The role of preoperative radiotherapy in nonmetastatic high-grade osteosarcoma of the extremities for limb-sparing surgery

PURPOSE: To assess the role of preoperative radiotherapy in patients with nonmetastatic high-grade osteosarcoma of the extremities for limb-sparing surgery and to compare the response of neoadjuvant therapies, local control, and survival with the literature results. METHODS AND MATERIALS: Forty-six patients with osteosarcoma of the limbs who were treated within a limb salvage protocol including preoperative radiotherapy and chemotherapy between 1987 and 2002, were retrospectively analyzed. Median age was 17 years (range, 14-66 years). Treatment was started with neoadjuvant chemotherapy. Cisplatin, epidoxorubicin, ifosfamide, and methotrexate were used in different combinations. Preoperative radiotherapy was applied, usually between the second and third cycle of chemotherapy. Radiotherapy was given (35 Gy in 10 fractions) to 44 patients. Two patients were treated with 46 Gy at 2 Gy/day. Definitive surgery was administered after the third course of chemotherapy. Chemotherapy was complete 6 courses postsurgery. RESULTS: Median follow-up time was 44 months (range, 2-154 months). Forty-four patients had limb-sparing surgery, whereas 2 had amputation. Tumor necrosis rate was >/=90% in 87% of the patients (Huvos Grade 3-4). Two patients had local failures, and 26 patients (56.5%) had distant metastases. The 5-year local control and overall survival rates were 97.5% and 48.4%, respectively. On univariate analysis, age 相似文献   

Chromosome 1p36 and 22qter deletions in paraffin block sections of intracranial meningiomas

Meningiomas are the most frequent benign tumors of the intracranial cavity. The classification and underlying pathogenetic mechanisms have been reported to be investigated by both pathological and genetic methods. In this study, we aimed to detect Ip36 and 22qter deletions by fluorescence in situ hybridization (FISH) in archival materials of 50 intracranial meningioma patients. The clinical material consisted of paraffin-embedded tissue sections from 50 patients who were surgically treated and had histopathologic diagnosis of an intracranial meningioma. We observed Ip36 deletion in 23/50 (46%) and 22qter deletion in 33/50 (66%) patients. In addition, we observed 22qter deletion in 26/36 (72.2%) patients with meningothelial meningioma. This finding implies that 22qter deletion might play an important role in the pathogenesis of meningothelial meningioma. On the other hand, no alterations were documented in the frequency of these chromosomal alterations according to the grade of meningiomas, suggesting that malignant progression of these tumors depends on other, more relevant, genetic changes.     

The analgesic effects of gabapentin in monitored anesthesia care for ear-nose-throat surgery

We investigated the efficacy and safety of gabapentin in rhinoplasty or endoscopic sinus surgery patients. Patients received either oral placebo or gabapentin 1200 mg 1 h before surgery. After standard premedication, 25 patients in each group received propofol, fentanyl, and local anesthesia at the operative site. Sedation was maintained by a continuous infusion of propofol adjusted according to the Ramsay scale. Sedation and pain scores were obtained at 5, 15, 30, 45, and 60 min during surgery and 30 min and 2, 4, 6, 8, 12, 16, 20, and 24 h after the procedure. Diclofenac 75 mg IM was administered as a rescue analgesic. Postoperative pain scores and intraoperative pain scores at 45 and 60 min were significantly lower in the gabapentin group. Fentanyl (122 +/- 40 microg versus 148 +/- 42 microg; P < 0.05) and diclofenac (33 +/- 53 mg versus 111 +/- 92 mg; P < 0.001) consumption was smaller and the time to first analgesic request (18 +/- 9 h versus 9 +/- 7 h; P < 0.001) was longer in the gabapentin group. A more frequent incidence of dizziness was found in the gabapentin (versus placebo) group (24% versus 4%, respectively). We conclude that gabapentin provided a significant analgesic benefit for intraoperative and postoperative pain relief in patients undergoing ambulatory rhinoplasty or endoscopic sinus surgery; however, dizziness may be a handicap for ambulatory use.     

Comparison of effects of nebivolol and atenolol on P-wave dispersion in patients with hypertension

BACKGROUND: P-wave dispersion has been shown to be a noninvasive electrocardiographic predictor for development of atrial fibrillation . Thus it may be possible to attenuate atrial fibrillation risk through normalization of P-wave variables and improvement in P-wave dispersion may be an important goal in treatment of hypertension. OBJECTIVE: To compare the effects of nebivolol, a new b-blocker that have additional vasodilating activity via acting on endothelium and nitric oxide release, and atenolol on P-wave duration and dispersion in patients with mild-to-moderate hypertension. METHODS: A total of 34 newly-diagnosed hypertensive patients were enrolled in the study. The patients were randomly assigned to receive treatment with either nebivolol (5 mg) or atenolol (50 mg). P-wave durations (Pmin and Pmax) and P-wave dispersion were measured before and one month after treatment. RESULTS: While Pmin increased (50,6 +/- 11,2 ms to 54,7 +/- 9,1 ms, p=0,05), Pmax decreased (111,9 +/- 9,1 ms to 104,0 +/- 12,4 ms, p=0,003) and P-wave dispersion decreased (62,5 +/- 10,6 ms to 51,3 +/- 8,9 ms, p < 0,001) with nebivolol, Pmin increased (44,4 +/- 9,8 ms to 58,0 +/- 15,5 ms, p=0,02), Pmax didn t change (106,1 +/- 13,8 ms to 107,0 +/- 11,6 ms, p=NS) and P-wave dispersion decreased (61,7 +/- 15,0 ms to 49,0 +/- 13,7 ms, p < 0.001) with atenolol. However, there was no statistical difference between pre- and post-treatment values of two groups. CONCLUSIONS: Both nebivolol and atenolol are effective in improvement of P-wave dispersion in patients with hypertension and there s no significant difference between them.     

