent macroscopic changes in the extremity. When injected distally to the temporarily occluded femoral artery, muscle drug levels were below the level of sensitivity of the fluorometric assay used, but all animals showed varying degrees of ipsilateral skin ulcerations and melanosis.With a tight tourniquet applied to the extremity proximally and maintained for 15 min after Am injection, 40-fold or higher muscle levels of Am were found, compared to those after simple intraarterial injection. There was fairly uniform drug distribution throughout the infused limb and minimal systemic leak. Severe ulcerations occurred after injection of 1 mg Am/kg with tourniquet application. With reduction of the dose to 0.25 and 0.125 mg/kg, erythema in the first 2 weeks and melanosis of the skin at 2 to 4 weeks occurred and involved the whole extremity.This technique of intraarterial injection of chemotherapeutic drug(s) with a proximal tourniquet has a potential clinical applicability in extremity tumors; high tissue drug levels are obtained and frequent administration is possible via an indwelling catheter.With the present development of the ability to assay microconcentrations of drugs in tissues, a critical reappraisal of the methods of regional infusion chemotherapy should now be possible, in association with the physiochemical characteristics of the drugs used.     

Increased cytosol glucocorticoid receptor content of leiomyosarcoma

Glucocorticoid receptor content was determined in cytosol preparations of soft tissue tumors from 42 patients. Leiomyosarcoma had significantly elevated receptors in comparison to malignant melanoma, liposarcoma, malignant fibrous histiocytoma, and invasive desmoid.     

Mitotic Rate as a Predictor of Sentinel Lymph NodePositivity in Patients With Thin Melanomas

Background Lymphatic mapping and sentinel lymphadenectomy (LM/SL) provide important prognostic information for patients with early-stage melanoma. Although the use of this technique in patients with thin melanomas (1.00 mm) is not routine, risk factors that may predict sentinel lymph node (SLN) positivity in this patient population are under investigation. We sought to determine whether mitotic rate (MR) is associated with SLN positivity in thin-melanoma patients and, therefore, whether it may be used to risk-stratify and select patients for LM/SL.Methods Clinical and histopathologic variables were reviewed for 181 patients with thin melanomas who underwent LM/SL from January 1996 through January 2004. Univariate and multivariate logistic regression analyses were performed to identify factors associated with SLN positivity. Risk groups were defined on the basis of the development of a classification tree.Results The overall SLN positivity rate was 5%. All patients with positive SLNs had an MR of >0. By univariate analysis, MR and thickness were significant predictors of SLN positivity. The association between MR and SLN positivity remained significant controlling for each of the other variables evaluated. On the basis of a classification tree, patients with an MR >0 and tumor thickness .76 mm were identified as a higher-risk group, with an SLN positivity rate of 12.3%.Conclusions In patients with thin melanomas, MR >0 seems to be a significant predictor of SLN positivity that may be used to risk-stratify and select patients for LM/SL. To confirm these results, the predictive value of MR for SLN positivity needs to be validated in other populations of thin-melanoma patients.Published by Springer Science+Business Media, Inc. © 2005 The Society of Surgical Oncology, Inc.     

Phase II study--intra-arterial BCNU therapy for metastatic brain tumors

Thirty-one patients with metastatic brain tumors (MBT) from lung cancer and ten patients with MBT from melanoma received BCNU, 100 mg/m2, every four weeks by intracarotid and/or vertebral artery infusion into each involved site. Twenty-five patients with lung cancer and all melanoma patients are currently evaluable. Twelve patients with lung cancer had complete and partial responses lasting from 1 to 14 months. Four of them with the histologic diagnosis of small cell carcinoma, one with large cell carcinoma and one with squamous cell carcinoma showed complete response. None of the patients with melanoma MBT experienced any response. All of the patients had periorbital erythralgia and/or occipital pain during the infusion. Four patients manifested mild focal seizures during the infusion or 6 to 24 hours after the treatment. Transient confusion with disorientation was observed in two patients 4 and 24 hours, respectively, after a BCNU infusion. Two patients developed reversible thrombocytopenia after the fifth course of the IA chemotherapy. Median survival of patients with MBT from lung carcinoma was 4 months, with two of them still alive at 10 and 14 months, respectively. Only one patients of the 25 with lung carcinoma died from MBT. Failure to control the primary disease resulted in the deaths of a vast majority of the patients.     

Surgical treatment of locally progressive stage IIIB carcinoma of the cervix: use of the inverted "T" incision

Stage III carcinoma of the cervix is treated usually, and often effectively, with the combination of radiation and chemotherapy. For tumors locally recurring, without evidence of distant lymphatic or hematogenous spread, the option of pelvic exenteration rises. The described surgical technique derives from soft tissue sarcoma pelvic surgery. It is a lower midline incision extending transversely at its lower end ("reverse T"), which improves the exposure and hence resectability of some of these tumors.