Prognostic Index for Extremity Soft Tissue Sarcomas With Isolated Local Recurrence

Background: Local recurrence occurs in 10% to 20% of patients with extremity soft tissue sarcomas despite optimal treatment. The association of local recurrence with subsequent survival is controversial and conflicting. There is a need for a staging system to predict outcome in this subset of patients and also to plan optimal treatment, including adjuvant systemic therapy.Methods:Data collected from 110 patients with locally recurrent extremity soft tissue sarcomas were studied. The influence of clinical and pathologic factors on local recurrence, distant metastasis, and disease-specific survival were analyzed by univariate and multivariate techniques.Results: Of the 110 patients who presented with local recurrence, 92 had an isolated local recurrence and 18 had prior or concomitant distant metastases. The 5-year disease-specific survival for all patients was 63% and for those with isolated local recurrence, it was 69%. Histologic grade, malignant fibrous histiocytoma histology, pathologic margins, previous local recurrence, and prior radiotherapy were independent prognostic factors for subsequent local recurrence. Tumor size, histologic grade, and time to local recurrence were independent prognostic factors for distant metastasis and disease-specific survival. A prognostic index was calculated by assigning a score of 1 to 3 for each of the three independent prognostic factors for survival and added to give the prognostic index for each patient. As the prognostic index increased from 3 to 9, there was a progressive increase in the hazard ratios and a corresponding deterioration in survival. The patients were then categorized into three prognostic groups based on the hazard ratios for disease specific survival. The differences in the survival curves were highly statistically significant (P < .0001).Conclusions: Tumor size, histologic grade, and time to local recurrence are the primary determinants of distant metastases and survival in locally recurrent extremity soft tissue sarcomas. The impact of local recurrence on survival varies considerably. The nature of the local recurrence, rather than its presence per se, is a more useful guide to prognosis. We propose a simple staging system based on size, grade, and time to recurrence that correlates extremely well with prognosis and may serve as a guide to make therapeutic decisions in patients with locally recurrent extremity soft tissue sarcomas.     

Cryptosporidium and isospora belli diarrhoea in immunocompromised hosts

Cryptosporidium and isospora, two of the intestinal coccidian parasites known to be the causative agents of acute diarrhoea in animals, have now emerged as one of the main causes of prolonged life threatening diarrhoea in immunocompromised patients particularly so in patients with AIDS. Between June 1996 and December 1997, a total of 75 immunocompromised patients presenting with diarrhoea were investigated both for Cryptosporidium and Isospora. The study group consisted of cancer and AIDS patients with history of diarrhoea. Cryptosporidium oocysts were detected in 35 patients (46.7%). One of the faecal samples from an AIDS patient with diarrhoea showed the presence of both Cryptosporidium and Isospora oocysts. To the best of our knowledge, this is the second documented report of Isospora associated diarrhoea in an AIDS patient from India. The various techniques used for demonstration of these parasites were modified acid fast staining, Safranine Methylene-blue staining and direct immunofluorescence test.     

Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis

Psoriasis and Psoriatic Arthritis (PsA) are chronic inflammatory diseases that have a major impact on health. The prevalence and incidence estimates of these two closely related diseases show ethnic and geographic variations, being generally more common in the colder north than in the tropics. In Europe the prevalence of psoriasis varies anywhere from 0.6 to 6.5%. In the USA, the estimated prevalence of diagnosed psoriasis is 3.15%. The prevalence in Africa varies depending on geographic location, being lowest in West Africa. Psoriasis is less prevalent in China and Japan than in Europe, and is entirely absent in natives of the Andean region of South America. There are fewer reports on the incidence of psoriasis, but a recent study from Rochester, USA showed an increasing trend over the last 2 decades. The prevalence of PsA also shows similar variation, being highest in people of European descent and lowest in the Japanese. Although, study methodology and case definition may explain some of the variations, genetic and environmental factors are important. Genetic epidemiologic studies have shown that both diseases have a strong genetic component. The strongest association is with HLA-Cw*06. Associations with a number of genes including IL12B and IL23R have recently been confirmed. Environmental risk factors including streptococcal pharyngitis, stressful life events, low humidity, drugs, HIV infection, trauma, smoking and obesity have been associated with psoriasis and PsA. Here we have reviewed the current literature on the epidemiology and genetics of psoriasis and PsA.     