Repetitive Profound Thrombocytopenia After Treatment with Tirofiban: A Case Report

Summary The GPIIb/IIIa inhibitors are used in the acute coronary syndromes and interventional cardiology as antiplatelet agents. These drugs induce thrombocytopenia in approximately 1–5% of patients. Thrombocytopenia is rapid in onset and antibody mediated. Abciximab is associated with higher incidence of thrombocytopenia than eptifibatide and tirofiban. Profound thrombocytopenia has reportedly been an issue with abciximab, but not with tirofiban. We reported a case of acute profound thrombocytopenia due to on tirofiban treatment in the same patient at two different times.     

TGF-beta1 expression in renal allograft rejection and cyclosporine A toxicity

BACKGROUND: To assess short- and long-term influence of the TGF-beta1 on renal allografts. METHODS: Expression of TGF-beta1 and TNF-alpha, and the proportion of macrophages and eosinophils in interstitium were evaluated in 64 cases including five cases with nonrejected kidneys (NRK), 18 cases with acute rejection (AR), 26 cases with chronic allograft nephropathy (CAN), and 15 cases with acute cyclosporine A (CsA) toxicity. Follow-up biopsies of all cases with AR and CsA toxicity were evaluated for development of interstitial fibrosis (IF) and graft atherosclerosis (GAS). Additionally, influence of tubular-TGF-beta1 expression on graft function during 6 months after the diagnostic biopsy was evaluated. RESULTS: A significant differences was seen between rejected kidneys and acute CsA toxicity in regards of tubular TGF-beta1 expression that patients with CsA toxicity exhibited significantly higher grade of tubular TGF-beta1 expression than patients with AR (P<0.05) and CAN (P<0.05). A significant difference was found between the grades of tubular TGF-beta1 expression in regards to graft function of cases with AR and CsA toxicity (P<0.05). Higher grade tubular TGF-beta1 expression showed better graft function during 6 months. Besides the degree of renal TGF-beta1 expression was positively correlated with development of diffuse IF and GAS (P<0.05) that the risk of the IF and GAS was higher in cases with grade 2 renal TGF-beta1 expression. CONCLUSIONS: Despite the short-term posttransplantation tubule-repairing effects of TGF-beta1, the overall effects of TGF-beta1 in the kidney seem to be negative that increased expression of TGF-beta1 promotes IF and vasculopathy associated with CAN.     

Serum lipid levels in patients with dissociative disorder

OBJECTIVE: There may be an association between a low serum cholesterol level and dissociative disorders. METHOD: The subjects of the study were 16 patients with dissociative disorder and 16 normal comparison subjects (two men and 14 women in each group). Total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, and very low density lipoprotein levels were compared. RESULTS: Patients with dissociative disorders had lower serum triglyceride, total cholesterol, low-density lipoprotein, and very low density lipoprotein levels than normal comparison subjects. CONCLUSIONS: Low serum lipid concentrations may be related to a high incidence of self-injurious behaviors and borderline features in patients with dissociative disorders.     

Suramin modulates wound healing of rabbit conjunctiva after trabeculectomy: comparison with mitomycin C

PURPOSE: To investigate and compare the effects of suramin and mitomycin C on conjunctival wound healing after trabeculectomy in a rabbit model. MATERIALS AND METHODS: Thirty New Zealand White rabbits were divided into three groups, and trabeculectomy was performed on the left eyes under general anesthesia. During the surgery, suramin (250 mg/ml) and mitomycin C (0.4 mg/ml) were applied to the scleral flap site for 2 minutes in groups 1 and 2, respectively. The control animals (group 3) received no pharmacological treatment during trabeculectomy. Intraocular pressure (IOP) measurements were recorded before surgery and every 3 days after the operation, starting from postoperative day 1. Three animals from each group were sacrificed on days 15, 20, and 25, yielding a total of 27 eyes for histopathological study. Each specimen was histochemically and immunohistochemically (CD3, CD20, CD68, and collagen III) evaluated, and graded. RESULTS: Bleb failure time was significantly longer in both the suramin (15.0 +/- 4.7 days) and mitomycin C (16.7 +/- 5.1 days) groups than in the controls (10.3 +/- 4.2 days) (p < 0.05). Starting from postoperative day 9, the IOP in the suramin and mitomycin C groups was significantly lower than that in the control group (p < 0.05). This difference continued to be significant until day 18 for the suramin group, and until day 24 in the mitomycin C group. Histopathological evaluation showed lower degrees of cellularity, fibrosis, collagen III deposition, and CD3 density in the suramin- and mitomycin C-treated eyes compared to control eyes at all time points (p < 0.05). There was also no significant difference between the suramin and mitomycin C groups concerning these histopathological findings and CD3 density (p > 0.05). Although there were trends towards reduced mean elastic fiber deposition and lower CD20 and CD68 density in both groups of treated eyes, the differences between the treated and control groups were not significant (p > 0.05). CONCLUSIONS: The results of the current study suggest that suramin has beneficial effects on wound healing in glaucoma surgery, and effectively prolongs bleb survival in rabbits. Suramin may be a promising alternative to anti-metabolite therapy in glaucoma surgery.