Stage IIB osteogenic sarcoma.

Two hundred seventy-one consecutive patients treated from 1976 through 1986 were reviewed to estimate long-term survival. Disease-free survival for the entire cohort was 77% at five years and 74% at ten years. Humeral lesions had the best probability of survival (84% at ten years), followed by tibial lesions (81%) and femoral lesions (67%). Histologic response to preoperative chemotherapy was the strongest predictor of outcome. Those with little response had a survival estimate of 54% at ten years as compared to 68% for partial responders and approximately 90% for complete responders. Local recurrence was seen in 6.6% and was associated with an adverse effect on survival. Only two of the 18 patients with local recurrence have been rendered long-term disease-free survivors.     

A preliminary report on the effect of a psychosocial and educative rehabilitation programme on quality of life and symptomatology in schizophrenia

Individuals with schizophrenia who participated in a psychosocial and educative rehabilitation programme showed a 46% improvement in quality of life in the absence of any significant change in symptom severity. In contrast, there was no significant change in quality of life for individuals who continued with supportive rehabilitation. Our preliminary findings highlight the ‘quality of life’ benefits of psychosocial and educative rehabilitation for individuals with schizophrenia who are clinically stable and living in the community.     

Heel spur syndrome: A retrospective report on the percutaneous plantar transverse incisional approach

The purpose of this retrospective study was to investigate patient satisfaction and pain relief of chronic heel spur syndrome via a percutaneous plantar transverse incisional surgical approach. Forty-five patients underwent the procedure between June 1995 and August 1997; 29 responded to a questionnaire. Of the 29 respondents, a 96% success rate was obtained (the procedure met or exceeded patient expectations) at an average of 21 months postoperatively. Based on a 10-point visual analog scale, pain improved from an average of 8.4 +/- 0.3 preoperatively to 1.2 +/- 0.3 at the time of the survey. The surgical technique is also described.     

Changes in serum fibroblast growth factor 2 in patients with glucocorticoid-induced osteoporosis treated with human parathyroid hormone (1–34)

Since the ability of parathyroid hormone (PTH) to increase osteoblast maturation and activity is associated with basic fibroblast growth factor (bFGF) we determined the changes in serum bFGF levels in patients treated with human parathyroid hormone (hPTH) (1–34) for 12 months and 12 months follow up. All studied subjects (n=51) had postmenopausal osteoporosis, had been receiving long-term treatment with glucocorticoid plus estrogen or estrogen/progesterone and were randomly allocated either to a group receiving hPTH, 400 U/day (n=28), or to a control group (n=23). Osteocalcin (OST), bone-specific alkaline phosphatase (BSAP) and bFGF were monitored at the baseline, every 3 months for 18 months, and at 24 months. In the hPTH group, OST increased by more than 150% above baseline at 3 months and was maintained at this level throughout the treatment period. BSAP had increased more than 80% over the baseline level at 3 months and was maintained at 90% above baseline for the next 9 months. bFGF levels had increased by 45% at 3 months, 60% at 6 to 9 months (P<0.05) and had increased more than 90% from baseline by 12 months (P<0.05). We found that daily hPTH injections increased bFGF levels. These results support the hypothesis that up-regulation of bFGF could play a role in the osteoblastic response to PTH.     

Immediate and delayed effects of risperidone on cerebral metabolism in neuroleptic naïve schizophrenic patients: correlations with symptom change

OBJECTIVE: Different symptom patterns have been shown to be associated with specific patterns of cerebral metabolic activity in schizophrenia. Treatment with various neuroleptic drugs results in decreased metabolism in frontal cortical regions. The temporal and regional relation between changes in metabolism and symptom improvement after treatment with risperidone was studied in eight previously unmedicated schizophrenic patients. METHOD: Cerebral metabolic activity was measured using PET before neuroleptic exposure, after the first dose of risperidone, and after 6 weeks of treatment. Pearson correlations were calculated for regions of significant change in metabolism and symptom change. RESULTS: After 6 weeks of treatment significant deactivations were seen in the left lateral cortical frontal region and medial frontal cortex. Significant changes were detectable in the medial frontal region 90 minutes after the first dose of risperidone. Patients with higher baseline activity in the identified medial frontal cluster had higher baseline positive symptom scores and reduction in medial frontal metabolism was correlated with reduction in positive symptom score. CONCLUSION: The evidence suggests that the reduction in medial-frontal activity after treatment with risperidone is a direct effect of risperidone and not a consequence of symptom improvement. Reduction of medial frontal metabolism may be one of the physiological mechanisms by which risperidone alleviates symptoms of psychosis in schizophrenia.     

Resection of locally advanced pancreatic cancer after downstaging-wth continuous-infusion 5-fluorouracil,mitomycin-C,leucovorin, and dipyridamole

Patients with locally advanced pancreatic adenocarcinoma who receive conventional therapy with radiation with S-fluorouracil(5-FU) have median survivals ranging from 8 to 12 months. Here we report our experience with a four-drug chemotherapeutic regimen that resulted in sufficient downstaging of tumor in some patients to justify surgical reexploration and resection. From April 1991 through April 1994,38 patients received 5-FU as a continuous infusion (200 mg/m²/day), calcium leucovorin weekly by imravenous bolus injection (30 mg/m²), mitomycin-C every 6 weeks (10 mg/m² intravenously), and dipyridamole daily orally (75 mg) for locally advanced unresected pancreatic cancer. All of these patients were evaluable for response, toxicity, and survival. There were 14 partial responses and one complete response—a 39% response rate. The median survival for all patients was 15.5 months; the l-year survival rate from time of initial diagnosis was 70%. Six of 15 responding patients had sufficient tumor regression to meet clinical criteria for resectability and reexploration, four of whom underwent a curative resection. The median survival of these six patients was 28 months from the time of original diagnosis. The l-year survival was 83 %, with one patient still alive and free of disease at 53 months. We believe this unique experience from a single institution justifies a prospective multi-institutional trial to evaluate the efficacy of this approach iu a larger number of patients. Presented at the Thirty-Eighth Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington, D.C., May 11–14, 1997.     

Genetic and immunochemical analysis of mutant p53 in human breast cancer cell lines.

The expression of the tumour suppressor gene p53 was analysed in 11 human breast cancer cell lines by immunohistochemistry, immunoprecipitation and cDNA sequencing. We used a panel of anti-p53 monoclonal antibodies for cell staining and found abnormalities in every case. Eight of the cell lines produce a form of p53 which can be immunoprecipitated by the monoclonal antibody PAb240 but not by PAb1620. In the murine system PAb240 only immunoprecipitates mutant p53. We sequenced p53 cDNA directly from four of the PAb240 positive cell lines using asymmetric PCR templates. All four contained missense mutations in p53 RNA, with no detectable expression of the wild type sequence. Different residues were affected in each cell line, but all the mutations changed amino acids conserved from man to Xenopus. These results imply that as in the murine system, the PAb240 antibody reliably detects a wide variety of p53 mutations and that these mutations have a common effect on the structure of p53. Immunohistochemical data suggest that p53 mutation is the commonest genetic alteration so far detected in primary breast cancer.