Guidelines for Evaluating the Educational Performance of Medical School Faculty: Priming a National Conversation

Background: The academic community needs a sound framework for the promotion and advancement of educators. The Group on Educational Affairs of the Association of American Medical Colleges organized a consensus conference that affirmed the use of five domains for documenting the quantity and quality of scholarly engagement in educational activities: teaching, curriculum, advising/mentoring, educational leadership/administration, and learner assessment. Summary: In this article, we offer detailed guidelines to evaluate these five domains of educator performance and the essential elements of scholarly activity. The guidelines are adapted from our developmental educator portfolio template and educator portfolio analysis tool, previously published in MedEdPORTAL. A short tool for educator performance evaluation that summarizes items in the guidelines is proposed for discussion. Conclusions: Our goal in this article is to itemize criteria for systematic faculty evaluation that can be applied in any institutional setting to assist promotion decision makers in their task of evaluating medical school faculty.     

Perforating invasive mole masquerading as an ovarian tumour--case report.

An invasive mole causing uterine perforation is a rare occurrence. We describe below a case with an unusual presentation which was mistaken for an ovarian tumour. The difficulty in diagnosis and the need for a high index of suspicion is highlighted.     

ADad 3: The Epidemiology of Anxiety Disorders Among Adolescents in a Rural Community Population in India

Hyperleukocytosis is defined as peripheral blood leukocyte count exceeding 100,000/mm³. Acute leukemia is the most common etiology in pediatric practice. Hyperleukocytosis is a medical emergency. The increased blood viscosity, secondary to high white cell count and leukocyte aggregates, results in stasis in the smaller blood vessels. This predisposes to neurological, pulmonary or gastrointestinal complications. In addition, patients are at risk for tumor lysis syndrome due to the increased tumor burden. Initial management includes aggressive hydration, prevention of tumor lysis syndrome, and correction of metabolic abnormalities. A red cell transfusion is not indicated in a hemodynamically stable child, as it adversely affects the blood viscosity. Leukapheresis is the treatment of choice for a very high count, or in patients with symptomatic hyperleukocytosis. The technical expertise required, a relative difficult venous access in younger children, risk of anticoagulation and possible non-availability of the procedure in emergency hours are limitations of leukapheresis. However, it is a rewarding procedure and performed with relative ease in centers that perform the procedure frequently. An exchange transfusion is often a practical option when hyperleukocytosis is complicated with severe anemia. The partial exchange aids in correcting both, without the risk of volume overload or hyperviscosity, which are the limitations of hydration and blood transfusion, respectively. Etiology and management of hyperleukocytosis in relevance to the pediatric emergency room is outlined.     

Cauda equina syndrome without mechanical cauda compression: a report of 2 cases

Study design Case report. Objective To highlight the concept of Cauda Equina Syndrome without cauda compression. Summary of background data Cauda equina syndrome (CES) is a rare disorder. CES occurs usually due to direct physical compression of the cauda nerve roots, most often from the extruded nucleus pulposus; other rare causes reported in the literature include compression by tumour, infection, fracture, penetrating trauma, chiropractic manipulation, free epidural fat graft, postoperative haematoma, ankylosing spondylitis, metastatic invasion, schwnnoma, Paget’s disease and laminar hook compression. All these causes of CES physically compress the cauda. Chemical irritation of the root can cause radicular pain but this has not been noted to cause CES before. We present two cases of Cauda Equina Syndrome was brought on by non-physical compression of the cauda. Annular tears can induce CES by chemical irritation of the cauda by inflammatory mediators. Conclusion The idea of presenting this paper is to highlight that cauda equina syndrome can be caused by non-mechanical cauda compression; in our cases it was due to chemical irritation and caudal epidural steroid injection has produced satisfactory outcome. Awareness of non-physical cauda equina syndrome is essential to identify and to initiate appropriate treatment, and the outcome seems to be satisfactory.